According to a study conducted by the Barcelona Institute for Global Health (ISGlobal), community health workers can make a great difference in saving thousands of maternal and infant lives. They can increase the number of pregnant women who receive life-saving preventive anti-malaria treatment. The study was conducted in four sub-Saharan African countries by ISGlobal, an institution that is supported by “la Caixa” Foundation. The findings, which was published in The Lancet Global Health journal, will help to guide malaria control strategies in pregnant women and improve maternal and infant health in malaria-endemic countries.
Malaria puts the health of both mother and child at risk if she contracts it during pregnancy. An estimated 11.6 million pregnancies in Africa were exposed to malaria infection in 2020. The cases resulted in 11 percent of neonatal deaths and 20 percent of stillbirths that year. Because of this, the World Health Organization (WHO) recommends that pregnant women receive three doses of the anti-malarial drug sulfadoxine-pyrimethamine (SP) during their antenatal visits if they live in areas with high to moderate malaria transmission.
The study used an innovative, community-based approach.
Despite this recommendation, the proportion of eligible women receiving this intermittent preventive treatment (IPTp) remains unacceptably low in many countries. The Unitaid-funded TIPTOP project (Transforming Intermittent Preventive Treatment for Optimal Pregnancy) took an innovative “no missed opportunity” approach to increase IPTp coverage. Community health workers, who have been shown to improve the uptake of health interventions such as childhood immunizations, were used. The project was co-led by Jhpiego and Clara Menéndez, Director of ISGlobal’s Maternal, Child and Reproductive Health Initiative.
This implementation science project took place in the Democratic Republic of Congo, Madagascar, Mozambique and Nigeria between 2017 and 2022. The WHO and Medicines Malaria Venture collaborated throughout the project life. According to Raquel González, TIPTOP senior epidemiologist and lead author of the study, “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.”
Community worker’s intervention increased prevention significantly.
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. Coverage increased from 133.6 percent in Madagascar to 473 percent in Nigeria, where coverage increased from 12.7 percent to 31.8 percent.
Notedly, 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,” Clara Menéndez says. Approximately 10,000 pregnant women and 200,000 of their newborns die each year from malaria. It means that increasing IPTp uptake through community health workers can save thousands of maternal and infant lives in African countries. These community workers can not only penetrate remote communities but also gain their trust because of familiarity.
TIPTOP director delighted at the difference made.
The project director of TIPTOP, Elaine Roman, said, “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.” She said that this offers promise and opportunity well beyond the life of project and it provides a sustainable and trustworthy pathway to improve the health of women across a range of challenges.
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