Improving case management of malaria during pregnancy by antenatal care providers in Akwa Ibom State, Nigeria

Bright Orji, William Brieger, Emmanuel Otolorin and John Orok presented today at the 141st APHA Annual Meeting in Boston of Jhpiego’s experiences with malaria in pregnancy in Akwa Ibom State Nigeria. A summary appears below.

In Nigeria malaria causes approximately 11% of maternal deaths. Malaria is responsible for 63% of hospit al admissions and 70% of illness among pregnant women. While intermittent preventive treatment (IPTp) and Long Lasting Insect icide-treated Nets (LUNs) are supposed to be given to pregnant women to prevent the dis·ease, coverage is poor.

Unfortunately since malaria is often being treated presumptively, pregnant women st ill die from other fever-related illnesses. Use of rapid diagnostic test (RDTs) to confirm malaria before treatment provides an opportunity for earlier recognition of febrile illnesses not due to malaria.

This study assessed the pattern of malaria diagnosis and treatment in pregnant women attending Antenatal care (ANC) in Akwa Iborn State, Nigeria. Record cards of pregnant women attending six government owned ANC before and after staff training on malaria diagnosis using RDTs.

The patients’ cards were drawn from ANC clinics with first non- follow-up visit of the year before training (February 20 10) and after (March 20 11) by three nurses/midwives.

Health care providers fever gave 85% of 3 13 women attending ANC antimalarial drugs before the introduction of RDTs training. Afterwards 82% of 179 febrile women were tested with RDTs. All 29 with positive RDT received artemisinin-based combination therapy, 6 RDT-negative women got ACTs, and no women who were not tested were treated for malaria.

Training encouraged health workers to adherence rational prescribing of antimalarials and made it possible t o offer better management of other fever-related illnesses during  pregnancy. Support is now needed to scale-up RDTs use in ANC clinics in Nigeria.

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