Interventions to prevent malaria-related morbidity and mortality in pregnancy
RHL practical aspects by Fawole B
The evidence in support of benefit from chemo-prophylaxis in terms of higher mean birth weight, reduced incidence of low-birth-weight infants and reduced incidence of severe antenatal anaemia appears confined to women of low parity. The appropriate choice of drug will be guided by regional resistance patterns.
Use of insecticide-treated nets (ITNs) is associated with higher mean birth weights, reduced incidence of low-birth-weight babies, and peripheral and placental parasitaemia. Women of all parities benefit from some of these effects of ITNs.
Each level has a role in the implementation of these interventions.
FIRST CONTACT (PRIMARY CARE) LEVEL
Mobilize all health-care workers at primary health centres, maternity clinics and outpatient clinics to implement chemo-prophylaxis for women of low parity and distribute ITNs to all pregnant women.
Provide information about the benefits of drug prevention and ITNs for both mother and the newborn; this will help to improve compliance with chemo-prophylaxis.
REFERRAL HOSPITAL (SECONDARY CARE) LEVEL
Provide information about the benefits of drug prevention for both the mother and newborn and ensure that all women of low parity receive the drugs.
Provide information and distribute ITNs to all pregnant women.
AT HOME OR IN THE COMMUNITY
Community mobilization to sensitize the population about the dangers of malaria during pregnancy and the benefits inherent in drug prevention for women of low parity will improve compliance. Women should also be given information on the advantages of early antenatal visits to maximize the advantages of drug prevention.
Increase community awareness about the benefits for the individual pregnant woman, the newborn and the community conferred by ITN use. Promote sustainable mechanisms for distribution of ITNs within the community.
This document should be cited as: Fawole B. Interventions to prevent malaria-related morbidity and mortality in pregnancy: RHL practical aspects (last revised: 23 June 2009). The WHO Reproductive Health Library; Geneva: World Health Organization.