Supporting Pregnant Women to Adopt Preventive Therapy for Malaria in Nigeria

It’s early morning, but Rebecca Owolabi, a nursing officer at the Isokun Maternity Center in Ilesha in Osun State, Nigeria, is already providing group counseling on malaria prevention in pregnancy to women visiting the facility for antenatal care. She counsels them on the importance of sleeping under an insecticide treated bednet and seeking treatment at the first sign of malaria. Also, as preventive therapy, she hands two tablets of sulphadoxine pyrimethamine (SP) to the women, who then swallow them with water. Nurse Owolabi, as she is fondly called by clients, reminds everyone of their next meeting date, which will be their third and last dose of the medication, as she bids them goodbye.

A year ago, it was rare to find clients who had completed the recommended number of SP doses in this facility, a situation that is prevalent in Nigeria and most sub-Saharan African countries where malaria remains endemic. One key reason for the low uptake is the confusion among health workers about how to administer the treatment. Notably, since 2004, when the World Health Organization (WHO) recommended SP in areas with moderate to high transmission of malaria for Intermittent Preventive Therapy (IPTp), it was discovered that the uptake of the first, second, and third dose in Sub-Saharan Africa was about 52%, 40%, and 17% respectively. This low uptake was also linked to the high number of maternal deaths due to malaria in the region. 

In 2018, MSH—as a subrecipient to Catholic Relief Services through the Global Fund-supported malaria project, GF Malaria—began its program to reduce maternal deaths in 13 states, including Osun. The project conducted trainings on the use of the IPTp method among community health workers, nurses, and doctors, focusing on the WHO’s revised recommendation to encourage the proper use of the treatment. Owolabi and other trainees took refresher courses and practical sessions to update their knowledge and skills using the IPTp method.

“It was good [to refresh] our memory in these trainings,” says Owolabi. “I was able to go back and teach others at my health facility about the new changes,” which included increasing the maternity team’s understanding on the IPTp method and malaria prevention in pregnancy. To then ensure staff understood how to administer SP, regular mentoring and supervisory visits were conducted in facilities across the state. “During these visits, we found out exactly how much other health workers have understood from our training,” explains Owolabi. “If there are areas they didn’t understand properly, we had that opportunity to explain it to them again.”

Owolabi credits the work conducted by MSH for the increased uptake of IPTp by pregnant women at the maternity center. According to Owolabi, “If you check our antenatal care register, you will see that we’ve had 20 more bookings in the past week, and all eligible pregnant women have been placed on SP. Staff are properly applying what we have taught them.” 

And this success is reflected in the data reported by the center: an increase in women’s attendance to antenatal sessions and the uptake of the second dose of IPTp, which rose to 71% in July 2019. Although there is still more work to be done in Osun State, the Global Fund Malaria project has begun to turn things around at the Isokun Maternity Center. 

As Nurse Owolabi continues to explain how things have improved in the health facility, another client walks in, placing her hand on her stomach as she sits down to receive her own dose of IPTp.