Highlights
Harnessing Community Power
An innovative strategy involving community health workers greatly increased the number of pregnant women receiving life-saving preventive malaria treatment
In 2022, an estimated 12.7 million pregnancies in Africa were exposed to malaria infection
Malaria during pregnancy puts the health of both mother and child at risk. That is why the WHO recommends that pregnant women living in malaria-endemic areas receive preventive treatment with sulfadoxine-pyrimethamine (SP) at each scheduled antenatal visit. The reality, however, is that many of the pregnant women who are eligible for this intermittent preventive treatment (IPTp) do not receive it.
To increase IPTp coverage, the Unitaid-funded TIPTOP project, led by Jhpiego and Clara Menéndez, director of the Maternal, Child and Reproductive Health Initiative, took an innovative “no missed opportunity” approach: involving community health workers.
A remarkable increase in IPTp coverage
During the project, which took place in the Democratic Republic of Congo, Madagascar, Mozambique and Nigeria between 2017 and 2022, community health workers identified pregnant women in the community, provided eligible women with the required SP doses and referred them to the health facility for antenatal care. More than 18,000 women participated in 32 household surveys over the three years.
Countries
Women
Surveys
Years
Countries
Women
Surveys
Years
The results show that the community-based intervention significantly increased IPTp coverage in the four countries: from 133.6% in Madagascar to 473% in Nigeria, where coverage increased from 12.7% to 31.8%.
No negative impact
As the TIPTOP team previously showed, community delivery of IPTp was widely accepted by pregnant women thanks to the involvement of influential actors and sustained trust in community health workers. Most importantly, despite community delivery of SP, women did not stop attending their antenatal care visits.
In addition, the intervention did not lead to an increase in parasite resistance to the SP drugs, at least in the short term. This was confirmed by regular monitoring of changes in molecular markers associated with SP resistance over time in areas where the community-based intervention took place, compared with areas where IPTp was only provided in health centres.
Last, but not least, a study led by Laia Cirera of the health economics group shows that community-based delivery of IPTp is a highly cost-effective intervention in the four countries, compared to the status quo (IPTp delivery in health centres).
“This is the largest implementation project carried out in collaboration with the countries’ ministries of health,” says TIPTOP senior epidemiologist Raquel González.
The results are very solid and will help inform malaria control strategies in these countries
adds Menéndez.
Increasing IPTp uptake through community health workers can save thousands of maternal and infant lives in African countries, directly contributing to SDG3 targets 3.1 (reduce maternal mortality), 3.2 (reduce neonatal and child mortality) and 3.3 (reduce malaria cases and deaths).
Malaria
kills about
10,000
pregnant women and
200,000
of their newborns every year.
References
- González R, Manun’Ebo MF, Meremikwu M, et al. The impact of community delivery of intermittent preventive treatment of malaria in pregnancy on its coverage: a quasi-experimental evaluation in four sub-Saharan African countries. Lancet Glob Health 2023; 11: e566–74. doi: 10.1016/PIIS2214-109X(23)00051-7.
- Figueroa-Romero A, Bissombolo D, Meremikwu M et al. Prevalence of molecular markers of resistance to sulfadoxine–pyrimethamine before and after community delivery of intermittent preventive treatment of malaria in pregnancy in sub-Saharan Africa: a multi-country evaluation. Lancet Glob Health 2023, 11:e1765-74. doi: 10.1016/S2214-109X(23)00414-X
- Cirera L, Sacoor C, Meremikwu M et al. Cost-effectiveness of community-based distribution of intermittent preventive treatment of malaria in pregnancy in Madagascar, Mozambique, Nigeria, and the Democratic Republic of Congo. BMJ Glob Health. 2023 Jul;8(7):e010238. doi: 10.1136/bmjgh-2022-010238.
