Intermittent preventive therapy for malaria during pregnancy
Percent of women who received three or more doses of intermittent preventive treatment during antenatal care visits during their last pregnancy.
Number of women receiving three or more doses of recommended treatment.
Total number of pregnant women/surveyed with a live birth in the last 2 years.
Age, place of residence, socioeconomic status.
When data are collected by reviewing facility records, or through direct observation of ANC consultations or client exit interviews, the numerator is the number of pregnant women given or prescribed malaria medication in a given period.
Where data on the total number of pregnant women are absent, WHO recommends using 3.5% of the total population as an estimate of the number of pregnant women (i.e., number of pregnant women = total population x 0.035 [WHO, 1999a, 1999b]).
When the indicator is calculated from populationbased surveys, the numerator is defined as the number of women who were given or who purchased malaria medication during their most recent pregnancy, and the denominator as the number of women who had a recent live birth. The time-periods for the most recent pregnancy/live birth should be specified for both the numerator and denominator. In most surveys, this period is normally restricted to three to five years before the survey.
See also: Number/percent of pregnant women who received two or more doses of IPTp while attending antenatal care; and Number/percent of women aged 15-49 who received two or more doses of IPTp during their last pregnancy
Household surveys
Facility information systems
This indicator measures both coverage and access to IPTp among pregnant women as well as service providers’ adherence to malaria in pregnancy protocols.
Malaria is a major health risk for womenand newborn in areas where Plasmodium falciparum malaria is endemic. In stable areas of malaria transmission, malaria infection causes anemia in the mother. The presence of malaria parasites in the placenta also damages placental integrity and interferes with the ability of the placenta to transport nutrients and oxygen to the fetus, thereby causing intrauterine growth retardation, a primary cause of low birth weight.
Pregnant women residing in low or unstable malaria transmission areas have a two to threefold higher risk of developing severe disease as a result of malaria infection. In such areas, malaria can cause maternal death directly from infection or indirectly by causing severe anemia. In addition, a range of adverse pregnancy outcomes, including spontaneous abortion, still births, and congenital malaria, can result from malaria, causing increased risk of infant mortality among all babies born to mothers living in areas of unstable malaria transmission.
Some large household surveys, such as the DHS, routinely collect data for this indicator. In addition some health facility surveys that conduct record reviews, direct observation of ANC consultations, or exit interviews with ANC clients yield this information for client populations. The questions asked in most population-based surveys assume that women are able to report on malaria treatment reliably, but few validation studies have tested this assumption. Population-based studies also rely on self-reported data, which are subject to recall bias that is likely to increase with the length of the recall period.
One major limitation of this indicator is that current data collection approaches lack information on the completeness of the drug regimen taken during pregnancy. In addition to determining the type of malaria medication taken, information on the frequency and timing of drug administration is required to determine whether pregnant women are adequately protected against malaria. Information on the frequency and timing of drugs administered could theoretically be obtained if clinics maintain records on the numbers of patients attending and on the number of women given a first, second and third course of IPTp or the number of packets of medicine disbursed.
Facility records measure the proportion of women given or prescribed malaria medication but do not reflect the proportion of women who took the medication. Compliance with the treatment will rarely be 100% and will vary depending on many different local factors. Where malaria is sporadic or seasonal, programs focus on screening women that present with symptoms and on treating those who are infected.
Antenatal care, Maternal health, Malaria
World Health Organization (WHO). 2015 Global Reference List of 100 Core Health Indicators.; 2015. http://apps.who.int/iris/bitstream/10665/173589/1/WHO_HIS_HSI_2015.3_eng.pdf
MEASURE Evaluation. FP and Reproductive Health Indicators Database — MEASURE Evaluation. http://www.cpc.unc.edu/measure/prh/rh_indicators/
Gage AJ, Ali D, Suzuki C. A Guide for Monitoring and Evaluating Child Health Programs. MEASURE Evaluation. Carolina Population Center, University of North Carolina at Chapel Hill.; 2005. http://www.coregroup.org/storage/documents/Workingpapers/ms-05-15.pdf
Further information and related links
Countdown to 2015 decade report (2000−2010): taking stock of maternal, newborn and child survival. Geneva and New York (NY): World Health Organization/United Nations Children’s Fund; 2010 (Retrieved from http://www.countdown2015mnch.org/reports-and-articles/previous-reports/2010-decadereport).
Household Survey Indicators for Malaria Control. Measure Evaluation / Measure DHS / President’s Malaria Initiative/Roll Back Malaria Partnership/ UNICEF/WHO. 2013 (Retrieved from http://www.malariasurveys.org/documents/Household%20Survey%20Indicators%20for%20Malaria%20Control.pdf).
Roll Back Malaria Partnership/WHO. Disease surveillance for malaria control: an operations manual. Geneva: World Health Organization; 2012 (Retrieved from http://www.who.int/malaria/publications/atoz/9789241503341/en/).
World Health Assembly governing body documentation: official records. Geneva: World Health Organization (Retrieved from http://apps.who.int/gb/or/).
