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Behavior Profile Sample: Intermittent Preventive Treatment of Malaria in Pregnancy

A Behavior Profile is a summary analysis of each behavior. This sample draws from global evidence and illustrates the result of using the Create Behavior Profiles Tool to analyze factors, supporting actors and strategies and to ensure logical pathways exist between strategies proposed and factors related to the practice of the behavior. This sample may be used as a starting point or reference for creating Behavior Profiles.

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Health Goal	Improve maternal and child survival
Accelerator Behavior	Pregnant women take intermittent preventive treatment of malaria (IPTp) during antenatal care (ANC) visits Indicator: Percentage of women age 15-49 with a live birth in the two years preceding the survey who during the pregnancy took 3 or more doses of SP/Fansidar, with at least one dose during an antenatal care visit Indicator: Percentage of women age 15-49 with a live birth in the two years preceding the survey who during the pregnancy took 2 or more doses of SP/Fansidar, with at least one dose during an antenatal care visit

Health Goal

Improve maternal and child survival

Accelerator Behavior

Pregnant women take intermittent preventive treatment of malaria (IPTp) during antenatal care (ANC) visits

Indicator: Percentage of women age 15-49 with a live birth in the two years preceding the survey who during the pregnancy took 3 or more doses of SP/Fansidar, with at least one dose during an antenatal care visit
Indicator: Percentage of women age 15-49 with a live birth in the two years preceding the survey who during the pregnancy took 2 or more doses of SP/Fansidar, with at least one dose during an antenatal care visit

Behavior Analysis	Strategy
STEPS What steps are needed to practice this behavior? Decide to seek ANC care early before the end of the first trimester Obtain IPTp at each ANC visit, beginning in second trimester Adhere to provider instructions on when to return for the next visit Click on any box to see the pathwaysA pathway illustrates how elements in the Behavior Profile are linked. When read from right to left, a pathway highlights how strategies are expected to address the factors to enable adoption of the Accelerator Behavior. of the behavior.	FACTORS What factors may prevent or support practice of this behavior? These should be analyzed for each country context. Structural Accessibility: Pregnant women cannot access SP because the SP or related commodities are unavailable Service Provider Competencies: Pregnant women do not receive SP at each visit because providers do not have the proper technical information to adhere to national MIP guidelines Social Family and Community Support: Pregnant women do not seek SP because it is not promoted or encouraged by community-based community health volunteers or agents Family and Community Support: IPTp is seldom endorsed or promoted by community-based service providers Internal Attitudes and Beliefs: Pregnant women refuse SP because they fear the side effects Attitudes and Beliefs: Pregnant women do not adhere to provider instructions because they do not understand the difference between drug-based prevention and treatment Knowledge: Pregnant women do not obtain SP or adhere to provider’s instructions because they are unaware of the benefits of SP for themselves and their unborn children	SUPPORTING ACTORS AND ACTIONS Who must support the practice of this behavior? Institutional Policymakers: Incorporate IPTp into broader reproductive health programs in collaboration with MIP point of contact and reproductive health staff Providers: Counsel about protective benefits, timing and dosing of IPTp to all pregnant women and their partners Providers: Administer SP appropriately during ANC visits Logistics Personnel: Procure sufficient stock of SP or other IPTp commodity supplies Managers: Conduct regular supportive supervisory visits with facility-based service providers to ensure proper administration of and counseling for IPTp Managers: Seek innovative ways to provide client-friendly services closer and more convenient to the client Community Community Leaders: Create or support structures that promote social accountability to encourage community-based service providers to promote the benefits of IPTp as part of ANC services Community and Religious Leaders: Engage men and male heads of households to support the decision of pregnant women to seek ANC especially in the absence of community-based service provider support	POSSIBLE PROGRAM STRATEGIES How might we focus our efforts based on this analysis? Enabling Environment Partnerships and Networks: Encourage delivery of ANC and IPTp in non-formal settings, such as through NGOs and by community health workers directly in the community to ensure that ANC is accessible to all women Policies and Governance: Integrate IPTp into reproductive health programs to ensure that all women accessing these services receive IPTp Policies and Governance: Create or leverage the power and influence of existing community leaders and members to advocate for accountability at health facilities Systems, Products and Services Supply Chain: Strengthen commodities and supply chain for Fansidar/SP or IPTp protocol at all levels to ensure adequate stock for the recommended minimum number of doses per expected pregnant woman Quality Improvement: Disseminate to providers clear IPTp guidelines and information to use in counseling women on benefits to ensure that all women are receiving recommended IPTp during ANC Quality Improvement: Expand and promote services offered during ANC to increase women’s perceived value of IPTp Quality Improvement: Equip health workers with relevant, locally tailored behavior-centered job aids to provide better IPTp services to women Demand and Use Communication: Use appropriate communication approaches to promote value of preventative services to mother and unborn child Communication: Exploit direct-to-consumer digital tools, such as mobile technologies, interactive voice response (IVR), etc. to reach women directly to convey benefits of and value for IPTp as part of routine ANC visits

Behavior Analysis

Strategy

STEPS

What steps are needed to practice this behavior?

Decide to seek ANC care early before the end of the first trimester
Obtain IPTp at each ANC visit, beginning in second trimester
Adhere to provider instructions on when to return for the next visit

Click on any box
to see the pathwaysA pathway illustrates how elements in the Behavior Profile are linked. When read from right to left, a pathway highlights how strategies are expected to address the factors to enable adoption of the Accelerator Behavior.
of the behavior.

FACTORS

What factors may prevent or support practice of this behavior? These should be analyzed for each country context.

Structural

Accessibility: Pregnant women cannot access SP because the SP or related commodities are unavailable

Service Provider Competencies: Pregnant women do not receive SP at each visit because providers do not have the proper technical information to adhere to national MIP guidelines

Social

Family and Community Support: Pregnant women do not seek SP because it is not promoted or encouraged by community-based community health volunteers or agents

Family and Community Support: IPTp is seldom endorsed or promoted by community-based service providers

Internal

Attitudes and Beliefs: Pregnant women refuse SP because they fear the side effects

Attitudes and Beliefs: Pregnant women do not adhere to provider instructions because they do not understand the difference between drug-based prevention and treatment

Knowledge: Pregnant women do not obtain SP or adhere to provider’s instructions because they are unaware of the benefits of SP for themselves and their unborn children

SUPPORTING ACTORS AND ACTIONS

Who must support the practice of this behavior?

Institutional

Policymakers: Incorporate IPTp into broader reproductive health programs in collaboration with MIP point of contact and reproductive health staff

Providers: Counsel about protective benefits, timing and dosing of IPTp to all pregnant women and their partners

Providers: Administer SP appropriately during ANC visits

Logistics Personnel: Procure sufficient stock of SP or other IPTp commodity supplies

Managers: Conduct regular supportive supervisory visits with facility-based service providers to ensure proper administration of and counseling for IPTp

Managers: Seek innovative ways to provide client-friendly services closer and more convenient to the client

Community

Community Leaders: Create or support structures that promote social accountability to encourage community-based service providers to promote the benefits of IPTp as part of ANC services

Community and Religious Leaders: Engage men and male heads of households to support the decision of pregnant women to seek ANC especially in the absence of community-based service provider support

POSSIBLE PROGRAM STRATEGIES

How might we focus our efforts based on this analysis?

Enabling Environment

Partnerships and Networks: Encourage delivery of ANC and IPTp in non-formal settings, such as through NGOs and by community health workers directly in the community to ensure that ANC is accessible to all women

Policies and Governance: Integrate IPTp into reproductive health programs to ensure that all women accessing these services receive IPTp

Policies and Governance: Create or leverage the power and influence of existing community leaders and members to advocate for accountability at health facilities

Systems, Products and Services

Supply Chain: Strengthen commodities and supply chain for Fansidar/SP or IPTp protocol at all levels to ensure adequate stock for the recommended minimum number of doses per expected pregnant woman

Quality Improvement: Disseminate to providers clear IPTp guidelines and information to use in counseling women on benefits to ensure that all women are receiving recommended IPTp during ANC

Quality Improvement: Expand and promote services offered during ANC to increase women’s perceived value of IPTp

Quality Improvement: Equip health workers with relevant, locally tailored behavior-centered job aids to provide better IPTp services to women

Demand and Use

Communication: Use appropriate communication approaches to promote value of preventative services to mother and unborn child

Communication: Exploit direct-to-consumer digital tools, such as mobile technologies, interactive voice response (IVR), etc. to reach women directly to convey benefits of and value for IPTp as part of routine ANC visits

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Intermittent Preventive Treatment of Malaria in Pregnancy

Key Points from Global Research