WORLD MALARIA DAY 2023

Blog 24 Apr 2023
14
Intermittent Preventive Therapy for Malaria has increased in the states of Kaduna and Oyo

Malaria in Pregnancy: Nigeria

Malaria is an infectious disease caused by the female anopheles mosquito. The disease is endemic in 84 countries, where 247 million cases of malaria occurred in 2021. Twenty-nine countries of the 84 account for 96% of the global burden for malaria and 4 countries account for almost half of the global burden with Nigeria having the highest burden of disease at 27%. (WHO, 2022).

People living in endemic areas develop immunity to malaria. Malaria mostly affects pregnant women, children, and immunocompromised people and these groups of individuals are susceptible to developing a severe form of the disease and have the highest mortality and morbidity from malaria. Pregnant women are at risk of dying from malaria in pregnancy due to complications like cerebral malaria. The unborn baby is also at risk because the malaria parasite can be transmitted from the mother to her baby which can lead to complications like miscarriage, intrauterine growth restriction, prematurity, and low birth weight (<2.5kg) which can lead to neonatal deaths. (Schantz-Dunn & Nour, 2009).

Malaria in pregnancy is prevented primarily by using Insecticide Treated Net (ITN) in pregnancy, indoor residual spraying, and Intermittent Preventive Therapy (IPT) with Sulphadoxine Pyrimethamine (SP) IPT-SP. IPT was introduced by WHO in 1998 and implemented in 2004 to replace chemoprophylaxis for malaria and recommended for pregnant women living in malaria-endemic areas.  (Briand, Cottrell, Massougbodji, et al, 2007).

Malaria accounts for 11% of maternal deaths in Nigeria and complicates up to 58.1% of pregnancies (Bello and Ayede, 2019). Nigeria adopted the new WHO IPT-SP policy of providing SP to pregnant women from the early second trimester till delivery. Although the policy was adopted by the Federal Ministry of Health, a lot of health workers do not have the knowledge as such it is not widely implemented in Antenatal (ANC) clinics.  Some health workers still use the previous recommendation of giving SP twice only during pregnancy. (Peters and Naidoo, 2020)

The Liverpool School of Tropical Medicine funded by Global Fund with financing from Takeda Pharmaceutical Company Limited has been implementing the programme “Quality Improvement (QI) in Integrated HIV, TB and Malaria Services in ANC&PNC in Kaduna and Oyo state Nigeria” The programme is supporting capacity-building of Health Care Workers and health systems strengthening by promoting integrated, people-centered health services. The programme is implemented through training Health workers (doctors, nurses, midwives, and CHEWs) working in ANC&PNC clinics to acquire hands-on skills in the prevention diagnosis, and management of malaria amongst other things. 

LSTM ANC&PNC manual cover pages for Healthcare Providers and Facilitators

The programme is supporting 60 facilities in Kaduna and 60 in Oyo states. So far 252 health workers in Kaduna and 188 in Oyo have been trained in ANC&PNC. After the training the health facilities are supported to establish Quality Improvement teams and conduct Standard Based Audits (StBA) in ANC&PNC. There is an on-going support for the health workers through a mentorship programme implemented in both states.

Through our work most of the facilities introduced routine screening for malaria during booking visit using rapid diagnostic testing, implementation of IPT-SP according to the WHO recommendations and improved case management for malaria and referral services. Most of the facilities especially the primary health centres provide ITN for pregnant women supplied through other malaria programmes in Nigeria.

As we celebrate World Malaria Day, we will double our effort to continue to provide training and retraining with mentorship to health workers in Nigeria. Together with the efforts of other stakeholders, we will move closer to the goal of eliminating malaria in Nigeria.  

References

Bello FA, Ayede AI. Prevalence of Malaria Parasitaemia and the Use of Malaria Prevention Measures in Pregnant Women in Ibadan, Nigeria. Ann Ib Postgrad Med. 2019 Dec;17(2):124-129. PMID: 32669988; PMCID: PMC7358809.

Briand, V., Cottrell, G., Massougbodji, A. et al. Intermittent preventive treatment for the prevention of malaria during pregnancy in high transmission areas. Malar J 6, 160 (2007). https://doi.org/10.1186/1475-2875-6-160

Peters GO, Naidoo M. Factors influencing the use of intermittent preventive treatment of pregnant women seeking care at primary healthcare facilities in the Bwari Area Council, Abuja, Nigeria. Afr J Prim Health Care Fam Med. 2020 Apr 16;12(1):e1-e8. doi: 10.4102/phcfm.v12i1.2256. PMID: 32370528; PMCID: PMC7203208.

Schantz-Dunn J, Nour NM. Malaria and pregnancy: a global health perspective. Rev Obstet Gynecol. 2009 Summer;2(3):186-92. PMID: 19826576; PMCID: PMC2760896.

WHO. (2022). World Malaria Report 2022. Retrieved from https://www.who.int/teams/global-malaria-programme/reports/world-malaria-report-2022