One of the biggest risks for pregnant women in sub-Saharan Africa is contracting malaria. The disease is responsible for as many as 200,000 newborn babies dying needlessly every year. In sub-Saharan Africa, where malaria is endemic in most countries, severe malaria accounts for approximately 10% of maternal deaths, suggesting that an estimated 10,000 maternal deaths could be prevented each year by improved control of malaria in pregnancy.
It is recommended by the World Health Organization (WHO) that women receive intermittent preventive treatment in pregnancy (IPTp) and are given insecticide treated bednets (ITNs). A systematic review of 98 articles from the Malaria in Pregnancy Consortium Library and the Global Health Database by researchers Jenny Hill and Jenna Hoyt from Liverpool School of Tropical Medicine (LSTM) published in Plos Med has found significant barriers remain affecting delivery, access and use of IPT and ITNs among healthcare providers and women.
ITNs were found to make women feel hot and uncomfortable and were an inconvenience to put up and take down in the home. There was also a belief among some women that the chemicals contained in the nets could be harmful to their unborn child. Cost of the ITNs was also an issue for women who may possess limited resources. As nets often get damaged in the home and if it is not believed they are being effective they are less likely to be replaced. However, at healthcare facilities often the main barrier to uptake was the lack of availability of ITNs.
Jenny Hill, Programme Manager for the Malaria in Pregnancy Consortium (MiP) coordinated by LSTM, highlighted a number of barriers to malaria prevention, including unclear policy and guidance from government ministers and health care officials and, at the clinical level, lack of clean water, drug shortages and confusion about procedures for administering IPT.
“They were unclear on when to give it in terms of gestational age of pregnancy and whether it could be given to women on an empty stomach, whether it should be given under observation in clinics, and so on and so forth," she advised. "So quite a few of those barriers were around lack of clear policy and guidance.”
The authors go on to say: "This analysis provides a comprehensive basis for identifying key bottlenecks in the delivery and uptake of IPTp and ITNs among pregnant women, and for understanding which scale-up interventions have been effective, in order to prioritise which interventions are most likely to have the greatest impact in the short or medium term."
Adding "The review also highlights the need for multi-country studies that evaluate targeted or multifaceted interventions aimed to improve the delivery and uptake of IPTp and ITNs."
This research activity is supported and endorsed by the MiP Consortium, which is funded through a grant from the Bill & Melinda Gates Foundation to the Liverpool School of Tropical Medicine.