Niger State: a Regression Approach

International Journal of Research and Reports in Gynaecology

3(3): 15-23, 2020; Article no.IJRRGY.61937

Economic Implication of Covid-19 on Antenatal Care in Niger State: A Regression Approach

Charity Ifeyinwa Anoke1*, Bright C. Orji2, Stephen I. Odo3 and Bartholomew Odio4

1Department of Economics, Ebonyi State University, Abakaliki, Ebonyi State, Nigeria. 2Texila American University, Zambia. 3Department of Economics, Godfrey Okoye University, Enugu, Nigeria. 4Federal Teaching Hospital, Abakaliki, Nigeria.

Authors’ contributions

This work was carried out in collaboration among all authors. Author CIA designed the study, performed the statistical analysis, wrote the protocol and wrote the first draft of the manuscript. Authors BCO and SIO managed the analyses of the study. Author BO managed the literature searches. All authors read and approved the final manuscript.

Article Information

Editor(s): (1) Dr. Sevgul Donmez, Gaziantep University, Turkey. (2) Dr. Abdelmonem Awad M. Hegazy, Zagazig University, Egypt. (3) Dr. Ashraf Talaat Youssef, Fayoum University, Egypt. Reviewers: (1) Ni Komang Yuni Rahyani, S. Si. T. M. Kes Politeknik Kesehatan Denpasar, Indonesia. (2) Jasmer, Lala Lajpat Rai University of Veterinary and Animal Sciences, India. (3) Berihan Rashad Elemary, Damietta University, Egypt. (4) Anup Pradhan, Sikkim Manipal University, India. (5) Amit Dineshchandra Sonagra, Banas Medical College & Research Institute, India. Complete Peer review History: http://www.sdiarticle4.com/review-history/61937

Received 23 September 2020 Original Research Article Accepted 23 October 2020 Published 11 November 2020

ABSTRACT

Antenatal care (ANC) service has been one of the major mechanisms to curbing maternal mortality in the world. This study analyzed the economic impact of COVID-19 on ANC in Niger State, Nigeria from March – July 2020. The study objective was to evaluate the economic impact of COVID-19 on ANC. The study used secondary data from National District Health Information System (DHIS); and adopted the values from ANOVA and regression statistical estimations statistical Excel packages for analysis. The data was randomly selected from 10 local government areas (LGAs) out of 25 LGAs of the State. These LGAs recorded confirmed cases of COVID 19. The data elements ______

*Corresponding author: E-mail: [email protected];

Anoke et al.; IJRRGY, 3(3): 15-23, 2020; Article no.IJRRGY.61937

(variables) were total ANC attendance and number of Sulfadoxine Pyrimethamine (SP or IPTp) taken by pregnant women in the health facility and confirmed malaria cases for pregnant women from March to July 2020. Study result indicated significant impact of COVID-19 on ANC with Pval of 0.00025. Positive and significant effect of ANC on IPTp uptake with the coefficient of 0.565912 and Pval of 0.008793, meaning that 1% increase in ANC could ead to 56.5% increase in IPTp uptake. There was no significant increase in confirmed malaria in Niger State within the period of study with Pvalue of 0.418786. The implications of the results were, it reduced the revenue being generated for the services of the health facility, exposing pregnant women and her fetus to dangers of malaria during pregnancy while stretching the fragile primary health care system; and give chance to unhealthy pregnant women and child. It could increase malaria in pregnancy which in turn reduce the efficiency of those women in economic activities, mostly, farming, buying & selling, predominant in the region. Thereby, reduced productivity and increasing poverty in that region. More so, it can lead to increase in maternal – child mortality in the State which has been a burden to the country, hence, reduction in working population that could have stimulated productivity and increase standard of living. In conclusion, the study highlights the impact of COVID-19 and potential factors for closer investigation to reduce its effects.

Keywords: Antenatal care services; Covid 19; Sulfadoxine pyrimethamine; malaria in pregnancy; Niger State.

1. INTRODUCTION quarter of 2020 within the period of COVID-19 pandemic. Antenatal care has been undermined Antenatal care is a unique opportunity where by Nigerian pregnant women, especially, women can receive varieties of health services Northern part of the country, Niger State inclusive through a health care system. It is a which if not detected and handled early, is precautionary healthcare with sole aim to make capable of manifesting some danger signs, like, available expected, regular and standard check- vaginal bleeding, loss of consciousness, severe ups on a pregnant woman within the course of headaches, abdominal pains, premature labour the pregnancy to prevent complications of pains, fever, swelling of the face, hands and legs, pregnancy and childbirth, detect early and among others. prompt management of problems, birth and emergency planning and promote healthy Experience shows that fever through malaria in lifestyles that benefit both mother and child. pregnancy is detrimental to both mother and Despite the importance of antenatal care to child, with effects like, anaemia, low birth weight, improve the health mother and baby, many still birth, etc, hence the need for ANC. The women find it difficulty accepting or maintaining preventive measures of malaria in pregnancy the protocol of antenatal visit. Appropriate (MIP) include the use of insecticides treated nets antenatal cares when available, have significant (ITNs) and intermittent preventive treatment in effect on women with different social pregnancy (IPTp). While, curative approach is backgrounds and offers socioeconomic, health through the use of ACTs as well as treatment, benefit to the receivers of the services. prevention of mother-to-child-transmission of HIV and health promotion for appropriate health- According to [1], antenatal care (ANC) is the care seeking behaviour. These are possible when a provided by skilled health –care professionals to pregnant woman attends ANC. pregnant and adolescent girls to ensure the best health conditions for both mother and baby With much knowledge on COVID-19 virus as a during pregnancy. Its components are; risk new virus linked to the same family of viruses as identification, prevention and management of Severe Acute Respiratory Syndrome (SARS) and pregnancy – related or concurrent diseases; and some types of common cold, the symptoms health education and promotion. include fever, cough and shortness of breath; in more severe cases, infection can cause In Nigeria, 917 women out of every 100,000 live pneumonia or breathing difficulties which put births, die as a result of pregnancy and childbirth, pregnant women in vulnerability state. Visiting World [2], this means approximately 76,417 health facility for antenatal care in conjunction maternal deaths occur in Nigeria every year, with keeping COVID-19 preventive protocols which is unacceptable. This data is as at first becomes a way out to healthy mother and baby.

Anoke et al.; IJRRGY, 3(3): 15-23, 2020; Article no.IJRRGY.61937

However, with the emergence of COVID-19 in iterate the negative effect of this disease to Nigeria, many pregnant women have not had a antenatal care services, hence, the research. pleasant experience going to the hospital for their ANC, Niger State not in exception. At 29th July, 1.1 Objective of the Study 2020, Niger State recorded 226 confirmed cases of COVID 19. Increase in confirmed cases, even The broad objective was to evaluate the within the health sector led to declaration of economic impact of COVID-19 on antenatal care curfew on 23rd March, 2020 by the governor from and service delivery. The specific objectives were 6am to 10pm every day which lasted for 3 months before it was adjusted. The adjustment, 1. To ascertain the if there is any significant 6am to 10 am was to accommodate the need for impact of COVID-19 on ANC attendance in citizens to meet up with economic activities; like, Niger State within the period of study going to farm, market for business, visiting the 2. to examine the effect of ANC attendance health facility for care, etc. Yet, it did not avail the on IPTp uptake in Niger State within the pregnant women the opportunity to seek for period of study. health care, because of limitation to transport 3. to investigate if there is any significant services and fear of infection from may be increase in confirmed malaria for pregnant carriers. women in Niger State within the period of study. Niger State has more rural area than urban with most of the health facilities far from the populace. 1.2 Statement of Research Question The curfew interrupted the means of transportation to the health facilities both for the The research stated the following questions; health providers and the pregnant women. It also affected the business, farm produce which is the 1. To what extent does COVID-19 major source of livelihood for the citizens, significantly impact on antenatal care thereby increasing the poverty level and reducing attendance in Niger State within the period the health seeking behavior of the pregnant of study? women. All pregnant women, including those 2. To what extent does ANC attendance with confirmed or suspected COVID-19 affect IPTp uptake in Niger State within the infections, have the right to high quality care period of study? before, during and after childbirth. This includes 3. Is there any significant increase in antenatal, newborn, postnatal, intrapartum and confirmed malaria for pregnant women in mental health care [1]. Niger State within the period of study?

To this end, the health providers reluctantly go to 1.3 Literature Review the health facility due to lack of means of transportation, fear of contacting the virus as In the opinion of [3], the combination of, there are no or inadequate Personal Protective constrained supply, reduced resources, Equipments (PPEs) for facility workers and suppressed demand and worsening clients. Again, the pregnant women are scared of socioeconomic inequality; creates a likelihood contacting the disease while going to or at the that the indirect effects on health and nutrition ANC venue, since different clients from different will be more harmful than the direct health locations are expected to be in attendance; as consequences of the disease. We also reviewed such antenatal service delivery declined and ongoing responses by the government and other reduces ANC attendance. relevant agencies with the following results, 45% increase in child deaths and a 39% increase in Using the WHO focused ANC protocol for maternal deaths across low and middle-income positive pregnancy experience with 8 contact, it countries. is pertinent that women that conceived within the last quarter of 2019 and early months of 2020 Wu et al. [4] reported how the COVID-19 were denied of compulsory antenatal care in the pandemic brings not only opportunities for the State, as the lock down and curfew got stringent development and popularization of online day-by-day with the period of study. Medical antenatal care programs but also challenges. experts have always advised pregnant women to The researchers stated that people across the attend antenatal care (ANC) to monitor their world have been greatly affected by the ongoing health and that of their unborn babies. Inferences coronavirus disease (COVID-19) pandemic

Anoke et al.; IJRRGY, 3(3): 15-23, 2020; Article no.IJRRGY.61937

which became so problematic for recently describe the outbreak. We also reviewed delivered mothers and currently pregnant women ongoing responses by the government and other who require professional antenatal care. The relevant agencies with the following results, study suggested online antenatal care as a evidence of ongoing and increasing community preferable alternative since it can provide transmission of COVID-19 infections, inadequate pregnancy-related information and remote clinic testing capacity and overwhelming of health consultations. They also encouraged clinical resources. The researchers recommended that ANC to provide relatively economical medical the government needs to promptly bring services and diminish health care inequality in community health workers on board, deploy rapid accessing online ANC. The authors did not epidemic intelligence and scale up the use of recognize the disadvantage of people from low mobile Apps for contact tracing. This will result in income countries where it will be difficult to fund an effective and coordinated response to the online ANC and poor internet connection. ongoing outbreak, sustain routine health services especially at the community level, reduce In the same vein, [5] revealed that the morbidity and mortality, and preserve health exponential increase in the number of cases has indices gains already made in the health system. resulted in panic and confusion among healthcare workers and the vulnerable Sarah [8] exclaimed that antenatal care services population. Pregnant and lactating mothers are a have been affected by the COVID-19 pandemic vulnerable group and need evidence-based despite the fact that pregnant women were advice to protect the health of the mother and the placed in the ‘vulnerable group’ by the UK child. The authors did not employ any statistical Government on 16 March 20201. The author evidence which this research will fill the gap. continued that the risk of pregnant women contracting COVID-19 means that careful With respect to this research, [6] stated that surveillance of their health is needed. Prevention coronavirus disease (COVID-19) continues to and control of COVID-19 infection among ravage health and economic metrics globally, pregnant women and the potential risk of vertical including progress in maternal and child nutrition. transmission have become a major concern. In Although there has been focus on rising rates of the same manner, [9] supported that hard to childhood wasting in the short term, maternal and reach women who, under usual circumstances, child undernutrition rates are also likely to may not access or engage with maternity increase as a consequence of COVID-19 and its services. Women who inadequately utilize impacts on poverty, coverage of essential antenatal services are twice as likely to be at risk interventions, and access to appropriate for maternal morbidity. While, [10] iterated that nutritious foods. disruption of maternity services and diversion of resources away from essential pregnancy care, This has collapsed the effectiveness of key because of prioritizing the COVID-19 response, sectors and reduced efficiency in terms of food are expected to increase risks of maternal systems, incomes, and social protection, health morbidity and mortality. care services for women and children and services and access to clean water and Theoretically, the study adopted the theory of sanitation. The study suggested span Utility and Preference propounded by [11] which investments in sectors that have sustained direct posits that some decisions can be appropriately and indirect impact on nutrition, which include taken partly on subjective evaluation. Utility and interventions to strengthen the food-supply chain preference theory states that a high risk, and reducing food insecurity to assist those at untested decision, which does not enjoy immediate risk of food shortages, among others. consumer or user or beneficiary acceptance, in spite of its potentialities, is not assured. Ajisegiri et al. [7] explained the current situation Preference would be given to the high-risk of COVID-19 in Nigeria and argued the need for decision in which utility is guaranteed, that is, effective engagement of community health inherent quality or value is potentially more workers for an appropriate response. The assured to be constant than the low risk decision authors adopted review of different published in which utility is not assured. Applying this articles on COVID-19 and daily epidemiological theory, quality antenatal care, especially during reports from the website of the Nigeria Centre for this COVID-19 gives more satisfaction and Disease Control (NCDC) from 27 February 2020 preferred by the consumers (pregnant women) till 3 May 2020 (Epidemiology week 7 – 17) to with its inherent high – risk.

Anoke et al.; IJRRGY, 3(3): 15-23, 2020; Article no.IJRRGY.61937

2. METHODOLOGY indicates the combine impact on ANC attendance by the 10 LGAs. This study employed descriptive design to analyze the economic implication of COVID-19 From the result, using the overall assessment, on antenatal care in Niger State. This is in we deduce that there is significant difference in consonance with [12] who posited that survey the ANC attendance between the month of research focuses on people, their beliefs, March to July with the probability value of opinions, attitudes and behaviours. As well, 0.00025 which is less than 0.05 critical value. descriptive survey design deals with the present This means that COVID-19 caused noticeable and is oriented toward the determination of the difference in pregnant women attending status of a given phenomenon rather than antenatal for adequate and quality health care. towards the isolation of causative factors in the course of seeking information from respondents Table 2 depicts relationship between ANC or available data as the situation exists without attendance and IPTp uptake which by the manipulation [13]. coefficient is positive having 0.565912 and 0.008793 significant probability value. This mean In analyzing the data, the researchers used that 1% increase in ANC will lead to 56.5% One Way ANOVA analytical method and increase in IPTp uptake, as such curb malaria in regression statistical estimations and graph pregnancy and reduce maternal mortality. The through statistical Excel packages to conduct implication of this result is that as many that were the investigation. The data used were randomly able to attend ANC within the COVID-19 selected, 10 local government areas out of 25 pandemic period of study received IPTp which is LGAs in the State, with respect to the 4 cardinal a boost to healthy pregnancy and outcome. point and additional from State capital. The LGAs were: Agaie, Bida, Chanchaga, The R- square is 0.59698 showing that 59.1 Kontagora, Agwara, Gbaiko, Magama, Muya, percent variation in the dependent variable is Rafi and Rijau. These LGAs recorded confirmed explained by the explanatory variable and 40.9 cases of covid 19. The data elements percent difference being explained by other data (variables) adopted were total ANC attendance elements not captured by this model. and number of Sulfadoxine Pyrimethamine (SP or IPTp) taken by pregnant women in the health The F – statistics of 11.85014 with p value of facility and confirmed malaria cases for 0.008793 which is less than 0.05 shows that pregnant women from March to July, 2020. The there is statistical significant joint influence of data source was the DHIS2. explanatory variable on the dependent variables. This entails that IPTp uptake have a great and 3. RESULTS AND DISCUSSION joint impact on antenatal care for pregnant women in Niger State, which is supported by the 3.1 Analysis of Variance (ANOVA) positive coefficient.

In Table 3, the result revealed a negative and Requirement for the ANOVA test is that the insignificant impact of ANC on confirmed malaria variances of each comparison group are equal, case of pregnant women within the scope and also declaring the test of homogeneity of period under review, adjudged by the P value of variance. A significant result suggests a real 0.418786; meaning that confirmed malaria cases difference in variables; therefore, insignificant for pregnant women has not significantly results are encouraged. increased. This could be attributed to constant IPTp uptake which prevents malaria in Decision rule: The value that is less than 5% (< pregnancy. This is in line with the appriori 0.05) indicates statistical significant difference expectation, being the assumption that as between means of ANC attendance across the women seek antenatal care and take malaria 10 selected LGAs. preventive commodities, like IPTp and LLINs, they have the chances of not attracting the With respect to the linearity of variables, the falciparum that inject malaria to them. following results are presented; Fig. 1 showed that ANC attendance by pregnant The row in the Table 1, explains individual output women did not drastically decrease within the (each LGA) of data employed, while the column period of COVID 19, though there is inconsistent

Anoke et al.; IJRRGY, 3(3): 15-23, 2020; Article no.IJRRGY.61937

reduction. This is in line with the ANOVA result in 3.2 Implication of Result Table 1 that shows a significant difference in the number of ANC within the period of study. The researchers analyzed the implications of the result in line with the objectives and questions In Fig. 2 the graph indicated a relationship asked, discussing the overall results as it affects among the three data elements examined. the selected LGAs in Niger State.

Table 1. Antenatal care

ANOVA Source of Variation SS df MS F P-value F crit Rows 35962881 9 3995876 39.86086 1.02606E-20 2.05852 Columns 3163339 6 527223.1 5.259314 0.000250574 2.271989 Error 5413262 54 100245.6 Total 44539482 69

Table 2. Antenatal care and IPTp

Regression statistics R Square 0.59698 F – Statistics 11.85014 F - Statistics Pvalue 0.008793 Coefficient 0.565912 P-Value 0.008793

Table 3. Antenatal care and confirmed malaria cases for pregnant women

Regression Statistics R Square 0 .08325 F - Statistics 0.726559 F - Statistics – P value 0.418786 Coefficient -2.81805 P-Value 0.418786

ANC ATTENDANCE IN SELECTED LGAs - NIGER STATE

4000 3000 2000 1000 0

JAN FEB MAR APR MAY JUN JUL

Fig. 1. Antenatal care visit by pregnant women

Anoke et al.; IJRRGY, 3(3): 15-23, 2020; Article no.IJRRGY.61937

ANC Attendance, IPTp Uptake and Confirmed Malaria

30000 25000 20000 15000 10000 5000 0

ANC Attend. Jan - Jul IPTp CONF.MAL Jan - Jul Jan - Jul

Fig. 2. Antenatal care, IPTp and confirmed malarial in selected LGAs of Niger State

The implication of positive and significant impact Health workers and clients or patients by the of COVID-19 on ANC attendance as can be seen State Government, which led to increased fear of in Table 1 is that firstly, it reduces the revenue COVID-19 spread. Another possible inhibitor to being generated for the services of the health ANC attendance within this period could be poor facility. It also give chance to unhealthy pregnant attitude of health workers to health care service women and child, increase malaria in pregnancy delivery. which in turn reduce the efficiency of those women in economic activities, mostly, farming, 4. CONCLUSION buying & selling, white collar job, etc. Thereby, reducing productivity and increasing poverty in Many factors inhibit women from receiving that region. Antenatal care, ranging from health workers attitudes, unavailability of basic communities and More so, it can lead to increase in maternal – equipments, distance to health facility, cultural child mortality in Nigeria which has been a believe, no support from spouse, etc. in the midst burden, hence, reduction in working population of these inhibitors, COVID-19 played a major role that could have stimulated productivity and in making women not to access healthcare within increase standard of living. There exists much the period of study. fear by healthcare providers of contacting the disease, since there no or inadequate basic This research therefore, conclude that there is PPEs for health workers and clients. Again, these significant impact of COVID-19 on antenatal care effects imply that there will be increase in and service delivery. Economically, this effect has unskilled delivery, mostly by traditional birth actually distorted most economic activities that attendants (TBAs), which has evident negative increase the income and livelihood of these effects on mother and child. pregnant women and their families.

Though, in Niger State, there was training of 5. RECOMMENDATIONS community health workers on COVID-19 protocols, this contributed to the knowledge on Based on the result, the researchers suggested the best practices to avoid contacting the the following; disease. 1. Governments, donors, and development However, as can be seen from the R Square partners should re - strategize and explanation that there could be other influencers reprioritize investments for the COVID-19 of low ANC within these periods, not just COVID era, necessitate data-driven decisions, 19. This could be attributed to lack of PPEs for commitment in managing their political

Anoke et al.; IJRRGY, 3(3): 15-23, 2020; Article no.IJRRGY.61937

economy. This could be done by 5. Ranganathan R, Khan AM, Chhabra P. stimulating agricultural productions with Antenatal care, care at birth and possible grants, loans, equipment for breastfeeding during the Coronavirus farmers in the State. Hence, increase (COVID-19) pandemic: A review. Indian healthy living in a case of pandemic. Journal of Community Health. 2. Government should provide all necessary 2020;32(1):17-20. PPEs for CHW and clients/patients at the 6. Nadia Akseer, Goutham Kandru, Emily C. health facilities. Keats, Zulfiqar A. Bhutta. COVID 19 3. Citizen to maintain and increase the best pandemic and mitigation strategies: practices for preventing covid 19. Implications for maternal and child health and nutrition. America Journal of Clinic CONSENT Nutrition. 2020;112:251–256. The Author(s) on behalf of the American Society for It is not applicable. Nutrition, 2020. 7. Ajisegiri WS, Odusanya OO, Joshi R. ETHICAL APPROVAL COVID-19 outbreak situation in Nigeria and the need for effective engagement of It is not applicable. community health. Workers for Epidemic Response. 2020;1(4). COMPETING INTERESTS 8. Sarah Esegbona-Adeigbe. Impact of COVID-19 on antenatal care provision. Authors have declared that no competing European Journal of Midwifery. 2020;4(5): interests exist. 16. 9. Nair M, Nelson-Piercy C, Knight M. Indirect REFERENCES maternal deaths: UK and global perspectives. Obstetrics Med. 1. World Health Organization. WHO 2017;10(1):10-15. recommendation on antenatal care contact DOI: 10.1177/1753495X16689444 schedules; 2018. 10. Rasmussen SA, Smulian JC, Lednicky JA, [Cited 2020 7 April] Wen TS, Jamieson DJ. Coronavirus Available:https://extranet.who.int/rhl/topics/ Disease 2019 (COVID-19) and pregnancy: improving-health-system- What obstetricians need to know. performance/who-recommendation- America Journal of Obstetrics Gynecol.; antenatal-care-contact-schedules 2020. 2. The World Bank. Food Security and Covid DOI: 10.1016/j.ajog.2020.02.017 19; 2020. 11. Paul A. Samuelson. The pure theory of 3. Phillips DE, Bhutta ZA, Binagwaho A, et al. public expenditure. The Review of Learning from exemplars in global health: Economics and Statistics. 1954;36(4):387- A road map for mitigating indirect effects of 389. COVID-19 on maternal and child health. 12. Kerlinger Fred N. Behavioral research: A BMJ Global Health. 2020;5:e003430. conceptual approach. New York: Holt, DOI: 10.1136/ bmjgh-2020-003430 Rinehart and Winston. 1979;336:22xi. 4. Wu H, Sun W, Huang X, Yu S, Wang H, Bi 13. Osuala EC. Research methodology. X, Sheng J, Chen S, Akinwunmi B, Zhang Enugu: New Generation Books. Paul A. CJP, Ming WK. Antenatal care during the Samuelson, 1950. Evaluation of Real COVID-19 pandemic: Opportunities and National Income, Oxford Economic challenges. Journal of Medic. Internet Res. Papers, Oxford University Press. 2020;22(7):e19916. 2005;2(1):1-29.

Anoke et al.; IJRRGY, 3(3): 15-23, 2020; Article no.IJRRGY.61937

Appendix 1. Data on ANC attendance, March – July

LGA ANC attendance Jan Feb March April May June July A gaie 1218 1074 949 980 857 1061 997 Bida 1986 1403 714 975 947 1312 592 Chanchaga 3950 3509 3831 3145 2370 3621 2996 Kontagora 2669 1780 1966 1672 1407 2178 1674 Agwara 1040 1035 1020 1252 1130 1464 1439 Gbaiko 769 1017 1061 903 929 1058 23 Magama 1703 1304 1463 1324 1115 1393 1740 Muya 1135 931 919 828 862 917 890 Rafi 2175 1806 1770 1162 1064 1367 98 Rijau 946 1031 933 919 845 916 539

Appendix 2. Data on IPTp uptake, March – July

LGA IPTp uptake Jan Feb March April May June July Agaie 220 343 230 329 178 204 131 Bida 1081 762 507 623 649 890 458 Chanchaga 1759 1410 1348 1115 1044 2136 1821 Kontagora 2454 1661 1836 1621 1372 2030 1636 Agwara 319 558 714 865 685 1010 1053 Gbaiko 294 600 644 459 463 580 8 Magama 405 219 469 404 279 434 416 Muya 500 416 525 420 388 569 503 Rafi 1229 802 744 534 414 673 0 Rijau 397 538 447 497 475 464 209

Appendix 3. Data on total ANC, IPTp and confirmed malaria, March – July

LGA Total ANC Jan - Jul Total IPTp Jan - Jul Total Conf. Mal Jan - Jul Agaie 7136 3270 124 Bida 7929 9940 26 Chanchaga 23422 21266 40 Kontagora 13346 25220 33 Agwara 8380 10408 872 Gbaiko 5760 6096 38 Magama 10042 5252 908 Muya 6482 6642 126 Rafi 9442 8792 543 Rijau 6129 6054 1609 ______© 2020 Anoke et al.; This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Peer-review history: The peer review history for this paper can be accessed here: http://www.sdiarticle4.com/review-history/61937