Challenges of Addressing Malaria in Pregnancy through Antenatal Care Services: A Nigerian perspective

Against a backdrop of fragile health systems in Nigeria (and elsewhere), there are currently critical facility-level challenges when trying to address malaria in pregnancy. While the platform of antenatal care may seem ideal—especially in high burden, malaria-endemic countries—increasing coverage will rely on improved quality of and access to focused antenatal care (FANC), which is currently an under-resourced and over-burdened service. It is worth taking a closer look, however, at how FANC might be improved. We know that clinical outcomes of malaria prophylaxis with intermittent preventive treatment in pregnancy and sulfadoxine pyremethamine are correlated with less malaria parasitemia, higher hemoglobin levels, a decline in placental infection, and fewer low birth weight babies. In Nigeria, clinical providers are trained in medical or nursing school to understand the significant benefits of malaria prophylaxis for pregnant women. Yet, when antenatal care services are limited to a few hours a day or a few days a week, clients often do not get the care they need. The quality of that interaction may be low for any number of reasons. While this interaction might be a perfect time for patient education and counseling, realistically, that might not happen. In considering how to train providers to address malaria in pregnancy at the facility level, the global health community must rethink how many interventions (and which interventions) the antenatal care platform can effectively absorb and deliver, and how stronger linkages between the facility and the community might be nurtured to better manage this critical issue.