Pilot project brings malaria preventive therapy closer to rural communities in Nigeria

1 April 2019

Each year, more than 50 million pregnant women in Africa are at risk of malaria. Without treatment, malaria in pregnancy can lead to maternal death, anemia and low birth weight – a major cause of infant mortality. Intermittent preventive treatment in pregnancy (IPTp) with the quality-assured medicine sulfadoxine-pyrimethamine (SP) can prevent the development of adverse malaria consequences.

WHO/G. Osodi

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To protect pregnant women in Africa from malaria, WHO recommends a 3-pronged approach: sleeping under insecticide-treated nets, prompt treatment with effective antimalarial medicines following a confirmed diagnosis of the disease, and the administration of 3 or more doses of preventive malaria therapy (ITPp-SP). In countries with a high burden of malaria infection, coverage of IPTp-SP lags noticeably behind the other control measures. Here, a T-shirt promotes 1 of the 3 WHO-endorsed malaria control measures.

WHO/G. Osodi
A Health worker supported by WHO is conducting house calls.

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Launched in 2018, TIPTOP is an innovative project that aims to expand community-based access to preventive malaria therapy for pregnant women living in 4 countries of sub-Saharan Africa. Through the project, supported by WHO and partners, health workers like Mercy Nkiruka Agbo, pictured here, conduct house calls to educate expectant mothers about preventive malaria therapy and the importance of receiving antenatal care. They have been trained to recognize signs and symptoms of malaria, to determine when and how to administer IPTp- SP and to refer women to the nearest antenatal care facility for comprehensive care.

WHO/G. Osodi

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As she makes her rounds in the community, Agbo wears a T-shirt that allows for easy recognition by pregnant women in need of her counsel and services. Agbo takes great pride in her role: she knows everyone in the community she serves and is respected for her volunteer work. She gives confidential advice and is often one of the first to know who is pregnant. Several months pregnant herself, she is leading by example by making all of her recommended antenatal care appointments and taking her SP on schedule.

WHO/G. Osodi

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An expectant mother reports to a health facility in Ebonyi State, Nigeria, to receive a dose of SP and other antenatal care services. Nigeria accounts for 25% of the world’s malaria cases and nearly 1 in 5 malaria-related deaths. It is 1 of 4 countries that the TIPTOP project is supporting, along with the Democratic Republic of the Congo, Madagascar and Mozambique.

WHO/G. Osodi

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Careful record is kept of a woman’s pregnancy. The blue Patient Reference Card lets a woman know when she is due for her next dose of SP and her next antenatal care visit. That card goes home with her. The yellow Maternity Booklet is a more comprehensive document that stays at the health facility and records the entire pregnancy, including a woman’s check-up history and any complications.

WHO/G. Osodi

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According to the 2016 revised WHO guidelines on antenatal care, a woman should have at least 8 contacts with a health care provider during pregnancy. This ward-level supervision through a woman’s pregnancy is a critical supplement to the support provided by the community health worker.

WHO/G. Osodi
A health worker and a pregnant woman standing by the entrance of an antenatal care clinic.

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Often the journey between the community and the antenatal care clinic can be long. Community-based health workers can help encourage pregnant women to make the trip, underscoring the benefits of receiving ongoing supervision to prevent malaria, and ensure a healthy pregnancy and safe delivery.

WHO/G. Osodi

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A pregnant woman receives her dose of SP at the government health facility under the careful eye of a nurse. This is best practice at work: the woman is provided with important information about the medicine she is taking, and the SP is administered under direct observation, using a clean cup filled with fresh drinking water.

WHO/G. Osodi

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Keeping the pharmacy at the Ngbo Maternity Health Facility stocked with quality-assured SP and other medication is critical. The beige stock management card helps track supply levels. For TIPTOP to function optimally – and to build trust and confidence – SP must be available at both facility and community levels at all times. Systems have been established to avoid SP stock-outs, especially at antenatal care clinics where community health workers report monthly to replenish stock, update patient health records and check in.

WHO/G. Osodi
A pregnant woman sitting on a bed at an antenatal care facility.

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WHO does not currently endorse a community-based approach to IPTp; according to WHO guidelines, IPTp should be delivered by trained medical providers at antenatal care facilities. A key aim of the TIPTOP project is to generate evidence from sub-Saharan Africa on a community-based approach to IPTp delivery. This evidence – together with evidence from other similar projects – may guide future WHO policy recommendations on preventing malaria in pregnancy.

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