This document summarizes a study conducted in Uganda to identify barriers to the uptake of intermittent preventive treatment for malaria in pregnancy (IPTp) and test an intervention to address the key barriers. The study employed an "embedded approach" involving stakeholders throughout the research process. Formative research identified supply issues and confusion over IPTp guidelines as barriers. The study is now piloting text messages to health workers to reinforce guidelines. Early results include commitments to address identified barriers, such as providing anti-malarial drugs to private facilities and updating IPTp guidelines. The Ministry of Health is overseeing the pilot intervention and hopes to scale it nationwide if effective.

1. Putting research into practice:
Assessing and addressing barriers to IPTp
uptake in Uganda
Badru Gidudu Walimbwa
ResUp MeetUp Symposium, Nairobi, 9th -12th February 2015

2. Malaria in pregnancy and IPTp
• Malaria infection during pregnancy
poses substantial health risks to
mother and child.
• WHO recommends intermittent
preventive treatment in pregnancy
(IPTp), delivered as part of
focused antenatal care (ANC), as
a strategy for the prevention and
control of malaria in pregnancy.
• In many countries, IPTp coverage
is low despite high ANC
attendance and efforts to address
some of the bottlenecks.

3. Study on barriers to IPTp uptake in Uganda
• Malaria Consortium conducted
formative research to explore
barriers that continue to impede
uptake of IPTp in Uganda.
• Based on the findings from the
formative research, the team is
currently developing a pilot
intervention that aims to increase
coverage of this crucial service.
• The pilot involves sending text
messages to health workers to
reinforce IPTp provision
guidelines.

4. Research uptake
In addition to exploring barriers to IPTp uptake in Uganda and testing
an intervention that addresses the key barriers identified, the study
also specified an objective relating to research uptake:
 To engage with national and international stakeholders throughout
the project in order to maximise the study’s potential to achieve
change in policy and practice with regard to IPTp provision.
In order to achieve this objective, the team adopted an “embedded
approach” to research uptake.

5. The embedded approach
• Developed by COMDIS-HSD, a
research programme consortium
which aims to support and
develop feasible and effective
health service delivery strategies
in low and middle income
countries.
• Multi-stage approach based on
the assumption that operational
research is best prioritised,
designed, conducted and
replicated when it is embedded
within Ministry of Health (MoH)
structures. Download the booklet here.

6. Embedded approach in practice
Applying the principles of the embedded approach, the study on
barriers to IPTp uptake in Uganda included the following research
uptake activities:
• Study designed in consultation
with MoH to address a national
research priority.
• Analysis of relevant stakeholders,
including analysis of stakeholders’
interest in malaria in pregnancy
and their alignment with the
study’s objective of increasing
IPTp uptake.

7. Embedded approach in practice
• Research uptake strategy outlined
how key stakeholders would be
informed and involved throughout
the project.
• For each stakeholder, key
messages, appropriate activities
and expected measurable
targets/outputs/outcomes were
defined.
• Stakeholder engagement
supported by appropriate
materials, e.g. a project brief and
a research brief.
Download the project brief here.

8. Embedded approach in practice
• Progress, results and implications
were discussed regularly at
national stakeholder meetings.
• Relevant MoH departments
represented on steering
committee, which oversees
implementation of pilot
intervention.
• Study was discussed at two UK
all-party parliamentary meetings.
• A poster was presented at the
Third Global Symposium on
Health Systems Research.

9. Early successes
Study finding Change in policy and practice
The current supply mechanism
leads to stock-outs of the drug
used for IPTp in private sector
facilities.
MoH has pledged to provide the
drug free-of-charge to private
sector facilities.
Current guidelines for IPTp
provision are not in line with
most recent WHO policy
recommendations.
Stakeholders have committed to
treating the adoption of the
current WHO policy
recommendations for IPTp
provision as a matter of priority.
Health workers are confused
about correct timing and dosage
of IPTp provision.
Stakeholders have tasked
Malaria Consortium with
developing a pilot intervention
addressing this issue.

10. Scale-up and stakeholder feedback
As relevant MoH departments are
closely involved in overseeing the
pilot intervention of sending text
messages to improve health worker
knowledge of IPTp provision
guidelines, it is expected that, if
shown effective, the intervention will
have strong endorsement from MoH
for nationwide scale up.
“This study pointed out
which areas need
attention if MoH and
Uganda are to improve on
the uptake of IPTp
services. The study
significantly challenged
our perception of where
the limitations lie. I would
expect the harmonisation
of IPTp guidelines to be
the most significant
change resulting from the
study.”
Quote from a Roll Back
Malaria partner

11. Funding
The study is conducted by Malaria Consortium through COMDIS-
HSD, a research programme consortium funded by the UK
government. It also received Programme Partnership
Arrangement funding from the UK government.
Malaria Consortium is a not-for-profit organisation which aims to
improve lives in Africa and Asia through sustainable, evidence-
based programmes that combat targeted diseases and promote
child and maternal health.

12. www.malariaconsortium.org
Thank you
For more information, please contact b.gidudu2@malariaconsortium.org