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Gestation: the key to optimal delivery of insecticide treated bednets in pregnancy.
  1. Tanya Marchant1,*,
  2. Kara Hanson1,
  3. Rose Nathan2,
  4. Hadji Mponda2,
  5. Jane Bruce1,
  6. Caroline Jones1,
  7. Yovitha Sedekia2,
  8. Hassan Mshinda2,
  9. Joanna Schellenberg1
  1. 1 London School of Hygiene and Tropical Medicine, United Kingdom;
  2. 2 Ifakara Health Institute, Tanzania, United Republic of
  1. Correspondence to: Tanya Marchant, Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London, Wc1E7HT, United Kingdom; tanya.marchant{at}


Background: Across sub-Saharan Africa pregnant women attend routine health services around the twentieth week of gestation. With a view to maximizing effectiveness of malaria control tools delivered via routine services, we investigated coverage of an antenatal clinic insecticide treated net (ITN) voucher scheme in Tanzania by gestational age.

Methods: We collected and analysed household and antenatal clinic survey data from 21 districts in Tanzania, annually 2005-2007. We defined optimal voucher protection as giving women access to vouchers for 24 pregnancy weeks (weeks 16 and 40 gestation). We explored the relationship between gestational age and use of ITNs throughout pregnancy.

Results: Coverage of the ITN voucher was high (84% in 2007), but only 61% of optimal voucher protection was achieved. It was reduced by a combination of late attendance to clinic, and staff not distributing vouchers at first visit. Each survey year an increasing trend by gestational age in ITN use was observed, rising in 2007 from 23% of first trimester women to 30% of women post-partum (÷2 = 5.9, p=0.01).

Conclusion: Uptake of malaria interventions is not evenly distributed throughout pregnancy. Including gestational age in pregnancy coverage indicators can enhance understanding of the public health potential available from pregnancy interventions.

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