Malaria Journal has published experiences from Luwero, Uganda that show the difficulties of getting two appropriately times doses of intermittent preventive treatment (IPTp) to women even if they attend antenatal care (ANC) clinics frequently. Among the over 750 post-partum women who were surveyed in 2005, 94% had attended ANC once and 88% at least twice.
Only 36% of the women received two or more doses of IPTp, and 31% used a bednet during their last pregnancy, well below the 60% target set for 2005 for IPTp and ITN use by the RBM partnership. Educational level was positive associated with taking any IPTp. Even these figures look good compared to the 2006 DHS in Uganda where only 10% of pregnant women said they had slept under a bednet the previous night and 16% reported receiving IPTp twice. The DHS did agree with ANC attendance wherein it was reported that 89% of women attended two or more times.
This pattern of good ANC attendance and poor malaria control coverage is not uncommon. It demonstrates the neglect of routine MCH and Reproductive Health services by national malaria control programs. ANC clinics do not receive regular net supplies and pregnant women do not benefit from community campaigns that mainly target children under five years of age. Countries phase out SP for treatment and forget to keep it on hand for IPTp during ANC.
A priority for all funders – PMI, GFATM, World Bank, DfID, UNICEF and others should be to foster integration of ANC strengthening into malaria control efforts in order to prevent maternal anemia and morbidity and ultimately low birth weight and neonatal mortality. Alternative approaches that involve the community should also be considered.