In 2016, the World Health Organization (WHO) released new
antenatal care (ANC) guidelines with the aim of promoting evidence-based
practices and improving women’s pregnancy experiences. Notably, the new WHO ANC
guidelines include a recommended change from four visits to at least eight ANC
contacts.
Addressing the issue of malaria in pregnancy
(MiP) is a key component of providing high quality ANC, particularly in endemic
areas. A group of experts representing a number of organizations recently
published a brief
containing guidelines for preventing and treating MiP in the context of the
updated WHO ANC guidelines.
Key
messages
1. All
pregnant women living in areas at risk for malaria transmission should:
o
Sleep
under an insecticide-treated net (ITN).
o
Seek
prompt quality diagnosis when signs and symptoms of malaria are present and
receive effective malaria case management with an appropriate drug at the
correct dose.
2.
Pregnant women living in moderate to high malaria transmission areas in Africa
should also receive:
o
Intermittent
preventive treatment in pregnancy using sulfadoxine-pyrimethamine (IPTp-SP)
under directly observed therapy (DOT) starting as early as possible in the
second trimester, with doses given at least one month apart until the time
of delivery.
o
To
enable pregnant women in endemic areas to start IPTp-SP at the beginning of the
second trimester, policymakers should put in place supportive policies to
ensure that women have an ANC contact at 13 weeks’ gestation.
o
IPTp-SP
should be given to a pregnant woman at every ANC contact starting from 13 to 16
weeks, with each dose being given at least one month (four weeks) apart.
o
Pregnant
women who have an ANC contact twice between 13 and 20 weeks, at least one month
apart, should receive IPTp-SP by DOT at both contacts.
o
If
a woman comes for her first second-trimester contact anytime between 13 and 20
weeks, she should receive IPTp-SP, and at every following contact, with doses
one month apart.
o
Pregnant
women can receive IPTp-SP safely starting as early as possible in their second
trimester up until the end of pregnancy.
o
SP
should not be administered to women living with HIV who are receiving
co-trimoxazole.
3.
Countries should only provide quality-assured SP for IPTp to ensure effective
care for pregnant women.
o
Current
procurement sources of quality-assured SP can be found on the
Global Fund’s list of pharmaceutical products compliant with the quality
assurance policy.
4. Iron
and folic acid requirements increase during pregnancy.
o
Administer
30 to 60 mg of elemental iron and 400 mcg (0.4 mg) of folic acid.
By: Sarah Hodin,
Project Coordinator II, Women and
Health Initiative, Harvard T.H. Chan School of Public Health
