Transforming Intermittent Preventive Treatment For Optimal Pregnancy (TIPTOP) Project in Ebonyi State Nigeria

Bright Orji who is the Project Manager for the Jhpiego and UNITAID Transforming Intermittent Preventive Treatment For Optimal Pregnancy (TIPTOP) Project in Nigeria shares remarks that introduce the program in Ebonyi State of Nigeria.

The project will help protect pregnant women from malaria. Malaria is very dangerous to pregnant women and unborn babies. It causes abortion, low birth weight in babies as well as responsible for about 11% (6,050) of maternal deaths of Nigerian women

Jhpiego’s original community IPTp in Akwa Ibom State involved community volunteers in preventing malaria in pregnancy

Building on Jhpiego’s effort to ensure Intermittent preventive treatment in pregnancy (IPTp) reaches all women in the community. Between 2007 and 2010, Jhpiego collaborated with the National Malaria Elimination Program (NMEP), Reproductive Health division of the Federal Ministry of Health and provided technical assistance to the Ministry of Health in Akwa Ibom State to introduce a community directed approach with a focus on malaria in pregnancy with support from the ExxonMobil Foundation. That project reached over 35,000 pregnant women representing an increase in IPTp uptake by 35.3% going from 21.7% at baseline to 57.0% at the endline.

With support coming from Unitaid, Jhpiego and her partners will be implementing Transforming Intermittent Preventive Treatment for optimal pregnancy – shortened to TIPTOP project reach all pregnant women in Ohaukwu, Ebonyi State (South-East), Suleja in Niger State (North Central and Akure south in Ondo State (South West).

Bright Orji and Colleagues review clinic records on malaria in pregnancy

These States were selected on the basis of malaria prevalence rate; national commitment to generate evidence across the six geographical zones; given that similar project has been implemented in Akwa Ibom State representing South-South, and Sokoto state representing North West. Poor status of IPTp interventions in the selected Local government areas; and to further complement our on-going efforts with Maternal and Child Survival Project funded by the United States Agency for International Development (USAID/MCSP); Presidential Malaria Initiatives (PMI), Global Health Funds for Tuberclosis, HIV/AIDs and Malaria.

In this effort, we will work with the National Malaria Elimination Program (NMEP) that is charged with the responsibility of coordinating all malaria prevention and control activities in Nigeria; Reproductive Health Division of the Family health department, Federal Ministry of Health, State Ministries of Health, Local Governments authorities, communities development partners including World Health Organization (WHO); UNICEF, World Bank and other stakeholders (PMI/USAID, AFENTH etc).

To do this, TIPTOP project Nigeria will use a two-pronged approach that will increase the number of pregnant women in the three states who receive key malaria in pregnancy interventions by:

  • Strengthening ANC services in health facilities, ensuring that a strong foundation for MIP services is in place; and
  • Using community directed intervention approach where Community health workers,

Supervised by these strengthened ANC facilities, to initiate MIP interventions at the community level and refer women to the nearest ANC facility

Antenatal Clinics are the base for organizing training and community involvement in delivering Intermittent malaria Preventive Treatment in Pregnancy

Both parts of this approach will also strengthen local capacity in training, supervision, project implementation and evaluation by working with local civil society organizations that have strong ties to the community. As a component of this project, TIPTOP will seek a model for integrating MIP and other prevention services on the platform of ANC. TIPTOP project has planned for operations research that will provide some lessons and evidence and these include:

  • Household surveys to gain understanding how pregnant women think, where they receive services if they are not coming to the health centers, and how we can prove services they receive
  • Anthropological study – that would investigate community acceptability of community IPTp
  • Sulfadoxine-pyrimethamine (SP) resistance monitoring study and
  • Economic study – cost-benefit analysis

We are aware of the challenges ahead, Prof. ‘Dipo Otolorin the former Country Director for Jhpiego and now the Snr. Technical and Programmatic Advisor will always say, “a stick of broom cannot sweep the street, but when you have a bunch of sticks sweeping becomes delightful”. This is an African aphorism for team building.

So, from beginning of the grant application and subsequent development of the approved country operational plan (COP); we have engaged the key stakeholders that work on malaria in Nigeria. This is because we need the collaboration, coordination and cooperation of everyone. We will work together to mobilize all the communities in these three states, conduct community census that will guide us to estimate adequate number of SP doses; enter every kindred, family, household and home of pregnant women. We will identify all the pregnant women, refer them to attend ANC, as well as administer the life-saving medicines to the eligible ones both at facility and community levels. NO PREGNANT WOMAN SHOULD DIE OF MALARIA, BECAUSE IT IS PREVENTABLE, TREATABLE AND WE HAVE EVIDENCE-BASED INTERVENTIONS TO PROTECT THEM.

By the end of the project we would have achieved the goal of increasing the number of women who receive MIP services through strengthened ANC and community-level interventions. TIPTOP project expects additional outcomes from this initiative and these include:

  • Generate evidence for WHO policy change
  • set stage for scale up of community intermittent preventive treatment during pregnancy (IPTp)
  • Increased demand for quality assured sulfadoxine–pyrimethamine (SP) for IPTp and

With this project no pregnant woman should die from malaria. So let us all join hands to stop malaria – and make Nigeria a Malaria free nation!!!

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