William R Brieger, Bright C Orji, and Emmanuel Otolorin, of Jhpiego shared Jhpiego’s work on improving the health of pregnant women in southeastern Nigeria at the MIM2013 6th Pan-African Malaria Conference in Durban.
In Nigeria approximately 11% of maternal deaths are caused by malarial in pregnancy (MIP). Use of Long Lasting Insecticide-treated Nets (LLINs), intermittent preventive treatment (IPTp) and prompt and effective case management have been recognized as key interventions to control MIP. Of these three MIP interventions, case management is the less well developed with fever in pregnancy often being treated presumptively as malaria, possibly leaving pregnant women to die from other illnesses.
The use of rapid diagnostic tests (RDTs) to confirm malaria before treatment provides an opportunity for earlier recognition of febrile illnesses not due to malaria and appropriate treatment for those that are due to malaria. This study sought to learn whether the introduction of RDTs into antenatal care (ANC) would influence the pattern of malaria fever and malarial case management in Akwa Ibom State, Nigeria.
The study reviewed record cards of pregnant women attending government owned ANC clinics before and after introducing and training health staff on parasitological diagnosis of malaria using RDTs. The ANC client cards were drawn from first non-follow-up visits where a complaint of ‘fever’ was recorded. Data extraction was conducted between February 2010 and March 2011 by trained nurses/midwives across six primary health care centers in two Local Government Areas of the state.
At baseline 597 cards were reviewed, and 472 at endline. At baseline presumptive malaria treatment took place among 506 (84.8%) of the febrile women using ACT (23%), Quinine (32%) and other antimalarials (30%). At endline 361 (76%) of febrile women were tested with RDTs, with 71 (20%) of tests being positive.
All RDT+ women received an antimalarial, with 76% getting either ACT or quinine as recommended. Among the 290 RDT- women, 28% were given an antimalarial drug. In contrast 60% of RDT- women received an antibiotic, although most of them had complained of a respiratory illness.
The review of records did show that nursing and midwifery staff at government clinics could in a relatively short time period adopt the use of RDTs. They did improve their prescribing of appropriate antimalarials, but still were using some inappropriate ones and did treat a small proportion of RDT- women for malaria. Continued follow-up and supervision will be needed to ensure that correct malaria diagnostic and treatment guidelines are fully practiced.