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Community-Based Promotional Campaign to Improve Uptake of Intermittent Preventive Antimalarial Treatment in Pregnancy in Burkina Faso

Malaria preventive strategies in pregnancy were assessed in a health center randomized trial comparing intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP) with and without community based promotional activities in rural Burkina Faso. The study involved 2,240 secundigravidae and secundigravidae and evaluated factors associated with antenatal clinic (ANC) attendance and uptake of IPTp-SP. With promotion, 64.2% completed 3 ANC visits compared with 44.7% without (P = 0.05). Complete uptake of IPTp-SP was 71.8% with and 49.1% without promotion (P = 0.008). The IPTp-SP uptake was lowest in adolescents delivering during high malaria transmission with (29%) or without promotion (30%). Uptake of SP was higher during the low transmission season than in the high transmission season (adjusted odds ratio = 2.17, 95% confidence interval = 1.59–3.03). Community sensitization increased ANC attendance and IPTp-SP uptake. Adolescents were the most difficult to reach, particularly during the high malaria transmission period. The impact of IPTp-SP will be limited unless this high risk group is protected.

Received July 28, 2008. Accepted for publication November 4, 2008.

Acknowledgments: We thank the participating villages in Boromo Health District, the promoters of the health messages in the communities, and the health workers in the study health centers and the district laboratory for their cooperation. We also thank the field assistants (Odette Bonou, Nikiehan Danvio, Thérèse Gué, Marie Lougué, Sylvie Lué, Adjara Manakounou, Bessoué Nabié, Hakéro Sidibé and Alimata Traoré) for their help; Roselyne Vallo, Joëlle Compaoré, and Philippe Msellati (Data Management Unit, Centre Muraz, Bobo-Dioulasso) and Joris Menten (Institute of Tropical Medicine, Antwerp, Belgium) for statistical advice.

Note: This study was registered at clinicaltrials.gov NCT00730366.

Financial support: This study was supported by the European Union INCO-DEV programme (contract IC4-CT-2002-10022). Sabine Gies was partly supported by the Belgian co-operation (DGDC) through the framework agreement ITM-Centre Muraz.

^* Address correspondence to Sabine Gies, Epidemiology and Control of Parasitic Diseases Unit, Department of Parasitology, Prince Leopold Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium. E-mail: sgies{at}itg.be

Authors’ addresses: Sabine Gies and Umberto D’Alessandro, Epidemiology and Control of Parasitic Diseases Unit, Department of Parasitology, Prince Leopold Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium. Sheick O. Coulibaly and Clotilde Ky, Laboratoire National de Santé Publique, 09 BP 24, Ouagadougou, Burkina Faso. Florence T. Ouattara, District Sanitaire Boromo, BP 602, Boromo, Burkina Faso. Bernard J. Brabin, Child and Reproductive Health Group, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, United Kingdom.