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Interventions for Pregnant Women against Malaria: A Mini Review

Article Information

Ahmed Dahiru Balami*, Salmiah Muhammad Said, Nor Afiah Muhammad Zulkefli

Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor Darul Ehsan, Malaysia

*Corresponding Author: Dr. Ahmed Dahiru Balami, Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 UPM Serdang, Selangor Darul Ehsan, Malaysia

Received: 20 September 2019; Accepted: 01 October 2019; Published: 04 October 2019

Citation: Ahmed Dahiru Balami, Salmiah Muhammad Said, Nor Afiah Muhammad Zulkefli. Interventions for Pregnant Women against Malaria: A Mini Review. Obstetrics and Gynecology Research 2 (2019): 067-071.

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Keywords

Pregnant Women, Malaria, Interventions

Pregnant Women articles, Malaria articles, Interventions articles

Article Details

1. Introduction

Malaria remains highly endemic in sub-Saharan Africa [1], and about 25 million pregnancies are estimated to occur yearly in malaria-endemic regions of the sub-continent [2]. Several interventions aimed at improving knowledge, attitude, and practice of malaria prevention, have been studied among different groups, only a few of which were among pregnant women. A systematic review of educational interventions in sub-Saharan Africa, which included studies which focused on ITN, IPTp, home-based management and environmental management revealed evidence of its effectiveness in improving these practices among the intervention group [3]. Amoran [4] had demonstrated that directly training caregivers could lead to improvements in knowledge, attitudes and practice of ITN use. Among refugee mothers, health education, facilitated by Vector Control Program personnel and Voluntary Collaborators, also led to improvements in knowledge of malaria transmission and positive treatment seeking behaviors for fevers with chills [5]. In Iran, a health education intervention based on the Protection Motivation Theory had led to improvements in malaria prevention, self-efficacy scores, but not preventive behavior scores among households in the intervention group [6]. Net impregnation also significantly improved among households, following a health education intervention on malaria with provision of net impregnation services in Piron, Mali [7]. Among Home-Based Care workers in Limpopo, South Africa, enrolled into a three to four-week training under the Malaria Awareness Program (MAP), those who had completed the full course had thrice the odds of having knowledge of malaria transmission and knowledge of malaria prevention compared to those who were not in the training, or those who had dropped out after just a week [8].

For pregnant women, sleeping under an insecticide-treated net (ITN) and receiving intermittent preventive treatment in pregnancy (IPTp) would be the ultimate aim of any preventive intervention, as they are the main preventive practices recommended by the World Health Organization [9]. We reviewed published studies on interventions for pregnant women against malaria. The aim was to ascertain the progress made so far, identify current gaps, and provide suggestions for policy makers and future researchers on possible ways forward.

2. Results

Summaries of few intervention studies conducted among pregnant women are presented in Tables 1 to 3. A recent study in a health center in north-eastern Nigeria revealed that a four-hour malaria health, educational intervention based on the information-motivation-behavioral skills were effective in leading to an overall improvement in knowledge, motivation and behavioral skills by 12.75% (p < 0.001), 8.55% (p < 0.001), and 6.350% (p < 0.001) respectively [10]. Training of Community-Directed Distributors (CDDs) to give basic counselling to antenatal women, was effective in improving both ITN use and IPT uptake among the intervention group [11]. In another study in Bangladesh, Community Health Workers are visiting households with at least one pregnant woman or an under-five child, to give health education on malaria, was followed by an increase in insecticide net use to above 80% [11]. This study, however, makes it difficult to draw conclusions as it had no control group.

Study

Balami et al., 2019

Location

Maiduguri, Nigeria

Participants

372 antenatal care attendees (186 intervention + 186 controls)

Intervention:

a.       Malaria health education intervention

Contents

b.       Information on malaria transmission, complications, and prevention (ITN and IPTp)

Methods

a.       Lectures using power point projections

b.       Brain storming sessions

c.        Practical demonstration sessions

Duration

Four hours

Guiding theory

Information-motivation-behavioral skills

Control :

Educational session on breastfeeding

Methods

a.       Lectures with power point projections

b.       Brain storming sessions

c.        Practical demonstration sessions

Duration

Four hours

Guiding theory

None

Dependent variables:

a.       Knowledge, motivation and behavioral skills for malaria prevention

Follow-up duration

2 months and 4 months post-intervention

Summary of results:

Knowledge of malaria and malaria prevention in pregnancy = 12.75%

Motivation for malaria prevention in pregnancy  = 8.55%

Behavioral skills for malaria prevention in pregnancy = 6.350%

Table 1: Malaria health education intervention for household members.

Study

Okeibunor et al., 2011

Location

Akwa Ibom, Nigeria

Participants

Pregnant women: 1,280 and another 1,380

Intervention:

Complementary community-directed intervention (CDI)

program

Contents

Community-directed distributors (CDDs) were trained

a.       To deliver ITNs and SP (IPTp1 and IPTp2) to pregnant women, and

b.       To provide basic health counselling services.

Methods

 

Duration

Each batch was trained for 5 hours (all in a single day)

Guiding theory

None

Control:

a.       No CDI program

b.       Provision of public health clinics with drugs, functional
equipment and other supplies such as tracking sheets

c.        Training for health personnel to antenatal care

Contents

-

Methods

-

Duration

7 months

Guiding theory

-

Dependent variables:

a.       ITN use

b.       IPT uptake (at least two doses)

Summary of results

ITN use

Percentage increase for intervention group:

8.5 percentage points (95% CI: 0.045-0.122, p-value < 0.001)

IPT adherence

35.3 percentage points (95% CI: 0.280-0.425, p-value < 0.001)

Table 2: Malaria health education intervention for pregnant women.

Study

Ahmed et al., 2011

Location

Thirteen malaria-endemic districts in Bangladesh

Participants

3,760 households and another 7,895 households (household must have at least one under 5 children and/or a pregnant women)

Intervention:

a.       Malaria health education intervention, and

b.       Long-lasting insecticidal nets

Contents

Information on:

a.       Malaria and its transmission

b.       Norms of use of insecticidal bed nets (e.g., when to hang the net, where and how to wash and dry the net, and how many washes in a year etc.)

c.        Diagnosis (by rapid diagnostic test) and prompt treatment of malaria following an algorithm

Methods

a.       Each community health worker (CHW) visits 10 households in a day to give health education on malaria

b.       Distribution of long lasting insecticidal nets to poor households by the CHWs

Duration

 

Guiding theory

None

Control :

No control group

Contents

-

Methods

-

Duration

-

Guiding theory

-

Dependent variables:

a.       Knowledge of malaria and insecticidal bed nets

b.       Insecticidal net ownership

c.        Insecticidal net use

Follow-up duration

2 years

Summary of results:

Percentage of pregnant women who slept under an LLIN/ITN

South-eastern districts

North-eastern-districts

% change = 6.8

% change = 6.6

Table 3: Malaria health education intervention for household members.

The cost implications as well as small effect sizes of the previous interventions do not seem encouraging enough to make governments adopt them. More effective interventions are thus needed. The intervention module in one of the previous studies [10] could however complement the on-going routine health education given to pregnant women during their ANC. The target pregnant women need to be actively involved in all stages of the development of such interventions. Qualitative studies in the form of focus group discussion and key informant interviews would play a greater role in identifying strategies which need to be incorporated into such studies. Furthermore, additional interventions directed at significant others need to be implemented, considering the important role they play in determining the pregnant women’s use of ITN [13]. Owing to its wide coverage and effectiveness in influencing behavior [14], the mass media also provides a promising platform for not only disseminating such intervention programs, but also actively engaging remotely-located participants.

References

  1. WHO: World malaria report 2016. World Health Organization (2017).
  2. Centers for Disease Control and Prevention Web site, authors. Malaria facts (2007).
  3. Awusu-Addo E, Awusu-Addo S. Effectiveness of health education in community-based malaria prevention and control interventions in sub-Saharan Africa: A systematic review. Journal of Biology, Agriculture and Healthcare 3 (2014): 22-34.
  4. Amoran OE. Impact of health education intervention on malaria prevention practices among nursing mothers in rural communities in Nigeria. Nigerian Medical Journal 54 (2013): 115-22.
  5. Cropley L. The effect of health education interventions on child malaria treatment-seeking practices among mothers in rural refugee villages in Belize, Central America. Health Promot Int 19 (2004): 445-52.
  6. Ghahremani L, Faryabi R, Kaveh MH. Effect of health education based on the protection motivation theory on malaria preventive behaviors in rural households of Kerman, Iran. Int J Prev Med 5 (2014): 463-71.
  7. Rhee M, Sissoko M, Perry S, McFarland W, Parsonnet J, et al. Use of insecticide-treated nets (ITNs) following a malaria education intervention in Piron, Mali: A control trial with systematic allocation of households. Malar J 4 (2005): 35.
  8. Cox SN, Guidera KE, Simon MJ, Nonyane BA, Brieger W, et al. Interactive malaria education intervention and its effect on community participant knowledge: The malaria awareness program in Vhembe district, Limpopo, South Africa. Int Quart of Comm Heal Educ 38 (2018): 47-58.
  9. WHO: A strategic framework for malaria prevention and control during pregnancy in the African region. World Health Organization; National Population Commission (2004): 27.
  10. Balami AD, Said SM, Zulkefli NM, Bachok N, Audu B. Effects of a health educational intervention on malaria knowledge, motivation, and behavioural skills: A randomized controlled trial. Malaria Journal 18 (2019): 41.
  11. Joseph C Okeibunor, Bright C Orji, William Brieger, Gbenga Ishola, Emmanuel Dipo Otolorin, et al . reventing malaria in pregnancy through community-directed interventions: Evidence from Akwa Ibom State, Nigeria. Malaria Journal 10 (2011): 227.
  12. Ahmed SM, Hossain S, Kabir MM, Roy S. Free distribution of insecticidal bed nets improves possession and preferential use by households and is equitable: Findings from two cross-sectional surveys in thirteen malaria endemic districts of Bangladesh. Malar J 10 (2011): 357.
  13. Balami AD, Said SM, Zulkefli NM, Bachok N, Audu B. Knowledge, motivation, self-efficacy, and their association with insecticidal net use among pregnant women in a secondary health centre in Maiduguri, Nigeria. Malar J 17 (2018): 359.
  14. Ankomah A, Adebayo SB, Arogundade ED, Anyanti J, Nwokolo E, et al. Determinants of insecticide-treated net ownership and utilization among pregnant women in Nigeria. BMC Public Health 12 (2012): 105.

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