AMREF Calls for Greater Integration of Malaria into Maternal Health at Primary Health Care Level

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By: Dr. Sylla Thiam, Malaria Programme Lead, AMREF

This post is part of a blog series on Malaria in Pregnancy. To view the entire series, click here.

Pregnant women living in malaria-endemic regions are particularly vulnerable to the disease because pregnancy reduces a woman’s immunity to malaria, making her more susceptible to infection. It is a known fact that the main complications of malaria during pregnancy include maternal death, severe anaemia and adverse birth outcomes such as low birth weight. Therefore, controlling malaria during pregnancy is a key element of malaria programmes. Strategies include case management and preventive measures such as Insecticide Treated Nets (ITN) and Intermittent Preventive Therapy (IPTp) with Sulphadoxine-Pyrimethamine (SP).

The impact of these strategies on malaria in pregnancy are well known. There has been substantial progress in scaling up of ITN and IPTp, with antenatal care being the most widely used channel to provide these interventions. However, more work needs to be done because uptake of these strategies has been slow, particularly in sub-Saharan Africa. Indeed in 2010, only 52% of women attending antenatal clinics received the recommended two doses of IPTp, while coverage of ITN among pregnant women in most of the countries remains below 80%, which was the target in 2010.

This limited progress is due to many factors, with the main barriers being: (i) poor access to health services and malaria control measures, particularly in rural and remote areas; (ii) inadequate human resources and poor equipment; (iii) low antenatal care attendance; and (iv) lack of collaboration and integration between reproductive and maternal health services and malaria control programmes. Consequently, malaria programmes may need to reorient their efforts to address these issues through innovative approaches.

As an international African health organisation, AMREF is particularly concerned about the high rate of maternal death in Africa. Many of these deaths are caused by preventable causes such as malaria, because the women had no access to professional health care during pregnancy. AMREF is also paying special attention to women’s and children’s health to transform the health of communities from within. In the strong belief that no woman should die giving life, AMREF launched the international Stand Up for African Mothers campaign in October 2011 to draw attention to the plight of African mothers and to mobilise citizens worldwide to ensure that mothers get the basic medical care they need during pregnancy and childbirth. No child should be left an orphan due to lack of health care for women.

With 55 years of working with communities in some of the most remote and marginalised parts of Africa, AMREF has extensive experience and knowledge of local problems and remedies, and as such is capable of developing and implementing innovative models to improve the uptake of malaria control measures during pregnancy. In the past few years, AMREF has been implementing integration of malaria into reproductive health programmes in Kenya, Tanzania, Uganda and South Sudan. These programmes are structured around two key components: first, reinforcing the capacity of the limited health services and workforce, and secondly, building the capacity of the communities and linking them to the health facilities.

The main interventions are:

  • Distribution of ITN, which serves as a platform for other activities such as antenatal services, HIV testing, immunisation and health education
  • Training of community health workers on malaria, HIV, mother and child health, family planning and nutrition so that they can conduct health education for households, mobilise communities, support and refer pregnant women and patients to health facilities, provide information and counselling, and collect data.
  • Training of health professionals and improvement of peripheral facility services
  • Providing mobile outreach services to reach remote communities
  • Strengthening the capacity of community-based organisations at grassroots level for continuity and sustainability of the initiative

This community-based integrated approach has helped to bridge the gap between the formal health system and the communities, and has led to a significant improvement of malaria indicators as well as maternal health in targeted areas.

Learn more about AMREF’s work here.