More women are receiving preventive medicine for malaria during pregnancy in Africa
In the busy corridors of a Yaoundé hospital, Esther Sabouangis is attending an antenatal appointment. She is in her early thirties and expecting her third child.
"I am sleeping under an insecticide-treated net and have taken the medication against malaria every time. I never had any fever during pregnancy – and I never got sick. I am very happy about this – for my baby and for myself."
Esther is fortunate enough to live in a major city in Cameroon where communication about the risks of malaria in pregnancy is good. Her government antenatal clinic offers the 3 or more doses of medicine that WHO recommends to protect mothers and unborn children from the devastating impact of malaria infection. Even better, the medicine is available for free.
"This preventive therapy – known as intermittent preventive treatment in pregnancy, or IPTp – was introduced in Cameroon about 11 years ago, but then the uptake was terribly slow," said Professor Philip Nana Njotang, Esther’s attending physician. "It's a life-saving malaria preventive therapy and adding it to the existing antenatal care package, together with insecticide treated nets, seemed like an obvious and simple way to get it to expectant mothers."
Approximately 52 million women living in sub-Saharan Africa become pregnant each year and are at risk of exposure to Plasmodium falciparum, the deadliest malaria parasite, and the most prevalent on the African continent. IPTp can prevent maternal and infant death, anaemia and the other adverse effects of malaria in pregnancy.
IPTp is recommended by WHO for all pregnant women living in areas of stable malaria transmission in Africa. Doses should be given at routine antenatal care visits starting as early as possible in the second trimester.
WHO has been tracking implementation of its recommendations for malaria prevention in pregnant women. The 2016 World malaria report showed important progress: nearly 1 in 3 eligible pregnant women received the recommended 3 or more doses of IPTp in 20 countries in sub-Saharan Africa.
However, an estimated 69% of pregnant women are still not receiving the recommended number of IPTp doses. This year, on World Malaria Day, WHO is calling on all malaria-endemic countries in Africa, and their development partners, to urgently close the gap in access to IPTp and other critical malaria prevention tools.
"Today, in Yaoundé, I believe about 80% of our pregnant women can have access to all 3 doses of this medication. But in the periphery, in the rural areas – it's a different story," said Prof Nana.
In rural areas, health services are more sparse and women frequently have less information. Even if they are aware of the benefits of IPTp, they often can only obtain it at private pharmacies, which can be cost prohibitive.
"Our national health system across the 10 regions of Cameroon is currently not robust enough to serve our population with this type of routine care. If our professional societies, such as the Society of Paediatricians and Society of Obstetricians, for example, could help to implement these recommendations, it would strengthen the capacity and promote such services and we would be in far better shape," suggested Professor Nana.
Esther is indeed one of the lucky mothers. She has enjoyed three healthy malaria-free pregnancies and is looking forward to the birth of her third child.