Tuesday, 21 June 2011

MALARIA: The changing face of malaria in maternal health

Bill Brieger : 18 Jun 2011
Jhpiego organized a panel attended by over 80 people at the just concluded Global Health Council annual conference entitled, “The changing face of malaria in maternal health,” moderated by Bill Brieger and coordinated by Aimee Dickerson. The overlap between high malaria prevalence and high maternal mortality in Africa was stressed. Although both are generally decreasing, the pace of change is quite slow for meeting Millennium Development Goals and malaria elimination targets. The time of neglecting malaria in pregnancy (MIP) should be over.

malaria-risk-maternal-mortality-sm.jpgAs efforts increase toward malaria elimination and the epidemiology of malaria changes, we need to be prepared at the country and global levels. This was illustrated through four presentations that focused on …
Nigeria, a high burden country, needs to consider ways to scale up
Rwanda, a country closing in on elimination, needs to more carefully define and target MIP transmission
New interventions developed through research and Rolling out these new interventions through donor support Enobong Ndekhedehe of Community Partners for Development based in Akwa Ibom State Nigeria spoke on community involvement to increase IPTp & ITN coverage in a highly endemic area. This joint project with Jhpiego, sponsored by the ExxonMobil Foundation, showed successfully that community volunteers supported by front-line antenatal clinic staff could greatly increase uptake of intermittent preventive treatment and thus provided a model for scale up in a high burden country.
Corine Karema who heads the National Malaria Control Program in the Rwanda Ministry of Health, addressed the feasibility of determining the prevalence of MIP during ANC in an era of declining incidence. Intense distribution of long lasting insecticide treated nets and wide availability of artemisinin-based combination therapy for malaria treatment at the community level have resulted in a 70% decline in malaria incidence between 2005 & 2010. Good ANC coverage and availability of staff to test pregnant women on their first ANC visit were found to bode well for providing not only an opportunity for pregnancy-specific prevalence determination, but also an opportunity for future interventions based on routing screening and treatment.
Theonest Mutabingwa from the Hubert Kairuki Memorial University, Tanzania talked on “The future MIP research agenda in the context of malaria elimination,” based on the plans and experiences of the Malaria in Pregnancy Consortium (MIPc), of which he is a member. MIPc teams from African and northern research institutes are looking into such issues as the changing role of prevention (e.g. IPTp vs screening and treatment), When is it optimal to change interventions (use of modelling), what are the changing patterns of disease epidemiology and immunity in pregnant women, what are the criteria or thresholds upon which to switch control strategies, what should constitute guidelines to define high/moderate, low and very low transmission settings, among others.
Finally Jon Eric Tongren of the US President’s Malaria Initiative (PMI) provided a donor’s perspective on MIP programming in countries with changing malaria epidemiology. This presentation showed that even with input from multiple donors, MIP intervention targets for IPT and LLIN use are well below the RBM 2010 goal of 80% and the PMI goal of 85% despite demonstrated increases in coverage of both services. Even though effective MIP interventions exist, they need to be strengthened through well-executed assessments, collaborative implementation, and careful follow-up, monitoring, and evaluation. Echoing the research agenda expressed before, the presenter stressed the need for continued surveillance to map progress and change in prevalence and adaptation of MIP strategies as prevalence changes.
MIP control faces a double challenge. Since this component of national malaria control programs has often been neglected, there is a need to catch up and achieve 2010 coverage targets. Then moving forward, strengthened monitoring and surveillance is needed to fine tune, revise and better target MIP interventions to make a bigger impact on reducing maternal mortality in endemic countries.

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