As the sun breaks over the horizon in West Africa, Manzidatou Alao wakes up to pray. She enjoys the solitude with her spouse before their 10-year-old son and 9-month-old daughter start stirring. The breakfast porridge is heating up over a crackling fire. Within the hour she takes care of her family and then is out the door, taking her son to school and heading into the office to begin her work day.
Manzi, as she is known to many, lives in southern Benin. In March 2020, Manzi joined PMI Impact Malaria, the flagship malaria service delivery project of the U.S. President’s Malaria Initiative (PMI). She is a program officer supporting a study that measures the impact of peer groups for pregnant women. These groups, known as group antenatal care (G-ANC), or “pregnancy circles” by the participating women, are designed to provide all routine pregnancy services and monitor adherence to intermittent preventive treatment of malaria during pregnancy (IPTp). IPTp, a public health intervention aimed at preventing malaria in pregnant women, is a series of antimalarial medicine provided to women at routine visits to keep them safe from malaria infection during their pregnancy.
Manzidatou Alao, Program Officer, U.S. President's Malaria Initiative (PMI), PMI Impact Malaria Benin
Pregnant women are particularly at risk from malaria as their immunity against the disease declines during pregnancy, increasing the risk of anemia, severe illness, and death. For the unborn child, maternal malaria can cause premature delivery, low birth weight, and death. In areas like Benin that are malaria endemic or have moderate to high transmission of the malaria parasite, the World Health Organization (WHO) recommends a three-part package of interventions for preventing and controlling malaria and its effects during pregnancy, including administration of IPTp. While well over 90% of Beninese women receive some antenatal care, few attend the recommended eight routine visits and only around 20% take the recommended number of doses of IPTp.
Manzi can relate first-hand to the demands on moms-to-be to care for themselves during pregnancy while juggling the care of their families and livelihoods. While working with PMI Impact Malaria, Manzi gave birth to her second child. Throughout her pregnancy, she continued to "support the participating health facilities in the implementation of the [group antenatal care] model through the training of providers and monitoring of activities” to ensure the quality of the meetings. Manzi adds, “[I] always shared my personal experience and advice during the group meetings, including my delivery plan.” She felt it was important to "set the best example and help members of [her] community have access to the right information on malaria prevention and a healthy pregnancy.”
Manzi also shares that “the rural women are mostly shy and do not speak in groups.” Providing a space where pregnant women feel safe and respected is important to their participation in antenatal groups, which are beneficial to encouraging them to adhere to routine visits and to seek the appropriate care throughout their pregnancy. Over time, they “gain confidence and actively participate in meetings... they are very enthusiastic and they share their experiences and support each other.” She noticed “[the women in the pregnancy circles] are more assured when they listen to personal testimony among the group.”
Photo: Manzidatou Alao (right) with a group of pregnant women and one of the midwives after a group antenatal care (G-ANC), or "pregnancy circle," meeting (CS Tangbo-Djevie). Photo credit: PMI Impact Malaria Benin
While the study in Benin is ongoing, feedback thus far suggests that women feel greater social support from other women in their pregnancy circle by participating in group antenatal care. They are proud to take charge of their own health, such as weighing themselves and taking each other’s blood pressure. The PMI Impact Malaria Benin G-ANC study hopes to determine whether this sentiment makes women more likely to return for additional antenatal care and whether pregnant women are more likely to take the required doses of IPTp medicine to prevent malaria.
When asked what she enjoys most about her job, Manzi shared, “It's a great responsibility to know that other women can be inspired by me...to learn and adopt healthy behaviors in the fight against malaria. I have the opportunity to strengthen the guidelines of the WHO and the Ministry of Health of Benin in terms of control of malaria in pregnant women. I am delighted to participate in the well-being of pregnant women and babies in my country. As much as I have shared my experiences with other women, I learn even more from them.”
PMI Impact Malaria works with national malaria control programs in 11 countries to strengthen and expand malaria in pregnancy (MIP) preventive activities through a partnership between national malaria control, reproductive health, and maternal and child health programs. As part of this collaboration, PMI Impact Malaria supports country MIP programs from the central level to health service delivery points.
Header photo: A women's group in Benin sings a song about malaria. Photo credit: Nathaly Herrel/PMI
PMI Impact Malaria is funded and technically assisted by the U.S. President's Malaria Initiative (PMI) and is led by Population Services International (PSI) in partnership with Jhpiego, Medical Care Development International (MCDI), and the Malaria Elimination Institute (MEI) at UCSF.