Jhpiego at MIM2013 – Harmonizing Malaria in Pregnancy Guidance: A Review from 5 African Countries

Elaine Roman, Patricia Gomez, Aimee Dickerson from Jhpiego (An Affiliate of Johns Hopkins University) and MCHIP developed the following abstract for a poster presentation at MIM2013 in collaboration with the US President’s Malaria Initiative. A copy of the full report is available at MCHIP.

MIP 5 country doc reviewsmThirty-nine countries in sub-Saharan Africa have malaria in pregnancy (MIP) policies in place, including intermittent preventive treatment (IPTp), insecticide treated bed-nets (ITNs) and effective case management.  Nonetheless, IPTp and ITN coverage among pregnant women remains well below international goals.  MIP policies are typically produced by National Malaria Control Programs (NMCP), but are implemented by National Reproductive Health Programs (RHP).

We reviewed MIP policy documents from the NMCP and RHP in Kenya, Mali, Mozambique, Tanzania and Uganda to understand 1) how closely national MIP documents reflect  WHO MIP guidance and 2) how consistent documents produced by the NMCP and RHP are with each other.  We developed a framework to compare MIP documents from RHP and NMCP according to WHO guidance for MIP, including IPTp timing and dosing, directly observed therapy, linkages to HIV prevention programs, promotion and distribution of ITNs, and diagnosis and treatment.

All countries have national documents promoting IPTp, ITN use, and case management of MIP.  WHO guidance was not always reflected in these documents: four countries restrict dosing of the first and second IPTp doses to specific gestational weeks, provide inconsistent guidance on MIP prevention in HIV+ women, and fail to provide clear guidance on the different antimalarial treatment that should be administered in the first vs. later pregnancy trimesters. .  All countries had discordant guidance between RH and NMCP in at least one official MIP guidance document.  For example, all countries had conflicting guidance on the timing or dosing of SP and the mechanism pregnant women should use to obtain ITNs. Considerable discrepancies exist between MIP guidance documents from NMCP and RHP.

These discrepancies contribute to confusion by health workers implementing MIP programs, contributing to the low coverage of IPTp and ITNs.  Harmonization of national MIP documents is urgently needed, with effective re-orientation and supervision of health workers to updated materials to help accelerate implementation.  While this review is targeted primarily at country level stakeholders, the information is important for regional and global level stakeholders as well.  This exercise is being repeated in other President’s Malaria Initiative countries.

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