Malaria prophylaxis stock-outs and birth- and maternal outcomes in Zimbabwe

Preventing malaria is crucial, especially given that vulnerable groups such as pregnant women and neonates bear a disproportionate malaria burden and such illness can have long-term consequences for their health. Zimbabwe faces a high burden of malaria, which falls heavily on pregnant women and their neonates, contributing towards maternal and neonatal mortality, maternal anaemia and low birthweight. We contribute to the existing literature by examining the correlation between malaria prophylaxis stock-outs and health outcomes in this vulnerable group in Zimbabwe. Women who do not receive malaria prophylaxis during pregnancy are at risk of malaria infections, which can lead to maternal anaemia and lower birthweight.

Our data set combines the administrative data on malaria prophylaxis stock-outs from 2011 to 2015 accessed from the Ministry of Health and Child Care and the 2015 nationally representative Zimbabwe Demographic and Health Survey data. We estimate the correlation between malaria prophylaxis stock-outs and health outcomes using ordinary least squares and recentered influence functional unconditional quantile regressions analysis.

We found that malaria prophylaxis stock-outs increase over time and have a significant association with birthweight for neonates at the 50th percentile. For neonates with an average birthweight we see a significant and negative association between stock-outs and birthweight (coefficient: -0.271, 95%CI: -0.496;-0.046). However, stock-outs were insignificantly associated with low birthweight ranges as well as above normal birthweight. Although SP stock-outs were not associated with neonates with low birth weight, they push foetus with average weight towards the lower end of normal birth weight. These neonates are prone to developmental disabilities.

It is crucial to ensure the availability of Sulphadoxine/pyrimethamine drugs at the facility level. We recommend that policymakers invest in pharmaceutical information systems and stock ordering systems to prioritise malaria prevention and ensure frequent availability of malaria prophylaxis in Zimbabwe. On the demand-side, more frequent facility visits can also help to ensure adherence.