Malaria during pregnancy is a major public health problem in endemic countries.
The administration of an effective antimalarial drug during pregnancy has a
beneficial effect on the mother and child's health. However, few African
countries have implemented programmes that have achieved good coverage and
little attention has been given to this problem. This project proposes to
evaluate two different approaches for the delivery of antimalarial intermittent
treatment to pregnant women: one based on a campaign promoting the use of
sulfadoxine-pyrimethamine (SP) distributed through existing health services, and
the other on a village-based SP distribution system employing peer educators
from an adolescent girls' literacy programme. Advantages and disadvantages of
the two approaches will be compared and their applications in different settings
evaluated. Results generated by this study will be applicable to a large range
of situations in Africa.
The aim is to explore innovative approaches to deliver antimalarial
intermittent treatment to pregnant women in developing countries in order to
increase coverage and compliance, and prevent the malaria negative effects.
These approaches are based either on the promotion of intermittent treatment
through existing health services or through a village-based distribution system.
The specific objectives are:
1) to develop a promotional campaign for the use of intermittent antimalarial
treatment during pregnancy through the health services
2) to evaluate the impact of intermittent antimalarial treatment when
supported by a campaign promoting its use
3) to evaluate the impact of a village-based distribution system of
intermittent treatment for pregnant women based on peer educators from an
adolescent girls literacy programme.
The study will be carried out in Burkina Faso and Malawi where different
strategies to increase coverage of antimalarial intermittent treatment in
pregnant women will be tested. In Burkina Faso, health centres serving a
population of about 70 000 people will be randomly divided into three groups.
For two of these, health staff will be trained for providing
sulfadoxine-pyrimethamine (SP) as an intermittent treatment to pregnant women
attending antenatal clinics. In addition, in one of these groups a campaign
promoting the use of intermittent treatment and antenatal attendance in the
health centre's catchment area will be implemented. Such a campaign will be
based on the results of knowledge, attitudes and practice studies previously
carried out. The third group will be taken as the control and no intervention
will be implemented except for the current provision of CQ weekly
chemoprophylaxis to pregnant women. Effectiveness will be measured by comparing
parasitaemia, PCV, birth weight and compliance to intermittent treatment in
primi- and secundigravidae between the three groups. In addition, yearly
cross-sectional surveys on a sample of all gravidae II or III trimester of
pregnancy will be carried out. In Malawi, 40 villages having taken part in the
adolescent girls' literacy programme (AGLIT) will be randomised into two groups:
in one group a village-based SP distribution system will be set up while the
other group will be taken as the control. In the intervention villages, the
local peer educator will be responsible for SP distribution to pregnant women.
Effectiveness will be measured at delivery by comparing parasitaemia, PCV, birth
weight and compliance to intermittent treatment in all gravidae between the two
In Burkina Faso, KAP surveys and census carried out by June 2003,
finalisation promotion campaign by December 2003 and its implementation from the
beginning of 2004 onwards. Follow-up of pregnant women from September 2003 until
June 2006, cross-sectional surveys end 2003, 2004 and 2005.
In Malawi, village-based system operational by June 2003, follow-up done on
pregnant women from July 2003 until December 2005.
Both final reports and publications by June 2006.
Prince Leopold Institute of Tropical Medicine – Parasitology
Tel: +32 3 247 6354
Fax: +32 3 247 6309
|2||Sheick Oumar Coulibaly||Laboratoire National de Sante Publique, Laboratoire de Parasitologie|
09 BP 24, Ouagadougou
|Tel: +226 373 131/ 373 232|
Fax: +226 372 430
|3||Bernard Brabin||Liverpool School of Tropical Medicine|
UK-L3 5QA Liverpool
|Tel: +44 151 705 3207|
Fax: +44 151 708 8733
|4||Peter Kazembe||Lilongwe Central Hospital|
PO Box 149
|Tel: +265 721 018|
Fax: +265 756380