MCH Program Spotlight
A few steps forward on a long, winding road: Jhpiego's work in malaria in pregnancy in Nigeria
Each year, thirty million pregnancies are
threatened by malaria in endemic countries
throughout Africa. Of these, one of the hardest hit is Nigeria, where the disease accounts for 11%
of maternal mortality, and 12–30% of mortality in children under five years of age.
Despite the tragedy and economic loss reflected by these percentages, the majority
of pregnant women in Nigeria do not have access to the simple technologies that exist to prevent
and control malaria in pregnancy (MIP), including: insecticide-treated bednets (ITNs), which work by forming a
protective barrier between mosquitoes and women while they sleep; and intermittent preventive
treatment (IPT), the drug regimen recommended for protecting women and their unborn babies from
the effects of malaria.
One reason is that such interventions have only recently been adopted
into Nigeria’s national policy. Another reason is that there is low overall utilization of
antenatal care (ANC) services among Nigerian women compared to women in other African countries,
and ANC is often regarded as the ideal opportunity for provision of MIP interventions.
How do we ensure that MIP services are included in existing ANC programs, and
also made available to hard-to-reach women, like so many in Nigeria? Jhpiego has been working
to answer these and other important MIP-related questions for over six years in a total of 24
countries, and is currently building capacity in ANC facilities worldwide.
Through these diverse
experiences—and as a MIP leader in the World Health Organization's
Roll Back Malaria (RBM)
initiative, and one of four partner organizations in the U.S. Agency for International
Development's
Malaria Action Coalition (MAC)—Jhpiego has emerged as a leader in the area of
human capacity development around MIP.
Even with such experience and expertise, however, getting effective MIP
programming off the ground is very challenging, largely because of limited funding or funding
that targets only part of the problem—according to Dr. William Brieger, Jhpiego’s Senior
Malaria Specialist. "Our work in Nigeria perfectly exemplifies the kind of process and
commitment needed," Dr. Brieger continues; "You can’t just zoom in, fix the problem and
zoom back out again."
Jhpiego began working in MIP in Nigeria in 2003, as part of the MAC. MAC
was called upon by USAID/Nigeria to provide technical assistance in support of the country's
existing efforts around malaria. After conducting a situational analysis, MAC assisted
the National Malaria Control Program of the Federal Ministry of Health, RBM partners and
other key stakeholders in developing new MIP policies and guidelines.
Jhpiego played a
leading role—per its areas of organizational expertise—in roll-out activities aimed at
garnering buy-in among, and educating, service providers. These activities included
developing an orientation package, producing a complete curriculum and training package
(adapted from Jhpiego’s
global malaria package), and conducting workshops and trainings.
The new policies and guidelines were adopted by the government of Nigeria in 2005, and
Jhpiego conducted an additional follow-up training in early 2006.
Earlier this year, Jhpiego conducted a rapid assessment for ExxonMobil—as
part of its
Africa Health Initiative—of the MIP situation in Nigeria, Angola, Cameroon,
Chad and Equatorial Guinea. The purpose of this activity was to identify a country-specific
"roadmap" of future actions—in key areas such as policy, commodities, training, supervision
and community awareness of MIP—for the advancement of effective MIP programming. The
Nigerian assessment focused on Akwa Ibom State in the southeast, which is not only
ExxonMobil's "main footprint" in Nigeria, but is at the same time one of the most highly
malaria-endemic areas of the country.
The assessment revealed two major cross-cutting themes in the countries'
MIP situations. First, most of the countries, like Nigeria, have MIP policies and guidelines,
but they are not being disseminated. Second, even in those countries with high-quality ANC
services that are well utilized, ANC is not reaching enough pregnant women early enough in
pregnancy so that they can benefit fully from the protection of ITNs and IPT.
But there were also very important differences revealed among the countries.
As Dr. Brieger explains, "Although the goal is the same—the prevention and control of
malaria in pregnancy—the 'roadmap' is not the same for different countries because each
is starting from a different place."
In Nigeria, the assessment revealed especially low
availability and uptake of ANC services, and the lack of MIP services in existing ANC
programs. It also showed that community members were very aware of the problems malaria
can cause in pregnant women, and that they would be supportive of MIP services. "And this
points to an area of potential opportunity at the community level,” says Dr. Brieger.
Next steps under consideration for Nigeria, based in part on the ExxonMobil
assessment, include using Jhpiego’s Standards-Based Management and Recognition
approach to
strengthen ANC training, and developing a community-based intervention to get MIP services
to hard-to-reach women and link them with ANC services. "The ExxonMobil assessment enabled
us to continue important work in the area of MIP in Nigeria, to take important steps in
what is certain to be a long journey," Dr. Brieger explains.
As part of MAC, for example,
Jhpiego/ACCESS will soon be providing technical assistance to Nigeria's Malaria Global
Fund Grant principal recipient (Yakubu Gowon Foundation) and sub-recipient (National
Malaria Control Program) to improve planning for and delivery of MIP services. "Our work
in Nigeria," says Dr. Brieger, "will help us to establish practical approaches suited for
low-resource settings, which will contribute significantly to the global pool of
knowledge in MIP."
More Information
For more information about Jhpiego's work in malaria in
pregnancy,
contact us.
For more information about Jhpiego's activities in Nigeria, contact
the Jhpiego/Nigeria Office.
To read other spotlights, go to Program Spotlights.
For additional resources on maternal and child health, browse
our Information Sheets
and/or go to the MCH section of our
Publications Catalog.
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