Population Council Research that makes a difference

In the most malaria-endemic areas of Africa, women in their first and second pregnancies have the highest risk of acquiring malaria and, consequently, of malaria-associated anemia and low birthweight. Two USAID-funded interventions aimed at strengthening efforts to prevent and manage malaria in pregnancy were pilot-tested at the district levels in Kenya (1998–2002) and Malawi (1998–2004).

The goal of the projects was to reduce malaria illness and death among children and mothers primarily by: (1) providing intermittent presumptive treatment (IPT) of sulfadoxide-pyrimethamine (SP) to pregnant women visiting antenatal clinics, and (2) promoting the use of insecticide-treated bed nets by pregnant women through price subsidization, aggressive promotion, and wide distribution.

In 2005 and 2006, the Council’s FRONTIERS program conducted case studies to assess the sustainability of these initiatives, documented best practices for promoting their scale-up, and drew lessons for replication in other East and Southern African countries where malaria is endemic.

Findings demonstrated sustainability in pilot districts. Inventories show that most of the facilities surveyed (37 of 45 in Kenya and 26 of 29 in Malawi) were still offering malaria in pregnancy service two or more years after the pilot projects ended. The proportion of women sleeping under bed nets increased significantly by the time the evaluation study began (in Kenya from 3% to 58%, and in Malawi 81% of facilities provided nets).

In both countries, the programs have been scaled up, and IPT has been adopted as national policy. In Kenya, SP is now available over-the-counter, and bed nets are available at subsidized prices to facilitate access to them. In Malawi, national surveys show that a large proportion of women receiving antenatal care (90% of pregnant women) received first and second doses of SP in 2004, and use of bed nets by pregnant women doubled between 2004 and 2006.

National political commitment to a specific goal and to an evidence-based approach was essential to the success of both of these programs, which elicited high levels of support from development partners. Strong links within ministries of health and with district- and community-level organizations also enhance the potential for program sustainability.