This post is part of a blog series on Malaria in Pregnancy. To view the entire series, click here.
Malaria is a maternal and child health issue. Pregnant women are the most at risk for malaria and the likelihood of complications due to infection is much greater. Each year, approximately 50 million women living in malaria-endemic countries throughout the world become pregnant and are at risk of getting malaria. In Africa around 10,000 of these women and up to 200,000 of their infants die as a result of malaria infection during pregnancy. Malaria during pregnancy (MIP) accounts for maternal anemia, low birth weight, and infant deaths. And yet, the Roll Back Malaria goals of reaching 80% of pregnant women with intermittent preventive treatment during pregnancy (IPTp) and insecticide treated bed-nets (ITNs), two leading preventive measures, have not yet been met.
According to the Countdown to 2015 Decade report, tackling MIP and malaria among children is inextricably linked with achieving MDGs 4 and 5. Yet have we been able to truly make progress integrating MIP interventions into routine maternal and child health services along the platform of antenatal care? Have funding streams from malaria and maternal health strengthened basic services while maintaining a focus on certain, specific outcomes? The answer is not nearly enough.
There has been greater awareness that malaria disproportionally attacks pregnant women and their children and in the last year, we have been pleased to see a growing recognition that MIP programming needs to be re-prioritized. But while we know that each country context may be different, the recommendations for MIP programming remain the same. In each country context where malaria is endemic, there needs to be a critical partnership between reproductive health and malaria control. The World Health Organization strongly recommends that MIP services are incorporated into the focused antenatal care programs wherever there is a need for MIP programing.
USAID’s flagship Maternal and Child Health Integrated Program (MCHIP) brings together proven leadership and technical expertise to help countries address scale up prevention and treatment of malaria. As a key contributor to the President’s Malaria Initiative (PMI), MCHIP has been well positioned to implement a unique approach to supporting the reduction of malaria morbidity and mortality. Working in close collaboration with ministries of health, MCHIP builds national and local capacities and strengthens health systems so that they may accelerate scale-up prevention and treatment programs based on the MIP policies of the country.
For example, MCHIP recently completed a Maternal and Newborn Quality of Care (QoC) study of six countries: Kenya, Ethiopia, Madagascar, Mozambique, Rwanda and Tanzania. This survey focused on routine care and prevention and management of the most serious causes of maternal and newborn complications, including postpartum hemorrhage, pre-eclampsia/eclampsia and newborn asphyxia. The core of this study was the direct observation to assess QoC, both in antenatal care (ANC) and during Labor and Delivery (L&D), in 643 facilities, and through observations of over 2,500 deliveries and close to 3,000 ANC consults. What we found is that there are missed opportunities for MIP services during ANC visits. While over 90% of the women in some African countries have at least one ANC visit, an average of 57% of first visit ANC clients across four of the six countries surveyed received IPTp. The observed figure is way short of the RBM target. Several facilities reported lack of commodities. Other services that women should receive during ANC also were at low coverage.
As a global community we need to be involved in prioritizing messages and setting guidance for countries as to how they can coordinate programs with limited resources to accelerate the scale-up of MIP programs. The importance of collaboration between national departments of reproductive health and malaria programs cannot be understated. Together with all the partners working on malaria, we need to ensure that our investments in malaria focus on building on our successes and learning from our challenges to ensure that malaria in pregnancy remains not only on the global stage, but integrated along the maternal and reproductive health platform of care.