PT  - JOURNAL ARTICLE
AU  - Tanya Marchant
AU  - Kara Hanson
AU  - Rose Nathan
AU  - Hadji Mponda
AU  - Jane Bruce
AU  - Caroline Jones
AU  - Yovitha Sedekia
AU  - Hassan Mshinda
AU  - Joanna Schellenberg
TI  - Timing of delivery of malaria preventive interventions in pregnancy: results from the Tanzania national voucher programme
AID  - 10.1136/jech.2008.085449
DP  - 2010 Jan 01
TA  - Journal of Epidemiology and Community Health
PG  - jech.2008.085449
4099  - http://jech.bmj.com/content/early/2010/06/05/jech.2008.085449.short
4100  - http://jech.bmj.com/content/early/2010/06/05/jech.2008.085449.full
AB  - Background Across sub-Saharan Africa, pregnant women attend routine health services around the 20th week of gestation.Objective To investigate, with a view to maximising effectiveness of malaria control tools delivered via routine services, coverage of an antenatal clinic insecticide-treated net (ITN) voucher scheme in Tanzania by gestational age.Methods Household and antenatal clinic survey data from 21 districts in Tanzania were collected and analysed annually 2005–2007. Optimal voucher protection was defined as giving women access to vouchers for 24 weeks of pregnancy (weeks 16 and 40 gestation). The relationship between gestational age and use of ITNs throughout pregnancy was explored.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 at clinic and staff not distributing vouchers at first visit. An increasing trend by gestational age in ITN use was observed each survey year, rising in 2007 from 23% of first-trimester women to 30% of women post partum (χ2=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.