Indoor residual spraying household visits as a platform for engaging pregnant women in malaria prevention on Bioko Island, Equatorial Guinea

Abstract Background Pregnant women are particularly vulnerable to many health conditions, including infectious diseases, which place them at elevated risk of severe outcomes. In particular, malaria poses a significant burden during pregnancy, and as such there has long been a strong focus on delivering malaria prevention interventions to pregnant women during antenatal care (ANC), including long-lasting insecticide-treated nets (LLINs) and intermittent preventive treatment in pregnancy (IPTp). However, outreach to drive uptake of these interventions presents some distinct challenges. For example, pregnant women may not attend ANC or may not do it in public health facilities, where these interventions are freely available, precluding access. In this study, an implementation of routine annual indoor residual spraying (IRS) on Bioko Island, Equatorial Guinea was leveraged to identify pregnant women and conduct follow-up visits focused on awareness and uptake of LLINs and IPTp. Methods IRS campaign data was used to generate lists of households with pregnant women for follow-up visits, during which communication agents conducted an interview based on relevant sections of a malaria indicator survey to assess knowledge about malaria, LLINs and IPTp, and uptake of these interventions. Uptake was defined on an ordinal, three-category scale, and ordinal regression modeling was performed to assess the relationship between uptake and knowledge indicators. Results In total, 1,567 households were visited, and 589 pregnant women identified. There was a high awareness about LLINs (76.9% cited LLINs as a malaria prevention method), but low awareness of IPTp (34.5% could cite any benefit and 37.1% were aware of availability in public health facilities). In line with awareness levels, regular use of LLINs (54.8% reported using every night) was higher than IPTp uptake (35.2% on track for three doses). Ordinal regression modelling confirmed that LLIN use on some or all nights was associated with awareness that LLINs prevent malaria, and IPTp uptake was associated with awareness of the number of doses required. Conclusions This work demonstrated that complementary malaria control interventions can be leveraged to identify pregnant women for further outreach. The information collected provides a baseline to evaluate the impact of future activities on Bioko Island and suggests that increasing awareness of IPTp could improve coverage, while further increasing LLIN use will likely require identifying specific barriers to use.