Funding & Malaria in Pregnancy & Health Systems & Integration Bill Brieger | 19 Jun 2010
Buy Cialis Online Cheap
As we get very close to achieving the Roll Back Malaria Buy cialis online cheap, Partnership's 80% target for 2010 in prevention and treatment coverage, there is a tendency to worry when people talk of shifting funding priorities. The HIV community is particularly worried that funding for treatment and control may become stagnant or even decrease, cheap cialis pills. Cheap cialis online without prescription, As AFP reported from Johannesburg, "Thousands of protesters marched Thursday against what they say is a softening commitment to fighting AIDS in Africa by the United States and other developed countries."
Government donors are by and far the biggest contributors to global disease control efforts, order cialis c.o.d., Comprare cialis, but foundations and corporations can set trends and attract attention and thus influence priorities. For example, Koop korting cialis, Jotta cialis verkossa, Melinda Gates, speaking at the recent Women Deliver Conference in Washington addressed the issue of maternal and child health:
We are nurturing a vision that is changing the world, cheap cialis no rx. Cialis without prescription, Donors will spend more on women and children, and those donations will be tracked, Osta cialis online. Developing countries will pass rigorous policies for women's and children's health, and fully fund their implementation, and health workers will have the tools and training they need.
Rahim Kanani, reporting on Melinda's talk, concluded that, "With global leaders convening next week in Canada for the G8 and G20 Summits, maternal and child health is now a top international priority." And quoted Melinda thus: "The whole world will be looking to us for leadership, buy cialis online cheap. Order cialis cod, We need to be ready with a single plan."
These thoughts are certainly in sync with the current US administrations Global Health Initiative, which seeks an integrated approach to health care, Alabama AL Ala. . Order cialis overnight delivery, GHI will "help partner countries improve health outcomes through strengthened health systems - with a particular focus on improving the health of women, newborns and children through programs including infectious disease, buy generic cialis, Buy cialis online, nutrition, maternal and child health, ordering cialis online cheap, Arizona AZ Ariz. , and safe water."
Malaria definitely needs to be part of the integrated mix of maternal and child health (MCH) services. Pregnant women are more vulnerable to malaria; even mosquitoes are more attracted to them, Louisiana LA . Billige cialis Apotheke, Malaria leads to maternal anemia and death as well as intrauterine growth retardation leading to low birth weight babies, who have a poor chance of survival, köpa billiga cialis. Research is finding more about possible links between malaria and pre-eclampsia and postpartum hemorrhage Buy cialis online cheap, . Where to buy cialis, There ultimately should be no reason to fear a loss of malaria funding given the strong advocacy initiatives built by RBM partners. Even more, acheter cialis discount, Cialis pedido en línea, efforts of the integrated approach to strengthen health systems will benefit malaria control and elimination, which requires a strong health system, Wyoming WY Wyo. . Order cialis online, And in closing we are reminded that the wealthy people behind foundation and corporate giving can be advocates themselves. As NPR reported, "Microsoft Corp, buy cialis online cheap. co-founder Bill Gates and billionaire investor Warren Buffett are launching a campaign to get other American billionaires to give at least half their wealth to charity." We trust that malaria control within an integrated MCH program will remain part of this charitable urge..
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Malaria in Pregnancy & Equity Bill Brieger | 07 Mar 2010
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For 99 years International Women's Day Buy soma no prescription, (8 March) has been "a global day celebrating the economic, political and social achievements of women past, present and future." According to the UN Special Envoy for Malaria, Ray Chambers ...
The disease strikes infants, children under five and pregnant women in astonishing disproportion, as these segments of the population account for 90 percent of malaria deaths. Given the dual role of women as both victim and primary protector of victims, Montana MT Mont. , Ordering soma no prescription, malaria clearly belongs under the umbrella of traditional women's health issues.
The protective role of women in the fight against malaria extends beyond the household. In endemic most countries the majority of front line health workers who treat malaria patients and give out bednets are women. Women also play a major community role when they volunteer as village health workers and bring malaria treatment and prevention to the grassroots as seen in Ethiopia's "scheme to train thousands of young women in malaria fighting tactics."
Although women may not have equal numbers of positions compared to men when it comes to malaria policy making and program management, soma without prescription, Billige soma Apotheke, it was impressive at the November meeting of the RBM Harmonization Working Group to be addressed by the women who were directors of the national malaria control programs of Kenya, Nigeria and Ghana.
The World Gender Gap Report (2008) considers economic opportunity and participation, För soma online, Kjøpe soma, educational attainment, political empowerment, soma ordine on-line, New York NY N.Y. , and health and survival of women in each country. 130 countries were scored, and at ten of the lower 30 on the list are endemic for malaria compared to only 3 in the top 30, order soma online cheap. Halvalla soma apteekki, This does not mean that malaria per se creates inequality, but may have a harder time accessing malaria prevention and treatment where gender equality is highest.
Provision of Intermittent Preventive Treatment for pregnant women (IPTp) during antenatal care is an example of neglected services for women, order soma from canada. South Carolina SC S.C. , The World Malaria Report roughly estimates that no around 20% of pregnant women in areas of stable malaria transmission in Africa received the minimum two doses of IPTp even though the target for 2005 was 60%. The RBM website's country facts show that coverage with two doses can be as low as 3% in Angola and 5% in the Democratic Republic of the Congo. Only one country appears to have broken the 60% ceiling, Ohio OH , Soma generic, Zambia.
Countries need to step up and close the gender gap in malaria services. Resources are available from Jhpiego to help countries assess their current malaria in pregnancy program implementation status, soma pedido en línea, Colorado CO Colo. , update their malaria policies to reflect the needs of women and train health workers to deliver better malaria services to women.
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Malaria in Pregnancy Bill Brieger | 16 Jan 2010
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Over the past decade countries in stable falciparum malaria transmission areas adopted the use of intermittent preventive treatment of malaria in pregnancy Order cafergot, (IPTp) using the drug sulfadoxine-pyrimethamine (SP). At present only two of these locations are pulling back or considering stopping IPTp, ordering cafergot no rx. Köpa billiga cafergot, Both Rwanda and Zanzibar in the United Republic of Tanzania may no longer need IPTp because successful malaria control interventions have brought transmission down. Rwanda specifically stopped using IPTp, while Zanzibar is still considering the implications of changing policy until more evidence is available, Kentucky KY Ky. . Farmacia cafergot baratos, Currently in areas of unstable, seasonal or epidemic malaria where it is unlikely that adults would have developed partial immunity and carry asymptomatic disease, cafergot generic, Kaufen cafergot, IPTp has not generally been used. Instead prompt laboratory diagnosis (including RDTs) and appropriate treatment have been recommended for addressing malaria in pregnancy, Virginia VA Va. .
Just because the transmission picture changes as we successfully move toward sustained control and pre-elimination, does not mean pregnant women are not at risk of malaria, order cafergot. Illinois IL Ill. , In fact as high transmission areas begin begin to resemble the unstable transmission zones, all people will be at greater risk of severe malaria, Florida FL Fla. . Buy cafergot c.o.d., Recent articles show that this risk to pregnant women extends to their offspring. Aribodor and colleagues in Nigeria documented again that not only does placental malaria result in significantly lower birth weight than that of children born to mothers without infection, cheap cafergot online, Hawaii HI , but that low birth weight (LBW), defined as less than 2, cheap cafergot online, Arizona AZ Ariz. , 500 g, was more common among those born to mothers with placental malaria, cheapest cafergot prices. Cafergot, Low birth weight is an important risk factor in neonatal and infant mortality.
Walther et al Order cafergot, . looked beyond the actual birth of the child and found that regardless of whether the child was born with LBW, acheter cafergot discount, Cafergot online cheap, the fact that the mother had placental malaria had a "negative impact on the infant’s subsequent weight development that is independent of LBW, suggesting that the longer term effects of PM have been underestimated, cafergot pills, Nebraska NE Nebr. , even in areas where malaria transmission is declining."
The question arises as we move toward lower transmission and elimination, but not immediately toward lower risk - what can we do to protect pregnant women in addition to providing them bednets, Kjøp Discount cafergot. För cafergot online, Daniel Chandramohan at the 11th meeting of RBM's Malaria in Pregnancy Working Group suggested Intermittent Screening and Treatment (IST) as an appropriate strategy which might consist of:
- Screening for malaria (RDT or Microscopy) at first ANC visit
- Treatment with a long acting antimalarial combination (e.g. DHA+PPQ, North Dakota ND , Cheap cafergot overnight delivery, SP+AQ, SP+AZ, Michigan MI Mich. , SP+MQ)
- Further screening and treatment at 2nd and 3rd trimester (2 to 3 IST per pregnancy) plus passive case management
Lucy Smith and co-researchers found that pregnant women liked "both intermittent screening and treatment and intermittent preventive treatment appeared equally acceptable to pregnant women as strategies for the control of malaria in pregnancy," valuing the addition of such services to routine Antenatal Care.
Finding appropriate ways of protecting pregnant women from malaria, as we move toward elimination, must remain a priority in all endemic countries..
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Malaria in Pregnancy & Leadership Bill Brieger | 26 Dec 2009
USAID - new director confirmed
The US Senate has given the development community a holiday gift. The indo-Asian News Service reports, "The Senate unanimously on Thursday confirmed the nomination of Shah, 36, and some three dozen other officials nominated by President Barack Obama before taking its Christmas break."
Rajiv Shah has training in medicine and economics and has worked with the US Department of Agriculture. This gives him a broad development perspective and hopefully will ensure nutrition issues are not forgotten, "having championed Obama's global food security initiative."
Shah has also worked with the private and the NGO sectors, important partners in USAID's work.
When Shah was nominated, President Obama said, "Rajiv brings fresh ideas and the dedication and impressive background necessary to help guide USAID as it works to achieve this important goal."
There are those who are worried that fresh ideas alone may not be enough to guide an agency with such wide scope. NationalJournal.com remarked that, "Then there is the question of seasoning. While development junkies trade war stories of remote missions and malaria like currency, Shah has almost zero field experience. He may be the smartest guy in the room, but he doesn't have that wellspring to draw on."
During confirmation hearings Senator Richard G. Lugar posed a question about the future of the successful disease control programs initiated by the US Government in recent years. Shah explained that ...
The welcome increase in funding for health assistance since 2000, particularly for combating HIV and malaria, has largely been targeted to African countries where disease and overall poor health conditions have had substantial socio-economic impact. That said, there are still tremendous unmet health and development needs in these countries. The Administration is committed to a broad Global Health Initiative that takes account of the range of health and development needs and, if confirmed, I look forward to working with Congress on this important issue.The United Nations Foundations congratulated the President on Shah's nomination and reiterated its own priorities which address both disease control and strengthening maternal and child health (MCH) services:
The United Nations Foundation is particularly focused on development goals related to global health, including our efforts to eradicate polio, reduce measles mortality, and eliminate malaria worldwide. In light of the unmet need in the world for maternal health and family planning, I hope that USAID’s new leadership will keep women’s health and international family planning a priority.A good example of the nexus between malaria control and MCH is the challenge of preventing and treating malaria in pregnancy (MIP). Pregnant women bear a disproportionate burden of malaria that threatens their survival and that of the fetus and the newborn child. Without strong a antenatal and reproductive health foundation, MIP control cannot reach those in need. If Shah does have this bigger picture of malaria control in mind, we can hope for a broadening of malaria intervention into MCH programs that go beyond the limits of the 15 countries that constrained the potential impact of the President's Malaria Initiative.
Malaria in Pregnancy & Reproductive Health Bill Brieger | 19 Dec 2009
15 years since Cairo
On Monday, "Secretary of State Hillary Rodham Clinton will deliver a speech commemorating the 15th anniversary of the International Conference on Population and Development (ICPD)," held at Cairo. "At this event, Secretary Clinton will declare the U.S. Government’s renewed support for and dedication to reaching the ICPD and other related UN agreements, including the Millennium Development Goals, by 2015," which include reducing both maternal mortality and malaria.
In a publication marking 15 years since the Cairo Conference, UNFPA has published an update entitled, "Healthy Expectations: Celebrating Achievements of the Cairo Consensus and Highlighting the Urgency for Action." The document explains that ...
The attached map from UNFPA shows heightened maternal mortality in just the same regions of the world where malaria is most prevalent.
When Secretary Clinton speaks she will remind us that, "Millions of lives have been improved and saved through effective and affordable reproductive health programs, which have proven to prevent the deaths of women and children, reduce the spread of HIV/AIDS, grow economies, and preserve natural resources." These programs should include malaria in pregnancy control as an integral part of antenatal care.
It is useful in this context to think of the ICPD guiding principles. Principle 4 addresses "Advancing gender equality and equity and the empowerment of women." For malaria control this means ensuring malaria in pregnancy control programs are fully funded and operational since pregnant women suffer more from malaria than other adults in endemic areas.
Principle 8 recognizes the right of people to space their children. This process can be frustrated due to fetal loss during malaria in pregnancy or from peri-natal and infant mortality when children are born with low birth weight and are less likely to survive.
Neither our reproductive health nor our malaria programs are complete until we plan to meet the needs of pregnant women who are risk from this deadly parasitic disease. Integrated planning and service delivery is required.
In 2005, the lifetime risk of death from maternal causes was 1 in 22 for women in sub-Saharan Africa, compared with less than 1 in 6,000 for women in more developed countries. For each woman who dies, 20 additional women suffer pregnancy-related disabilities ... Most maternal deaths occur to women who live in sub-Saharan Africa and South Asia. The number of maternal deaths in sub-Saharan Africa has increased as the number of women in the childbearing ages has grown.
The attached map from UNFPA shows heightened maternal mortality in just the same regions of the world where malaria is most prevalent.
When Secretary Clinton speaks she will remind us that, "Millions of lives have been improved and saved through effective and affordable reproductive health programs, which have proven to prevent the deaths of women and children, reduce the spread of HIV/AIDS, grow economies, and preserve natural resources." These programs should include malaria in pregnancy control as an integral part of antenatal care.
It is useful in this context to think of the ICPD guiding principles. Principle 4 addresses "Advancing gender equality and equity and the empowerment of women." For malaria control this means ensuring malaria in pregnancy control programs are fully funded and operational since pregnant women suffer more from malaria than other adults in endemic areas.
Principle 8 recognizes the right of people to space their children. This process can be frustrated due to fetal loss during malaria in pregnancy or from peri-natal and infant mortality when children are born with low birth weight and are less likely to survive.
Neither our reproductive health nor our malaria programs are complete until we plan to meet the needs of pregnant women who are risk from this deadly parasitic disease. Integrated planning and service delivery is required.
Malaria in Pregnancy & Burden Bill Brieger | 11 Nov 2009
Burden of Malaria in Pregnancy
The Malaria in Pregnancy Consortium (MIPc) highlighted its ongoing research activities at the recently held 5th Pan-African Malaria Conference in Nairobi. While results on issues like new malaria treatment and preventive regimens are still in the works, the MIPc did report on preliminary efforts to measure the burden of malaria in pregnancy.
Although international agencies like WHO have given estimates of malaria in pregnancy (MIP) risk, one has not always been sure of how these figures were derived. The MIPc has begun to gather and reanalyze current data to get a better picture of the situation in 2007 since we expect that there will definitely be changes as progress is made toward malaria elimination.
The standard figures have been an annual 50 million pregnant women at risk globally, with 25-30 million in Africa. This may have been nased on live births reported. Other unknowns, according to the MIPc is whether Plasmodium vivax was considered and whether distinctions were made between stable and unstable transmission areas.
Advances made with the Malaria Atlas Project have helped as have UNDP population data for women aged 15-49 years. There was also the challenge of going beyond live births to counting all pregnancies, whether these terminated early or went to term. MIPc was able to determine that around 13% of pregnancies may end in miscarriage. This is important since malaria itself may lead to miscarriage - live births only would not pick this up.
The attached chart shows calculations presented by MIPc. They noted that the African P. falciparum numbers were not much different than have been estimated to date. more work on these data is underway, but the information presented in Nairobi provides us with the beginnings of a baseline prior to achievement of universal malaria intervention coverage and entry into the malaria elimination phase of intervention.
Another interesting MIP presentation was given by Patrick Duffey during the final plenary session of the MIM conference. He summarized research that has identified a genetically different form of P. falciparum that infects pregnant women, especially those pregnant for the first time. Some immunity is developed in later pregnancy. This research should contribute to vaccine development.
Dr Duffey also shared information that similar biomarkers for pre-eclampsia are found in women who are pregnant for the first time and have malaria.
The MIM conference has been an important venue for stressing the continued importance of addressing and preventing malaria in pregnancy as a central strategy in our efforts to eliminate malaria overall.
------- see for example ...
Muehlenbachs A, Fried M, Lachowitzer J, Mutabingwa TK, Duffy PE. Natural selection of FLT1 alleles and their association with malaria resistance in utero. Proc Natl Acad Sci U S A. 2008 Sep 23;105(38):14488-91. Epub 2008 Sep 8.
Avril M, Kulasekara BR, Gose SO, Rowe C, Dahlbäck M, Duffy PE, Fried M, Salanti A, Misher L, Narum DL, Smith JD. Evidence for globally shared, cross-reacting polymorphic epitopes in the pregnancy-associated malaria vaccine candidate VAR2CSA. Infect Immun. 2008 Apr;76(4):1791-800. Epub 2008 Feb 4.
Kabyemela ER, Muehlenbachs A, Fried M, Kurtis JD, Mutabingwa TK, Duffy PE. Maternal peripheral blood level of IL-10 as a marker for inflammatory placental malaria. Malar J. 2008 Jan 29;7:26.
The attached chart shows calculations presented by MIPc. They noted that the African P. falciparum numbers were not much different than have been estimated to date. more work on these data is underway, but the information presented in Nairobi provides us with the beginnings of a baseline prior to achievement of universal malaria intervention coverage and entry into the malaria elimination phase of intervention.
Another interesting MIP presentation was given by Patrick Duffey during the final plenary session of the MIM conference. He summarized research that has identified a genetically different form of P. falciparum that infects pregnant women, especially those pregnant for the first time. Some immunity is developed in later pregnancy. This research should contribute to vaccine development.
Dr Duffey also shared information that similar biomarkers for pre-eclampsia are found in women who are pregnant for the first time and have malaria.
The MIM conference has been an important venue for stressing the continued importance of addressing and preventing malaria in pregnancy as a central strategy in our efforts to eliminate malaria overall.
------- see for example ...
Muehlenbachs A, Fried M, Lachowitzer J, Mutabingwa TK, Duffy PE. Natural selection of FLT1 alleles and their association with malaria resistance in utero. Proc Natl Acad Sci U S A. 2008 Sep 23;105(38):14488-91. Epub 2008 Sep 8.
Avril M, Kulasekara BR, Gose SO, Rowe C, Dahlbäck M, Duffy PE, Fried M, Salanti A, Misher L, Narum DL, Smith JD. Evidence for globally shared, cross-reacting polymorphic epitopes in the pregnancy-associated malaria vaccine candidate VAR2CSA. Infect Immun. 2008 Apr;76(4):1791-800. Epub 2008 Feb 4.
Kabyemela ER, Muehlenbachs A, Fried M, Kurtis JD, Mutabingwa TK, Duffy PE. Maternal peripheral blood level of IL-10 as a marker for inflammatory placental malaria. Malar J. 2008 Jan 29;7:26.
Malaria in Pregnancy & Mortality Bill Brieger | 01 Aug 2009
Reverse the neglect of maternal mortality
Nicholas Kristof of the New York Times has often written on the shameful problem of maternal mortality. A few days ago he proffered a solution to the problem that goes beyond health system fixes. Specifically women's issues need political attention, and to do that, women need to be more involved in governance.
Kristof observed the U.S. experience that "after women’s suffrage became a reality, maternal mortality fell sharply. It seems that when women were accepted fully into the political system, then resources were also made available in the health system and they, less marginalized, were able to take advantage of them." In countries with high maternal mortality, the right to vote is not enough, especially when voting may not actually determine political outcomes.
Malaria, of course, is responsible for an important portion of maternal mortality, whether directly through severe episodes when women have reduced immunity, or through anemia caused by the infection. As we have often observed, of the main components of malaria control and elimination efforts, malaria in pregnancy (MIP) is the weakest leg of the stool. Until national malaria programs, with pressure from malaria partners, make MIP control an equal priority with bednet distribution and treatment of small children, the destructive work of the disease will continue.
Kristof wishes that groups promoting Safe Motherhood initiatives will "hopefully ... get strong backing from the Obama administration." Not only are pregnant women with malaria at risk themselves, but their newborn children would have suffered from growth retardation in utero and being born of low birth weight, would be more likely to die before they can benefit from bednets and artemisinin-based combination therapy.
Not only do women in malaria endemic countries need to vote, the people they vote for need the political will to reduce maternal mortality by all means including preventing malaria in pregnancy.
Kristof wishes that groups promoting Safe Motherhood initiatives will "hopefully ... get strong backing from the Obama administration." Not only are pregnant women with malaria at risk themselves, but their newborn children would have suffered from growth retardation in utero and being born of low birth weight, would be more likely to die before they can benefit from bednets and artemisinin-based combination therapy.
Not only do women in malaria endemic countries need to vote, the people they vote for need the political will to reduce maternal mortality by all means including preventing malaria in pregnancy.
Malaria in Pregnancy Bill Brieger | 30 Jul 2009
Malaria in pregnancy … and beyond
Roll Back Malaria reminds us that, " In areas of Africa with stable malaria transmission, P. falciparum infection during pregnancy is estimated to cause as many as 10,000 maternal deaths each year," many of which are associated with "malaria-related anaemia." We also know that the effects malaria in pregnancy (MIP) go beyond the birth of the child. The presence of parasites in the placenta leads to fetal growth retardation such that, "8% to 14% of all low birth weight babies, and 3% to 8% of all infant deaths" are due to MIP.
Now Malhotra and colleagues have provided new insight into additional ways that MIP can harm the newborn. Their research identified three groups of newborns based on maternal experience with malaria infection:
Even so, based on this research and what is already known about the dangers of MIP, there is increasing need to protect pregnant women from malaria for their own sake and that of the unborn child. Unfortunately MIP programming may be the weakest link in our efforts to roll back malaria.
The campaign approach to distribution of long lasting insecticide-treated nets (LLINs) can easily bypass pregnant women. Even efforts at universal coverage of nets that aim to place two nets in a household or one net per two people in a community does not guarantee that pregnant women will actually have access to and use of a LLIN. Family power dynamics and weaknesses in follow-up health education on net use are problematic.
Also many countries do not take intermittent preventive treatment in pregnancy (IPTp) seriously. Drug regulatory agencies allow the main drug for IPTp - sulphadoxine pyrimethamine (SP) - to be sold on the open market for treatment of the general public. This drug has obviously been experiencing problems of developing parasite resistance, and continued use for general treatment will only speed up that process.
Antenatal clinics should be the only place where SP is stocked and dispensed only to pregnant women. LLIN supplies in ANC clinics should be adequate to cover all pregnant women in a community - how else will the keep up component of LLIN interventions be maintained? RDTs and ACTs also need to be accessible to ANC clients. When will we be ready to make a serious commitment to protecting pregnant women from malaria?
- sensitized (and thus exposed)
- exposed not sensitized
- not exposed" based on evidence of malaria parasites in the mother and cord blood.
Even so, based on this research and what is already known about the dangers of MIP, there is increasing need to protect pregnant women from malaria for their own sake and that of the unborn child. Unfortunately MIP programming may be the weakest link in our efforts to roll back malaria.
The campaign approach to distribution of long lasting insecticide-treated nets (LLINs) can easily bypass pregnant women. Even efforts at universal coverage of nets that aim to place two nets in a household or one net per two people in a community does not guarantee that pregnant women will actually have access to and use of a LLIN. Family power dynamics and weaknesses in follow-up health education on net use are problematic.
Also many countries do not take intermittent preventive treatment in pregnancy (IPTp) seriously. Drug regulatory agencies allow the main drug for IPTp - sulphadoxine pyrimethamine (SP) - to be sold on the open market for treatment of the general public. This drug has obviously been experiencing problems of developing parasite resistance, and continued use for general treatment will only speed up that process.
Antenatal clinics should be the only place where SP is stocked and dispensed only to pregnant women. LLIN supplies in ANC clinics should be adequate to cover all pregnant women in a community - how else will the keep up component of LLIN interventions be maintained? RDTs and ACTs also need to be accessible to ANC clients. When will we be ready to make a serious commitment to protecting pregnant women from malaria?
Malaria in Pregnancy & HIV Bill Brieger | 23 May 2009
PMTCT, malaria in pregnancy share common problem
Partners “too often fail to coordinate programs to help promote more integrated, comprehensive health care for women,” and governments are “often unable or unwilling to initiate or sustain health care programs and reforms that would improve women’s access to services.” according to a new report from the International Treatment Preparedness Coalition.
If we did not know the source of this information we could assume it applies equally well to controlling malaria in pregnancy as it does to preventing mother-to-child transmission of HIV. Both services are supposed to be part of integrated focused antenatal care (ANC). Neither appear as regularly as needed to save the lives of mothers and newborns. This is not because women in developing countries fail to attend ANC.
Nearly 95 percent of pregnant women (in Uganda) attend antenatal care (ANC) services at least once during their pregnancy. They do not necessarily have access to comprehensive prevention of vertical transmission services, however, because just 43 percent of all health facilities that provide ANC and delivery services have integrated prevention of vertical. transmission.
Omo-Aghoja and colleagues point out that, "Part of the reasons for the low uptake of measures for malaria prevention in pregnant women in many African countries is the lack of proper integration of the recommended interventions into antenatal care (ANC) offered in health institutions."
In a recent New York Times article on maternal mortality Dr. Massawe, a Tanzanian clinician asks, "“Why don’t we have a global fund for maternal health, like the one for TB, malaria and AIDS?” Until the question of why women, including pregnant women, are not offered comprehensive and integrated services is answered, inequity and death of mothers and children will continue to be an unacceptable reality.
Malaria in Pregnancy & Human Resources Bill Brieger | 21 May 2009
Malaria Training Trounced by Transfers
In an effort to ensure the human capacity to deliver malaria services, partners are embarking on in-service and pre-service training throughout endemic countries. Such training is not something that can be accomplished quickly. Most partners plan training in a phased approach that eventually covers all districts and facilities, but quality training cannot be rushed.
Jhpiego has a 35 year history of capacity building of the health workforce in maternal and reproductive health, including the issue of malaria in pregnancy. Jhpiego has been working in Akwa Ibom State, Nigeria for the past 2 years to test the concept of community-clinic collaboration in the delivery of malaria in pregnancy control services. The effort began by developing a core team of trainers at the state level, who in turn trained another core among staff of seven of the states 31 local government areas (LGA).
These LGA teams then embarked on training front line health facility staff in both malaria in pregnancy control and outreach through community directed interventions. The actual service delivery of intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) took off in July 2008 after both health workers and community selected and directed volunteers were trained. Nearly 10,000 pregnant women have received two doses of IPTp since then.
Now the Pioneer Newspaper reports that many of those trained have been transferred to other LGAs, and this could disrupt the smooth delivery of MIP control services. The challenge in Nigeria is that while the State Ministry of Health provides technical guidance to LGA health staff, and the LGA itself provides the facilities and supplies to run the services, most of the actual health workers are employed by another entity - the State Local Government Service Commission. Transfers and repostings occur as frequently as every two years or only as often as every 5 years. Often a transfer is the only way a health worker can move into a higher grade position - in effect get a promotion.
So while the system may benefit the individual employee, it makes it difficult to offer continuity in service and to build strong community relations needed to deliver public health care. Eventually the State will have the resources through the World Bank Malaria Booster Program to train health staff in all LGAs on malaria. In the short term the efforts to prove that LGA health facilities can improve the quality and reach of malaria in pregnancy control services may be jeopardized.
The ultimate irony is that the bulk of health workers on the front line in Nigeria are not part of a system that could provide coordinated human resource planning for health. Instead, they are transfered by a non-health bureaucracy like any other LGA civil servant, whether she be a clerk, accountant, secretary or in this case a nurse. When Nigerian health planners are able to train and update all health staff in malaria, such transfers may not disrupt services. For now, these planners need to examine the effects of a system that treats health staff like civil service pawns.