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