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Timing of delivery of malaria preventive interventions in pregnancy: results from the Tanzania national voucher programme
  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. 1London School of Hygiene and Tropical Medicine, London, UK
  2. 2Ifakara Health Institute, Mikocheni, Dar es Salaam, Tanzania
  1. Correspondence to Dr Tanya Marchant, LSHTM, Keppel Street, London WC1E 7HT, UK; tanya.marchant{at}


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.

  • Malaria
  • pregnancy
  • vouchers
  • ITNs
  • antenatal
  • evaluation me
  • health services research
  • malaria
  • maternal DI
  • reproductive EPIDEM

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  • Funding This work was supported by the Tanzania Ministry of Health and Social Welfare through a grant from the Global Fund to fight AIDS, TB and Malaria, the Gates Malaria Partnership funded by the Bill and Melinda Gates Foundation, and Population Services International, supported by the UK Department for International Development and the Royal Netherlands Embassy in 2005/06, and by the United States President's Malaria Initiative in 2007.

  • Competing interests None.

  • Ethics approval The ethical review committee at London School of Hygiene and Tropical Medicine, UK and the Institutional Review Board at Ifakara Health Institute, Tanzania approved the monitoring and evaluation protocol. The purpose and potential risks were explained to all sampled persons, and anonymity was assured. Each interviewee provided written consent.

  • Provenance and peer review Not commissioned; externally peer reviewed.