Uniformed Services University of the Health Sciences Bethesda United States
Many African countries remain well behind international targets for use of preventive malaria interventions in pregnancy and childhood as well as provision of quality case management services. The objectives of this study were 1 to develop a quality of care diagnostic and use it to assess sub-national antenatal care ANC quality in Kenya for provinces, health facility types, and managing authorities 2 to determine whether the quality of integrated ANC and malaria in pregnancy services in Kenya, Namibia, Senegal, and Tanzania was associated with prophylaxis use in pregnancy and insecticide-treated net use in pregnancy and children under-five and 3 to determine whether health facility readiness to deliver malaria case management services varied with malaria endemicity in Kenya, Senegal, Namibia. Publicly-available facility and household surveys and malaria endemicity data were used for these analyses. I constructed overall and by dimension ANC quality scores and explored performance across Kenyan provinces and facility characteristics. Second, I extended this method to construct regionally-aggregated malaria in pregnancy and ANC quality scores for Kenya, Namibia, Senegal, and Tanzania, and built multilevel mixed effects modified Poisson pooled and country stratified models to predict individual use of prophylaxis and nets given regional quality scores. Third, I ran a multiple linear regression to examine pooled data to determine the association between the natural log of malaria endemicity and facility readiness to deliver malaria services. ANC quality varied overall and by dimension across facility types, managing authorities, and provinces in Kenya. Regional malaria in pregnancy quality was modestly associated with uptake of interventions in pooled, Kenya, Namibia, Senegal, and Tanzania models. There was a modest association of malaria endemicity with malaria.