This poster was made possible by the generous support of the American people through the United States Agency for International Development (USAID), under the terms of the Cooperative Agreement AID-OAA-A-14-00028. Funding for this effort was provided by the United States President’s Malaria Initiative. The contents are the responsibility of the Maternal and Child Survival Program and do not necessarily reflect the views of USAID or the United States Government.

Improving Pregnancy Outcomes: Alleviating Stock-Outs of Sulfadoxine-Pyrimethamine in Bungoma, KenyaAugustine Ngindu1, Gathari Ndirangu1, Waqo Ejersa2, David Omoit3, and Mildred Mudany4

1MCSP/Jhpiego, an affiliate of Johns Hopkins University; 2National Malaria Control Program, Ministry of Health; 3Bungoma County, Ministry of Health; 4Jhpiego

815

Malaria Policy in KenyaAll pregnant women in malaria-endemic areas:

• Receive free intermittent preventive treatment of malria in pregnancy using sulfadoxine-pyrimethamine (IPTp-SP).

• Have access to free malaria diagnosis and treatment when presenting with fever.

• Have access to long-lasting insecticidal nets.

Kenya Malaria Strategy 2009–2017Providing IPTp at antenatal clinics:

• Annual quantification of SP and supply of IPTp to endemic areas conducted.

• Training of antenatal care (ANC) service providers conducted in malaria-endemic districts on provision of IPTp.

• Community health volunteers (CHVs) provide information, education and communication and behavior change communication (IEC/BCC) materials and refer pregnant women to ANC.

• Appropriate IPTp messages and materials will be developed and disseminated as part of the integrated IEC/BCC campaign in malaria-endemic areas.

Key Achievements between 2009–2014Malaria-endemic areas:

• Targeted implementation of IPTp only in the high malaria-endemic regions

• Malaria in pregnancy (MIP) guidelines revised

• Adequate supply of SP

• Maternal and child health service providers trained on provision of IPTp-SP as per national guidelines

• CHVs trained on MIP messaging to sensitize pregnant women to start IPTp early in second trimester

Major Challenges between 2009–2014 • Late start of ANC attendance

• Poor data management and reporting at health facilities

• Lack of incentives for CHVs to promote MIP

• Limited private sector facilities providing IPTp

• Diverse practices among health care workers in provision of IPTp-SP as per national guidelines

Percentage of pregnant women who took IPTp1 dose at different weeks of pregnancy

Strategic Direction between 2014–2018The Kenya Malaria Strategy was revised to reflect the following:

• All pregnant women in the 14 malaria-endemic counties shall receive at least three doses of IPTp-SP

• Annual quantification of SP based on consumption to ensure adequate supplies

• Training, retraining and supervision of health care workers

• Dissemination of appropriate IPTp messages and materials

IPTp CoverageIncrease in IPTp coverage was much higher between 2010–2015 compared to 2007–2010:

Trends in IPTp coverage in malaria-endemic

areas

Provision of MIP Services at the County Level • Provision of health care services devolved to county

governments in 2013.

• Counties continued to receive SP from national-level stocks through the “push system.”

• SP had an expiry date of December 2014 and therefore could not be supplied after June 2014.

• Counties started experiencing SP stock-outs as of October 2014.

Mitigation Measures • SP stock-outs from October 2014 to February 2015:

• Pregnant women who received IPTp decreased from 7,845 to 3,865.

• Counties and facilities procured SP supplies from March 2015 to July 2015: • Pregnant women who received IPTp increased from 3,865

to 8,404.

• SP stock-outs from August 2015 to February 2016:• Pregnant women who received IPTp decreased from

8,404 to 3,445.

• Although the national level procured SP in November 2015, supplies did not reach counties until February 2016. At the national level, PMI and UNICEF procured enough SP stock to last the country until 2019–2020.

Total doses takenTrends of core indicators (January 2014 to

June 2016)

Conclusions • Bungoma County applied feasible mitigation measures to

alleviate SP stock-outs through:• Procurement of SP at the county level;

• Supplemented by additional procurement at the health facility level; and

• Distribution of SP from the national level.

• This is a practice that is replicable in other counties to ensure continued availability of SP to protect pregnant women from the effects of MIP.

• Commodity insecurity is a threat to adequate service delivery.

Acknowledgments • Departments of the Ministry of Health:

• National Malaria Control Program

• Reproductive and Maternal Health Services Unit

• Bungoma County Health Management Team

• President’s Malaria Initiative (PMI)/United States Agency for International Development (USAID) Washington

• PMI/USAID Kenya

AbbreviationsANC antenatal careBCC behavior change communicationCHV community health volunteerIEC information, education and communicationIPTp intermittent preventive treatment in pregnancyKMIS Kenya Malaria Indicator SurveyMIP malaria in pregnancyPMI U.S. President’s Malaria InitiativeSP sulfadoxine-pyrimethamineUSAID United States Agency for International Development

Kwale

Lamu

Taita Taveta

Kakam

ega

Vihiga

Bungoma

Busia

SiayaKisumu

Homa Bay

Migori

Kilifi

Tana River

Nairobi

Nairobi

MIP coverage

0

10%

20%

30%

40%

50%

60%

26–40 weeks16–25 weeks<16 weeks

4.4%

43.5%

52.1%

Weeks of pregnancy

0

2,000

4,000

6,000

8,000

10,000

Oct-

14

Nov-1

4

Dec-1

4Jan

-15

Feb-

15

Mar-15

Apr-15

May-1

5

Jun-1

5Jul

-15

Aug-1

5

Sep-

15

Oct-

15

Nov-1

5

Dec-1

5Jan

-16

Feb-

16

Mar-16

2007–2010 2010–2015

IPTp1 16% 35%

IPTp2 8% 34%

IPTp3 4% 27%

20%

40%

60%

80%

100%

Jan–M

ar 20

14

Apr–Ju

n 201

4

Jul–S

ept 2

014

Oct–

Dec 20

14

Jan–M

ar 20

15

Apr–Ju

n 201

5

Jul–S

ept 2

015

Oct–

Dec 20

15

Jan–M

ar 20

15

Apr–Ju

n 201

6

IPTp1% IPTp2%

78

61 6165

63

42

56 57

4131

70

78 7976

61

78

68

51 52

81

SP supply fromnational-level

Start of SP stock-outs

Counties and facilitiesprocured SP

National level and partners procured SP

0

10%

20%

30%

40%

50%

60%

70%

80%

KMIS 2015KMIS 2010KMIS* 2007

Perc

enta

ge

Surveys

26%

14%

7%

80%

42%

11%

80%77%

56%

38%

80%

22%

1 or more doses 2 or more doses 3 or more doses National target

*Kenya Malaria Indicator Survey