According to the Every Woman Every Child website (EWEC), “A strong focus on reproductive, maternal, child and newborn health (RMCNH) is integral to improving global health. RMNCH is linked to all 8 Millennium Development Goals (MDGs). MDGs 4 (Reduce Child Mortality), 5 (Improve Maternal Health) and 6 (combat HIV/AIDS, malaria and other diseases) each have specific targets and indicators related to RMNCH.” In order to achieve these goals life saving commodities must be made available to all women and children, and as implied in the statement above, they must include commodities that prevent and treat malaria in pregnancy.
The website further states that, “Based on these criteria, an initial list of 13 affordable, effective, but underutilized life-saving commodities were identified for consideration by the Commission. The UN Commission on Life-Saving Commodities for Women and Children aims to increase access to life-saving medicines and health supplies for the world’s most vulnerable people.” Ironically this suggestive list does not include medicine for intermittent preventive treatment of malaria in pregnancy (IPTp), insecticide treated nets (ITNs), malaria rapid diagnostic tests or artemisinin-based combination therapy medicines for malaria treatment.
Yes the list is only suggestive, and yes it is a global list, but WHO estimates that nearly 50 million women will become pregnant in malaria endemic areas each year. That’s a pretty big chunk of the world’s population to neglect.
EWEC does refer to two partner documents for more details on these essential commodities. One document is “The Essential Interventions, Commodities and Guidelines for Reproductive, Maternal, Newborn and Child Health – A global review of the key interventions related to reproductive, maternal, newborn and child Health.” This document mentions generically “Prevention and management of malaria with insecticide treated nets and antimalarial medicines.”
The second document, “Priority medicines for mothers’ and children’s health, 2011”, also identifies medicines that are in need of enhanced attention and utilization in order to avoid preventable deaths of women and children. This document mentions that commodities exist for malaria services, but refers the reader to the very detailed Global Malaria Program’s “Guidelines for the treatment of malaria” (2nd ed. Geneva, World Health Organization, 2010) that discusses medications for all species of Plasmodium and does not have an easy to view take away on the essential life saving commodities within.
Over the past year the Global Malaria Program of WHO has issued guidance for updating malaria in pregnancy interventions, including more frequency IPTp with sulphadoxine-pyrimethamine (SP). The briefing companion document to this new guidance spells out the following life saving benefits if IPTp with appropriate references:
- IPTp-SP prevents the adverse consequences of malaria on maternal and fetal outcomes, such as placental infection, clinical malaria, maternal anaemia, fetal anaemia, low birth weight and neonatal mortality.
- IPTp-SP has recently been shown to be highly cost-effective for both prevention of maternal malaria and reduction of neonatal mortality in areas with moderate or high malaria transmission.
- Despite the spread of SP resistance, IPTp-SP continues to provide significant benefit, resulting in protection against both neonatal mortality (protective efficacy 18%) and low birth weight (21% reduction in LBW) under routine program conditions.
Over the years rarely has IPTp if ever achieved high and sustained coverage. Factors relating to late antenatal care attendance are often mentioned first, but experience has shown that one of the key factors is stock-out of SP. Once SP was no longer a first line treatment drug, it was forgotten – a neglected medicine needed by an often neglected but vulnerable portion of the population. Now is the time to advocate strongly for direct and unconditional listing of SP for IPTp, ITNs and other malaria products among any list of RNMCH life saving commodities.