The devastating consequences of Plasmodium falciparum malaria in pregnancy (MiP) are well documented; these include higher rates of maternal anemia and low birth weight (LBW) babies in areas of stable malaria transmission. In areas of unstable P. falciparum malaria transmission, pregnant women are at increased risk of severe malaria, death and still birth of the fetus.
Evidence-Based Interventions for Preventing MIP
In areas of high to moderate malaria transmission, WHO recommends a three-pronged approach to control malaria in pregnancy. This approach includes:
- Administration of IPTp as early as possible in the 2nd trimester and at every scheduled ANC visit thereafter, at least one month apart
- Promotion of use of LLINs throughout and following pregnancy
- Effective case management among pregnant women showing signs and symptoms of malaria
Key Activities
To prevent and control MIP, MCHIP supported WHO’s three-pronged approach on a platform of focused antenatal care, recognizing that the majority of pregnant women will attend one (and often two) antenatal care visits. MCHIP provided global level leadership and country level technical assistance to drive the malaria in pregnancy agenda forward and accelerate MIP programming across countries. At global level, MCHIP fostered the dialogue among key stakeholders to increase the commitment and support for MIP programming. MCHIP’s global leadership in MIP extended to regional support working closely with the RBM sub regional networks as well as documenting MIP best practices and lessons learned to help countries scale up MIP programs. At the country level, MCHIP supported MIP programming in nine countries through a core set of interventions that help to strengthen health systems, build capacity, and sustain results across the continuum of care.
Key activities included:
a) Fostering partnerships among national Reproductive Health and Malaria Control Programs as well as national HIV/AIDS Programs;
b) Updating and disseminating MIP policies;
c) Developing and disseminating national standards and guidelines;
d) Developing training, supervision and quality improvement materials;
e) Strengthening pre-service education and in-service training;
f) Increasing community engagement and awareness;
g) Improving services through quality improvement processes; and
h) Establishing monitoring and evaluation systems.
Results
- Documentation of best practices and lessons learned in MIP programming led to wider recognition at country and global level of not only what is working but also what bottlenecks remain that need to be addressed. The documentation is informing program planning and prioritization for support across countries. (To learn more, read the Successes and Challenges for Malaria in Pregnancy Programming: A Three-Country Analysis.)
- Review of MIP-related policies, guidelines, training and supervision materials in 19 PMI focus countries (Angola, Benin, DRC, Ethiopia, Ghana, Guinea, Kenya, Liberia, Mali, Madagascar, Mozambique, Malawi, Nigeria, Rwanda, Senegal, Tanzania, Uganda, Zambia and Zimbabwe) was done to understand what countries are promoting as MIP guidance to service providers. The review is a useful tool that provides specific recommendations to assist countries with the process of revising and adapting their policies, guidelines and resources for consistency with current WHO guidance. (To learn more, read the Review of National-Level Malaria in Pregnancy Documents in 19 PMI Focus Countries.)
- In Kenya, MCHIP provided technical assistance to the Ministry of Health to bridge the link between communities and facilities; specifically, training community health workers to sensitize pregnant women to the importance of IPTp uptake and ITN use. This resulted in CHWs reaching nearly 50% of pregnant women in catchment who had not started attending ANC services.
- In Rwanda, MCHIP supported a study determine the current prevalence of detectable malaria among pregnant mothers using data from their first ANC visit in Rwanda. Due to low rates of malaria in pregnancy prevalence, which ranged between 1.6% and 5.6%, Rwanda is now reviewing its malaria policy to introduce intermittent screening and treatment.
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1 The study team recognizes that no test is 100% reliable in detecting malaria.