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Framework programme: 5
Project number:
EC contribution: € 859 930
Duration: 36 months
Type: RS
Starting date: 1 February 2002
Graphic element New Approaches to Improve Coverage and Compliance of Antimalarial Treatment for Pregnant Women in Rural Africa


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 groups.


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.


Umberto D’Alessandro
Prince Leopold Institute of Tropical Medicine – Parasitology
2000 Antwerp
Tel: +32 3 247 6354
Fax: +32 3 247 6309


Official Address Other Information
2Sheick Oumar CoulibalyLaboratoire National de Sante Publique, Laboratoire de Parasitologie
09 BP 24, Ouagadougou
Burkina Faso
Tel: +226 373 131/ 373 232
Fax: +226 372 430
3Bernard BrabinLiverpool School of Tropical Medicine
Pembroke Place
UK-L3 5QA Liverpool
United Kingdom
Tel: +44 151 705 3207
Fax: +44 151 708 8733
4Peter KazembeLilongwe Central Hospital
PO Box 149
Tel: +265 721 018
Fax: +265 756380

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