Sparking a national discussion: Using evidence to advocate for malaria in pregnancy interventions

National Malaria in Pregnancy Stakeholders Forum participants in Nairobi. Photo: PATH.

National Malaria in Pregnancy Stakeholders Forum participants in Nairobi. Photo: PATH.

By Wanjiku Manguyu
Family Health Advocacy Officer, PATH Kenya office

Last week, I congratulated my PATH colleagues in Kisumu, Kenya, as they celebrated the close of a pilot project that had positive implications for expectant mothers in their community. As my colleague Dr. Samwel Onditi wrote, the pilot demonstrated that community health workers (CHWs) can successfully bridge the gap between pregnant women and often far-away health facilities, ensuring that mothers can more easily access intermittent preventive treatment of malaria in pregnancy using sulfadoxine-pyrimethamine (IPTp-SP), an antimalarial medicine that is safe for pregnant women.

As an advocate for reproductive and maternal health, however, my work—and the work of my fellow advocates—is just beginning.

In order to share emerging evidence, engage a diverse set of stakeholders, and ultimately spark a national discussion, PATH hosted a National Malaria in Pregnancy Stakeholders Forum in Nairobi this week, which brought together members of the malaria and reproductive, maternal, newborn, and child health communities.

During the day-long meeting, advocates, program implementers, government officials, and technical experts presented and discussed local and regional evidence on effective ways to increase the number of women who are able to access IPTp-SP. We also examined the barriers and challenges to IPTp-SP distribution and—importantly—community-based solutions that could increase coverage and decrease morbidity and mortality rates resulting from malaria in pregnancy.

Throughout the day, we explored the need for an enabling environment where lower-level health care workers—in this case, CHWs—are allowed to take on certain tasks for prevention and treatment of malaria in pregnancy that are often limited to more highly trained health workers. Too often pregnant women attend their first antenatal care visit late in pregnancy and are not able to complete the recommended four antenatal care visits. This affects their ability to receive the recommended dosages of IPTp-SP. However, CWHs are well-known and respected in their communities, and they provide a direct link to the health care system. When policy allows for community distribution of IPTp-SP, data show that CHWs can effectively administer preventive interventions and also encourage women to visit a health clinic for full antenatal care.

As we listened to technical experts who traveled from Uganda, Tanzania, and Nigeria present on their own research related to community-based approaches, it became increasingly apparent that Kenya could be on the cusp of impressive changes to end morbidity and mortality stemming from malaria in pregnancy. We know that, alone, facility-based distribution of IPTp-SP has not allowed us to reach enough pregnant women, and we now have regional evidence to support community-based approaches. By distilling and packaging this research for decision-makers, we aim to turn evidence into policy action.

Moving forward, PATH and partners present at yesterday’s meeting will call on policymakers to support innovative approaches for Malaria in Pregnancy intervention. Working through our communities, Kenya can protect both mother and newborn from malaria.

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