Megan Fotheringham, Public Health Advisor, President’s Malaria Initiative
In the developing world, pregnancy is a dangerous time for women. In sub-Saharan Africa, malaria poses a major threat to the health of pregnant women and their developing babies; each year nearly 32 million pregnant women are at risk from this deadly disease. The dangers, which occur when malaria parasites infect the placenta, are serious and include maternal anemia, miscarriage, stillbirth, and low birth weight in newborns. The cost in lives and resources as a result of malaria infection places a heavy burden on families and national health systems.
Thankfully there is a solution. Women can reduce their risk of infection by taking an antimalarial drug as preventive treatment: intermittent preventative treatment for pregnant women or IPTp. For full protection, pregnant women take at least two doses of the treatment during pregnancy. In Africa, IPTp is widely available and usually given during routine antenatal care visits across the region. Despite this fact, IPTp rates are still surprisingly low.
The Kenyan government’s Division of Malaria Control recently found an innovative and simple way to respond to this problem and subsequently increased the percentage of women taking IPTp. In the Gem District of western Kenya, where only 7 percent of pregnant women received the recommended two doses of IPTp, the Government of Kenya teamed up with researchers from the Kenya Medical Research Institute and the U.S. Centers for Disease Control and Prevention to improve the use of IPTp.
With funding from the U.S. President’s Malaria Initiative, the researchers discovered one of the reasons for low compliance with recommended use was that health workers were confused about when to give IPTp. According to the official guidelines, pregnant women should only be given IPTp in their second trimester but the doses should be given at least 30 days apart. This is complicated by the fact that many women are not sure how far along they are in their pregnancy. In addition, a mother’s HIV status is also a factor in treatment protocol.
To address this confusion, the Government of Kenya piloted a simple approach. They sent an official memorandum to all government health facilities located in the Gem District and followed up with supervisory visits. The memo clearly listed five key messages about IPTp and instructed health workers to comply with these simplified guidelines. (Click here to see a sample memo.) To reinforce their message, officials made half-day visits to all facilities providing antenatal care services in Gem. To support the importance of this simplified approach, the same memo was re-sent six months later.
A year after the first memo was sent, a second survey was conducted with a sample of women who recently gave birth: 43 percent of these women had received the recommended two doses of IPTp, a dramatic increase in usage. As a result the Kenyan government is now repeating the process of disseminating the memo and following up with supervisory visits in all other districts in Kenya where IPTp is policy.
This simple approach, if replicated, could help improve IPTp coverage elsewhere in Africa, where use of IPTp is government policy. This is just one example of the new approaches the President’s Malaria Initiative is supporting to improve program implementation and malaria control across Africa. These approaches are driving forward progress through simple and cost effective processes to save the lives of those who are most vulnerable to malaria – pregnant women and young children.
Do you have other examples of simple, effective solutions that could improve the delivery of health services? We invite you to provide your comments and suggestions below.