According to a study conducted in four sub-Saharan African nations and directed by the Barcelona Institute for Global Health (ISGlobal), an organisation supported by “la Caixa” Foundation, community health workers can significantly improve the proportion of pregnant women who receive life-saving preventive antimalarial treatment.
The findings, which were published in The Lancet Global Health, will assist to direct programmes for malaria control among expectant women and enhance mother and newborn health in nations with a malaria epidemic.
Pregnancy-related malaria poses a threat to both the mother’s and the unborn child’s health. According to estimates, 11.6 million pregnancies in Africa were at risk for malaria infection in 2020, which led to 20% stillbirths and 11% neonatal deaths.
Using a novel “no missed opportunity” strategy to increase IPTp coverage, the TIPTOP project (Transforming Intermittent Preventive Treatment for Optimal Pregnancy), co-led by Jhpiego and Clara Menéndez, Director of ISGlobal’s Maternal, Child and Reproductive Health Initiative, employed community health workers, who have been demonstrated to increase the uptake of health interventions like childhood immunisations. Between 2017 and 2022, this implementation science project was conducted in the Democratic Republic of the Congo, Madagascar, Mozambique, and Nigeria. Throughout the course of the research, cooperation with WHO and Medications Malaria Venture was essential.
“This study is the largest implementation project carried out in collaboration with the countries’ ministries of health, in which we simultaneously evaluated the impact of community health workers on IPTp coverage and antenatal care attendance,” explains Raquel González, TIPTOP senior epidemiologist and lead author of the study. In the project, community health workers identified pregnant women in the community, provided the required SP doses to eligible women and referred them to the health facility for antenatal care. More than 18,000 women participated in 32 household surveys over three years to assess IPTp coverage before, during, and after the community-based delivery approach.
The results show that IPTp coverage increased significantly after the community-based implementation in all study countries, ranging from 133.6% in Madagascar to 473% in Nigeria, where coverage increased from 12.7% to 31.8%. Importantly, the approach did not reduce antenatal care attendance. On the contrary, it increased slightly in most study areas.
“These results are robust and will help to inform malaria control strategies,” says Clara Menéndez. Approximately 10,000 pregnant women and 200,000 of their newborns die each year from malaria, which means that increasing IPTp uptake through community health workers can save thousands of maternal and infant lives in African countries.
“We’re delighted to see these community-led approaches making a difference in the lives of thousands of pregnant women. Beyond achieving targets, TIPTOP has underscored the critical role community health workers play in supporting the health of women, where they live,” said Elaine Roman, TIPTOP Project Director. “This offers promise and opportunity well beyond life of project; providing a sustainable and trustworthy pathway to improve the health of women across a range of challenges.”
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