Abstract:
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.