WP4 – Acceptability, feasibility and cost effectiveness studies

Dr. Jenny Hill, from Liverpool School of Tropical Medicine, is leading this Work Package supported by Prof. Halidou Tinto (CNRST/IRSS, Burkina Faso) and Prof. Kassoum Kayentao (USTTB, Mali), the coordinator.

For the field implementation of the WP, she is supported in Mali by Samba Diarra (USTTB) and in Burkina-Faso by CNRST/IRSS field implementation team.

The economic study is leading by Dr. Eve Worrall (LSTM, UK) with support from a PDRA economist.

Social science research and economic studies are essential to bridge the gap between the efficacy and the effectiveness of the interventions promoted by identifying social, economic, political and cultural facilitators and barriers (contextual drivers) for the uptake of an intervention strategy.

Objectives of the WP2

O4.1: To explore the impact of COVID-19 on care-seeking practices for antenatal care.

O4.2: To assess the acceptability and feasibility of ANC + SMC combined delivery of IPTp-SP compared to standard care (ANC) among health providers.

O4.3: To assess the acceptability of ANC + SMC combined delivery of IPTp-SP compared to standard care (ANC) among pregnant women.

O4.4: To compare the incremental cost-effectiveness of IPTp-SP delivered using ANC + SMC combined delivery (intervention) with that of ANC alone from the societal perspective.

O4.5: To assess progress, implementation fidelity and identify any implementation challenges

How to reach these objectives?

How to reach O4.1

In-depth interviews and Focus group discussions (FGDs) will be conducted at baseline in both study arms. In-depth interviews will involve, in each country, a sample of health care providers from the health facilities involved in the study. FGDs will involve, in each country, a sample of pregnant women of different gravidity and mothers of children under 12 months old.
All in-depth interviews and FGDs will use topic guides and will be recorded. Audio files will be transcribed in the local language and translated in English with quality checks at each stage of transcription and translation. Qualitative data will be analysed by NVivo software.

How to reach O4.2 and O4.3

In-depth interviews and FGDs will be conducted at endline in both study arms.
A sample of pregnant women of different gravidity and mothers of children under 12 months old per country will be recruited. An additional sample of women will be selected for FGDs.
Health providers from intervention health facilities, in each country, and the community health workers involved in the IPTp-SP community delivery will be included. The interviews will also include the District Health Management Teams and Ministry of Health staff in the National Malaria Control and Reproductive Health departments. All in-depth interviews and FGDs will use topic guides and will be recorded. Audio files will be transcribed in the local language and translated into English with quality checks at each stage of transcription and translation. Qualitative data will be analysed by NVivo software.

How to reach O4.4

Cost-effectiveness will be expressed as incremental cost-effectiveness ratios which is the ratio of the difference in cost between the intervention and control arm, to the difference in effects between the intervention and control arm. Cost-effectiveness will be calculated taking into consideration results from the cost analysis (cost data will include health system costs of implementing and accessing IPTp and beneficiary costs of accessing and receiving IPTp), the household coverage survey, and clinical outcomes of the intervention. Expected costs outputs will be calculated using cost data. Expected coverage outputs will include number of women who receive at least 3 doses of IPTp and number of women with access to ANC. Expected clinical outputs will include number of low birth weight, neonatal death, maternal anemia and clinical malaria cases.

How to reach O4.5

A mixed-methods process evaluation will be conducted to establish whether the study intervention was implemented as intended and what was modified throughout implementation based on the MRC guidance for process evaluation of complex interventions. Quantitative and qualitative data will be synthesized to explore the three domains of i) implementation through assessment of fidelity, dose, reach and adaptation; ii) context, by identifying factors influencing implementation of the intervention and its outcomes; and iii) mechanisms underscoring how the intervention components were responded to/engaged with to produce changes in practice, experiences and outcomes.