Preventing malaria in pregnancy by health promotion and intermittent preventive treatment: A community-based intervention in rural Burkina Faso
Preventing malaria in pregnancy is a public health priority ail over sub-Saharan Africa, where every year about 25 million pregnant women are at risk of Plasmodium falciparum infection. Main consequences of malaria in pregnancy are maternal anaemia and low birth weight. Women are particularly vulnerable to the adverse effects of malaria during their first and second pregnancies. Currently, strategies to control malaria in pregnancy rely on the use of insecticide treated bed nets, case management of clinical illness and intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP), the latter having replaced chemoprophylaxis with weekly chloroquine (CQ).
The present study was carried out between 2003 and 2006 in rural Burkina Faso and evaluated the community effectiveness of IPTp-SP when introduced through antenatal clinics at public health facilities. A health promotion campaign specifically targeting pregnant women was conceived in order to overcome a major limitation of IPTp-SP programmes, i.e. the insufficient coverage with the required number of SP doses. Primary outcome measures were peripheral and placental parasitaemia, maternal anaemia and birth weight, secondary outcomes antenatal clinic attendance and IPTp-SP uptake.
Two thousand seven hundred and sixty six primi- and secundigravidae were enrolled into the study. In villages where IPTp-SP was introduced, pregnant women had a lower risk of peripheral and placental infections compared to those receiving CQ chemoprophylaxis while the effect on anaemia and low birth weight was only marginal. The health promotion campaign increased attendance to the antenatal clinics and resulted in a higher uptake of IPTp-SP. However, this did not translate in better parasitological and clinical outcomes. IPTp-SP uptake was lower in adolescent mothers and during the high malaria transmission season, two factors that may have diluted the overall community effectiveness of the intervention.
Pregnant adolescents are both biologically and socially vulnerable for malaria. Our results highlight the importance of identifying such high risk groups and of developing specific approaches to make effective interventions accessible to them.
0573: Public health