Consensus Statement: Optimizing the Delivery of Malaria in Pregnancy Interventions
Despite clear global gains in malaria control, the delivery of MiP interventions remains suboptimal. This Consensus Statement encourages policy-makers, program managers, and health-care providers to renew their commitment to fighting malaria in pregnancy and urgently take action.
According to recent reports from the World Health Organization (WHO) and the Institute for Health Metrics and Evaluation (IHME), the number of deaths from malaria has fallen rapidly in recent years [WHO 2011 (pdf); Murray et al. 2012]. Similarly, recent reports from the WHO as well as IHME show dramatic reductions in maternal mortality. Despite this encouraging progress, coverage of malaria control efforts among pregnant women remains low. Malaria in pregnancy (MiP) continues to be a substantial contributor to maternal mortality and morbidity in malaria-endemic regions. MiP also leads to neonatal mortality, low birth weight babies, spontaneous abortion, stillbirth, premature delivery, and other adverse birth outcomes.
MiP programming is at a critical juncture. Important gains have been made in malaria control, but without continued efforts, the gains achieved may quickly erode. Coverage of malaria prevention, screening, and treatment among pregnant women remains low in many locations in sub-Saharan Africa, despite clear evidence of effective interventions and significant investment in this area. Experts agree that the maternal health and malaria communities must work closer together in order to significantly increase coverage. Given the existing synergies and overlap between these communities, several opportunities exist to collaborate more effectively. These areas of overlap include the target population (pregnant women), common health outcomes (maternal and newborn mortality and morbidity), and a shared delivery mechanism (the antenatal care platform).
The role of the MHTF
During the June 2012 technical meeting “Malaria in Pregnancy: A Solvable Problem—Bringing the Maternal Health and Malaria Communities Together” held in Istanbul by the Maternal Health Task Force (MHTF), in collaboration with the Bill & Melinda Gates Foundation (BMGF), the Liverpool School of Tropical Medicine (LSTM), the London School of Hygiene and Tropical Medicine (LSHTM) and PATH, several challenges and opportunities to improve MiP outcomes were identified.
In October 2012, building on the Istanbul meeting, the BMGF awarded PATH and the WHO a one-year “Prevention of Malaria in Pregnancy” grant to reduce adverse outcomes due to malaria in pregnancy by increasing intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine and insecticide treated bed-net uptake in selected countries in East Africa (Kenya, Tanzania, and Uganda). A two-day project kick-off/planning meeting was organized in Arusha, Tanzania in January 2013. The gathering included representatives from the MHTF; the BMGF; the WHO; the United States Agency for International Development; PATH, the Maternal and Child Health Integrated Program; academia; and country delegations from Kenya, Tanzania, Uganda, and Zambia. Additional information is available in the Arusha meeting report (pdf).
At the Global Maternal Health Conference 2013 (GMHC2013) in Arusha, Tanzania in January 2013, MiP was well represented with 3 panels, 17 presentations, and an informal luncheon. The conference also provided an opportunity to disseminate the updated WHO Policy Recommendation on IPTp-SP (pdf) and “Malaria Protection in Pregnancy: A lifesaving intervention for preventing neonatal mortality and low birth weight,” a brief developed jointly by the President’s Malaria Initiative, the WHO, and MCHIP; the brief is available in both French (pdf) and English (pdf). Malaria in pregnancy presentations from GMHC2013 are available for viewing on the MHTF’s MiP Vimeo channel.
In addition to MHTF’s work fostering dialogue between the maternal health and malaria communities, the MHTF participates in Roll Back Malaria’s MiP working group and also coordinates a blog series (on the MHTF Blog) with posts from experts working to address MiP throughout sub-Saharan Africa. Posts share lessons from specific countries, organizations, and projects; make the case for strengthening the antenatal care platform across sub-Saharan Africa; and raise questions about next steps for increasing coverage of MiP interventions.
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