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"Every day they keep adding new tools but they don't take any away": Producing indicators for intermittent preventive treatment for malaria in pregnancy (IPTp) from routine data in Kenya.

Abstract Intermittent preventive treatment for malaria in pregnancy (IPTp) is part of a multi-pronged strategy aimed at preventing malaria in pregnancy in areas of moderate to high transmission in sub-Saharan Africa. Despite being formally adopted as a malaria prevention policy over a decade ago, IPTp coverage has remained low. Recent demands for action have incorporated calls to strengthen IPTp monitoring and evaluation systems, including the use of routine data, to measure coverage, track implementation and identify roadblocks to improving uptake. Concerns about the quality of malaria indicators reported through routine information systems are well recognized, but there are few data on the realities of IPTp recording practices in frontline facilities or their entry into District Health Information Software (DHIS2).
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title plos one
Publication Year Start




PMID- 29298303
OWN - NLM
STAT- MEDLINE
DCOM- 20180206
LR  - 20180210
IS  - 1932-6203 (Electronic)
IS  - 1932-6203 (Linking)
VI  - 13
IP  - 1
DP  - 2018
TI  - "Every day they keep adding new tools but they don't take any away": Producing
      indicators for intermittent preventive treatment for malaria in pregnancy (IPTp) 
      from routine data in Kenya.
PG  - e0189699
LID - 10.1371/journal.pone.0189699 [doi]
AB  - BACKGROUND: Intermittent preventive treatment for malaria in pregnancy (IPTp) is 
      part of a multi-pronged strategy aimed at preventing malaria in pregnancy in
      areas of moderate to high transmission in sub-Saharan Africa. Despite being
      formally adopted as a malaria prevention policy over a decade ago, IPTp coverage 
      has remained low. Recent demands for action have incorporated calls to strengthen
      IPTp monitoring and evaluation systems, including the use of routine data, to
      measure coverage, track implementation and identify roadblocks to improving
      uptake. Concerns about the quality of malaria indicators reported through routine
      information systems are well recognized, but there are few data on the realities 
      of IPTp recording practices in frontline facilities or their entry into District 
      Health Information Software (DHIS2). METHODS: Drawing on fieldwork conducted in
      two malaria endemic sub-counties in Kenya, we explore how local adaptations and
      innovations employed by health workers and sub-country managers to cope with a
      range of health system constraints, shape recording practices and in turn, the
      measurement of IPTp. Data were collected through observations, interviews, and
      document reviews. Data analysis and interpretation was guided by thematic
      analysis approach. RESULTS: Measurement of IPTp was undermined by health system
      constraints such as stock-out of drugs and human resource shortages. Coping
      strategies adopted by health workers to address these challenges ensured
      continuity in service delivery and IPTp data generation but had variable
      consequences on IPTp data quality. Unclear recording and reporting instructions
      also led to lack of standardization in IPTp data generation. The use of redundant
      tools created significant data burdens which undermined service delivery in
      general. CONCLUSIONS: There is need to integrate monthly reporting forms so as to
      remove redundancies which exacerbates workload for health workers and disrupts
      service delivery. Similarly, data collection instructions in registers and
      reporting forms need to be clarified to standardize IPTp data generation across
      health facilities. There is also need to address broader contextual factors such 
      as stock-out of commodities and human resource shortages which undermine IPTp
      data generation process.
FAU - Okello, George
AU  - Okello G
AUID- ORCID: 0000-0002-6263-1858
AD  - KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya.
FAU - Gerrets, Rene
AU  - Gerrets R
AD  - Department of Anthropology, University of Amsterdam, Amsterdam, Netherlands.
FAU - Zakayo, Scholastica
AU  - Zakayo S
AD  - KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya.
FAU - Molyneux, Sassy
AU  - Molyneux S
AD  - KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya.
AD  - Centre for Tropical Medicine and Global Health, University of Oxford, Oxford,
      United Kingdom.
FAU - Jones, Caroline
AU  - Jones C
AD  - KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya.
AD  - Centre for Tropical Medicine and Global Health, University of Oxford, Oxford,
      United Kingdom.
LA  - eng
GR  - Wellcome Trust/United Kingdom
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20180103
PL  - United States
TA  - PLoS One
JT  - PloS one
JID - 101285081
RN  - 0 (Antimalarials)
SB  - IM
MH  - Antimalarials/*administration & dosage
MH  - Female
MH  - Humans
MH  - Kenya
MH  - Malaria/complications/*prevention & control
MH  - Pregnancy
MH  - Pregnancy Complications, Parasitic/*prevention & control
PMC - PMC5751991
EDAT- 2018/01/04 06:00
MHDA- 2018/02/07 06:00
CRDT- 2018/01/04 06:00
PHST- 2017/04/24 00:00 [received]
PHST- 2017/11/30 00:00 [accepted]
PHST- 2018/01/04 06:00 [entrez]
PHST- 2018/01/04 06:00 [pubmed]
PHST- 2018/02/07 06:00 [medline]
AID - 10.1371/journal.pone.0189699 [doi]
AID - PONE-D-17-15801 [pii]
PST - epublish
SO  - PLoS One. 2018 Jan 3;13(1):e0189699. doi: 10.1371/journal.pone.0189699.
      eCollection 2018.