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Protecting Pregnant Women in Côte d’Ivoire from Malaria

A warm, energetic hum seems to follow Amichia Solange as she goes about her day providing guidance, listening to heartbeats, administering medication with clean water, transitioning from one patient to the next, and sharing goodbye hugs as women head out the door.

At Mouyassue Rural Health Center in Côte d’Ivoire, Amichia is one half of the indispensable duo that provides medical care to women throughout all stages of pregnancy. Amichia and her colleague, the two midwives at the health center, together see more than 400 pregnant women a year.

What these pregnant women learn from Amichia, if they don’t already know, is that malaria infection in pregnancy is a major threat to their lives and the health of their babies.

Pregnant women are particularly vulnerable to malaria when they become infected because pregnancy reduces a woman’s immunity, increasing the risk of illness, severe anemia, and death. For the fetus, maternal malaria increases the risk of miscarriage, stillbirth, premature delivery, and low birth weight—a leading cause of child mortality. Last year, an estimated 11 million pregnant women in sub-Saharan Africa—29% of all pregnancies—were infected with malaria.

This reality is hugely consequential for women in Côte d’Ivoire because every single person in the country—a population of about 24 million people—is at risk of malaria throughout the entire year, with spikes of malaria transmission during the rainy season.

Fortunately, there are proven ways to protect pregnant women from malaria. One of Amichia’s patients, Boni Awa, learned of her heightened risk several years ago when she was pregnant with her first child. Now a mother of three, Boni gave birth to a healthy baby a month ago after attending routine antenatal (ANC) visits where she received preventive malaria care that helped keep her malaria-free throughout her pregnancy.

At Mouyassue Rural Health Center in Côte d’Ivoire, Boni Awa discusses her pregnancy with midwife Amichia Solange after taking medication to prevent malaria. Credit: Mwangi Kirubi, PMI Impact Malaria

Boni prevented malaria during pregnancy by sleeping under an insecticide-treated bed net (ITN) every single night and taking antimalaria pills during three ANC visits with Amichia. The pills are part of a full therapeutic course, known as intermittent preventive treatment of malaria in pregnancy (IPTp), that is given to pregnant women at routine ANC visits, regardless of whether the woman is infected with malaria.

The World Health Organization (WHO) recommends IPTp in areas with moderate to high malaria transmission in Africa. In line with these recommendations, Côte d’Ivoire’s national guidelines state that all pregnant women should receive at least three doses of preventive treatment during pregnancy, with each dose given at least one month apart.

Through funds from PMI Impact Malaria, Boni received IPTp and an ITN for free.

When asked about her observations of preventing malaria in pregnancy among her patients, Amichia’s response is forthright. “I’ve noticed a decrease in malaria among women who adhere to my advice: those who come for monthly visits during pregnancy, take the malaria prevention pills, and use ITNs at home. My main challenge is getting women to come to the health center early in their pregnancies.”

In Côte d’Ivoire, midwife Amichia Solange provides guidance to Boni Awa on the importance of using an insecticide-treated bed net to prevent malaria in pregnancy. Credit: Mwangi Kirubi, PMI Impact Malaria

In 2018, 54% of pregnant women at Mouyassue Rural Health Center received three or more IPTp doses during pregnancy. This year, in an effort to reach more pregnant women, the health center is doubling down on guidance and counseling that emphasizes the importance of on-time IPTp. During Boni’s most recent visit, for example, Amichia pointed out that Boni can play a key role in educating her female friends and relatives about the importance of this intervention.

To continue building capacity in providing malaria services, Amichia recently attended a PMI Impact Malaria-supported training for health providers run by Côte d’Ivoire’s national malaria control program. During this training, Amichia and her fellow participants were reminded of the need to give all eligible pregnant women IPTp during ANC visits, and also guided on steps to follow if the stock of medication is low or unavailable.

Among 36 African countries that reported on IPTp coverage levels in 2018, an estimated 31% of eligible pregnant women received the recommended three or more doses of IPTp, compared with 22% in 2017 and 2% in 2010, indicating considerable improvement in country uptake of this intervention.

Boni Awa waits for her antenatal care visit at Mouyassue Rural Health Center in Côte d’Ivoire. Credit: Mwangi Kirubi, PMI Impact Malaria

With continued support, clear guidelines in countries, strong training and mentoring of health providers, and the antimalaria drugs available at health facilities, more pregnant women like Boni will be reached each year with this lifesaving intervention.

Sources: WHO World Malaria Report 2019, PMI, and PMI Impact Malaria

Header Photo Caption: Midwife Amichia Solange and her patient Boni Awa smile together outside Mouyassue Rural Health Center in Côte d’Ivoire. Credit: Mwangi Kirubi, PMI Impact Malaria

Written by Anne Bulchis, PMI Impact Malaria Communications Manager, and Kathryn Malhotra and Jacques N'dri Kouakou, PMI Impact Malaria Technical Advisors

A version of this story appeared as a blog post on USAID's Medium channel.

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 UCSF.

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