Intermittent preventive treatment of malaria in pregnancy (IPTp): participation of community-directed distributors of ivermectin for onchocerciasis improves IPTp access in Ugandan rural communities

Access and compliance to sulfadoxine–pyrimethamine (SP) for intermittent preventive treatment of malaria in pregnancy (IPTp) when delivered by community-directed drug distributors (CDDs) of ivermectin for onchocerciasis control (intervention arm) and through delivery of SP–IPTp during antenatal care visit (control arm) was investigated in western Uganda. Every woman in both arms who delivered during the study period was interviewed on access and compliance to SP–IPT during her previous pregnancy. Overall, 926 women participated in the study (473 and 453 in the intervention and control arms, respectively). There were 467 (98.7%) women who accessed SP–IPTp at least once in the intervention arm and 401 (88.5%) in the control arm (P<0.001), and 424 (89.6%) women accessed at least two doses of SP–IPTp in the intervention arm compared with 237 (52.3%) in the control arm (P<0.001). The findings of this study suggest that a strategy using community resource people such as CDDs is an effective and feasible option to deliver SP–IPTp, because it uses existing community structures and volunteers, which creates easy access of the intervention, and should complement SP–IPTp access during antenatal care visit.