New Ideas in Malaria in Pregnancy Service Delivery

Malaria in Pregnancy: A Solvable Problem—Bringing the Maternal Health and Malaria Communities Together – a meeting in Istanbul organized by the Maternal Health Task Force, Harvard University.

Take Away Messages from Day 2 Presentations. Report by James Kisia, Kenya Red Cross.

Innovative approaches to identify and apply context-specific interventions were discussed by Marcia Castro of the Harvard School of Public Health. She looked at the prevention of malaria in pregnancy with a multi-level modeling approach. She also addressed barriers to IPTp uptake spatially (geographic mapping), and considered three levels:

    • Woman:
    • Considered education,
    • bednet ownership and income
    • Facility:
    • Considered access, quality and characteristics
    • Cost is largely not an issue but distance and waiting time are
    • Fewer women per health facility means more uptake
    • She discussed the fact that measurement of quality remains poor—as we don’t understand various perceptions of quality
  • District:
    • Considered the proportion of district area covered by roads, and
    • ANC facilities per 1000 women of childbearing age in district

    dscn1704sm.jpgMarcia pointed out that there is more to the story than access; roads do not equal access but lack of roads could serve as a proxy for isolation. She discussed the process of tracking pregnant women that can be used for planning and supply chain management.

    Intermittent Screening Treatment (IST) offers a promising intervention in low transmission countries as well as high burden countries as they move closer to elimination (Consider the vivax context). In areas where IPTp may be abandoned due to low/decreasing risk and replaced with active case management, screening with RDT is likely to identify most infections in pregnant women

    Ultimately we need to give greater importance of bridging the gap between ANC attendance and actually receiving IPTp.

    Ib Christian Bygbjerg of the University of Copenhagen presented “Malaria in Pregnancy: Threats, opportunities, and new technologies.” He addressed both eHealth and mHealth.

    ehealth is many things including electronic health records, telemedicine, consumer health informatics, knowledge management, and mhealth. WHO Bulletin had a whole issue on eHealth in May 2012, showing the growing importance of technology.

    There is an obvious opportunity for mHealth because phone connections have more than tripled in past 10 years globally. An example of a program is ‘wired mothers’ —good results for maternal health generally, but can it work for malaria in pregnancy?

    Cell phones raise Ethical questions. They were designed for communication, not health. Who picks up the phone? Who reads the text message? Who owns your data?

    mhealth is an under-used and under-researched tool. Ib said his group found no results from pubmed for “malaria” and “mhealth”. More operations research needed!

    Ib Shared an smartphone app on emergency management of post partum hemorrhage—and asked what would an app for management of MIP look like? Would it be useful?

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