Effectiveness of antenatal care delivery of intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine in the context of an integrated strategy with seasonal malaria chemoprevention in Mali and Burkina Faso

BACKGROUND: To improve uptake of intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP), a cluster-randomised implementation trial of 'integrated IPTp-SP delivery' through seasonal malaria chemoprevention (SMC) alongside antenatal care (ANC) was conducted in Mali and Burkina Faso. This nested study assessed ANC provider acceptability and feasibility of the integrated strategy and whether the training they received as part of the intervention ('enhanced facilities') improved IPTp-SP delivery effectiveness. METHODS: A cross-sectional survey was conducted in 20 trial facilities in each country (10 intervention/10 control) from November 2023 to January 2024, involving ANC exit interviews with pregnant women, facility audits and structured interviews with ANC providers. The primary outcome was the proportion of eligible pregnant women receiving IPTp-SP by directly observed therapy (DOT). Predictors of receiving IPTp-SP by DOT were estimated using mixed model logistic regression. ANC provider attitudes towards the integrated strategy were assessed using Likert scales. RESULTS: In Mali, 240 and 297 of 703 women interviewed were eligible for SP in the intervention and control facilities, respectively, and 323 and 334 of 709 women, respectively, interviewed in Burkina Faso. Delivery effectiveness of IPTp-SP was higher in the enhanced facilities in both Mali (79.2% (95% CI 74.0% to 84.3%) vs 68.7% (95% CI 63.4% to 73.9%), p=0.006) and Burkina Faso (52.3% (95% CI 46.9% to 57.8%) vs 28.7% (95% CI 23.9% to 33.6%), p