Online Program

Improving case management of malaria during pregnancy by antenatal care providers in akwa ibom state, Nigeria

Monday, November 4, 2013 : 10:30 a.m. - 10:45 a.m.

William R. Brieger, MPH, CHES, DrPH, International Health, Bloomberg School of Public Health, The John Hopkins University, Baltimore, MD
Bright Orji, MPH, Nigeria, Jhpiego, Baltimoe, MD
Emmanuel Otolorin, MBBS, FRCOG, Jhpiego, Nigeria, Jhpiego, Abuja, Nigeria
John Orok, MBBS, Akwa Ibom State Ministry of Health, Uyo, Nigeria
In Nigeria malaria causes approximately 11% of maternal deaths. Malaria is responsible for 63% of hospital admissions and 70% of illness among pregnant women. While intermittent preventive treatment (IPTp) and Long Lasting Insecticide-treated Nets (LLINs) are supposed to be given to pregnant women to prevent the disease, coverage is poor. Unfortunately since malaria is often being treated presumptively, pregnant women still die from other fever-related illnesses. Use of rapid diagnostic test (RDTs) to confirm malaria before treatment provides an opportunity for earlier recognition of febrile illnesses not due to malaria. This study assesses the pattern of malaria diagnosis and treatment in pregnant women attending Antenatal care (ANC) in Akwa Ibom State, Nigeria. Record cards of pregnant women attending six government owned ANC before and after staff training on malaria diagnosis using RDTs. The patients' cards were drawn from ANC clinics with first non-follow-up visit of the year before training (February 2010) and after (March 2011) by three nurses/midwives. Health care providers fever gave 85% of 313 women attending ANC antimalarial drugs before the introduction of RDTs training. Afterwards 82% of 179 febrile women were tested with RDTs. All 29 with positive RDT received artemisinin-based combination therapy, 6 RDT-negative women got ACTs, and no women who were not tested were treated for malaria. Training encouraged health workers to adherence rational prescribing of antimalarials and made it possible to offer better management of other fever-related illnesses during pregnancy. Support is now needed to scale-up RDTs use in ANC clinics in Nigeria.

Learning Areas:

Provision of health care to the public
Public health or related organizational policy, standards, or other guidelines

Learning Objectives:
Differentiate between clinical and parasitological diagnosis of malaria in pregnancy Describe the process of training antenatal care workers on use of malaria rapid diagnostic tests (RDTs) Explain the effect of RDT use on malaria case management in pregnancy

Keyword(s): Maternal Health, Quality of Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a professor in the Department of International Health at The Johns Hopkins Bloomberg School of Public Health and JHPIEGO’s Senior Malaria Specialist. I worked at the African Regional Health Education Center, University of Ibadan, Nigeria, 1976-2002 on numerous research projects on social/behavioral aspects of tropical disease control, with special emphasis training community volunteers, peer educators and medicine vendors. Was co-investigator of the work presented.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.