Community-Clinic Collaboration to Control Malaria during Pregnancy in Nigeria

Malaria in pregnancy (MIP) not only threatens the health and lives of pregnant women in Africa, it also leads to low birthweight and threatens child survival. Akwa Ibom State in Nigeria not only has year round transmission of malaria but also low utilization of public health services, especially antenatal care, that could prevent MIP. With Support from the ExxonMobil Foundation, JHPIEGO (an affiliate of the Johns Hopkins University) is undertaking a proof of concept intervention to strengthen MIP control services in Akwa Ibom State using a two pronged approach: 1) improving the quality of ANC services and 2) borrowing a leaf from onchocerciasis control activities and enlisting communities to support volunteer community directed distributors (CDDs) for malaria. Formative research in clinics and communities in both intervention and control local government areas revealed low levels of utilization of intermittent preventive treatment and insecticide treated nets by pregnant, and the reasons for these problems. The findings were used for advocacy with state and national stakeholders to leverage malaria commodities and to reach a consensus on community involvement in malaria commodity distribution. A team of core trainers has been developed at the State level. They in turn have trained front line health staff in both quality improvement (e.g. maintaining stocks of essential malaria commodities) as well as outreach to mobilize communities and train over 100 CDDs. Community and clinic monitoring results for the first year of intervention address both achievements and challenges of this approach.