South Africa has no policy to prevent malaria in pregnancy, despite the adverse effects of the disease in pregnancy. However, malaria control measures consisting of indoor residual spraying and specific antimalarial treatment have been in place since the 1970s. This study was conducted to determine if the country needs a specific policy for malaria prevention in pregnancy, by determining the burden of malaria in pregnancy in KwaZulu-Natal (KZN) province, South Africa. Pregnant women were enrolled at their first antenatal care visit to three health facilities in Umkhanyakude health district in northern KZN during May 2004-September 2005 and followed up until delivery. Of the 1,406 study participants, 33.2% of the women were anaemic, but this was not related to malaria. The prevalence and incidence of malaria were very low, and low birth weight was only weakly associated with malaria (1:10). In conclusion, the low burden of malaria in these pregnant women suggests that they have benefited from malaria control strategies in the study area. The implication is that additional measures specific for malaria prevention in pregnancy are not required. However, ongoing monitoring is needed to ensure that malaria prevalence remains low.
Equitable health services
The World Health Organization (WHO) announced Thursday that Zambia had achieved a major reduction in malaria mortality through accelerated malaria control activities. Malaria deaths reported from health facilities have declined by 66% in Zambia and this result, along with other data, indicates that Zambia has reached the 2010 Roll Back Malaria target of more than 50% reduction in malaria mortality compared to 2000. WHO said Zambia’s efforts would be promoted as a model for other countries to follow. The decline in Zambia was especially steep after 3.6 million long-lasting insecticide nets were distributed between 2006 and 2008. During this period, malaria deaths declined by 47% and nationwide surveys showed that parasite prevalence declined by 53% from 21.8 to 10.2% and the percentage of children with severe anaemia declined by 68% from 13.3 to 4.3%.
This study examines the effectiveness of the current methods for the diagnosis of malaria in Uganda. Diagnosis has mainly been through presumptive management, namely diagnosis on the basis of episodes of fever. However, this paper argues that presumptive management has significantly contributed to the misdiagnosis of malaria. Interviews were conducted with patients at 188 facilities and laboratory samples were taken to assess the accuracy of existing diagnoses. Overall prevalence of malaria was around 24.2%, with a rate of 13.9% in adults and 50.5% for children under five, with 96.2 percent of patients with a positive diagnosis receiving treatment, as well as 47.6% of patients with a negative result. The study authors therefore argue for changes in existing public health policy to include the use of laboratory methods such as microscopy and the introduction of malaria rapid diagnostic tests.
KwaZulu-Natal seems to be winning the battle against malaria in the province, with only about 1,000 cases reported in the province in the past malarial season. According to Prof. Maureen Coetzee, an entomologist from the University of the Witwatersrand, in a paper presented to the International Congress of Entomology in Durban, the situation in the province and the country is favourable because of reduced rainfall and the changes made to malaria control programmes, with use of two insecticides to control mosquitoes and a change to the drug for treatment of the parasite. Similar control programmes have also been introduced in Mozambique. The use of fungi to kill mosquitoes is being tested and research at Wits University showed that mosquitoes exposed to
fungi died within 12 to 14 days after exposure.
A longitudinal study followed approximately 100 randomly selected farming households over six months in Kilombero Valley, Tanzania. Every household was visited monthly and whereabouts of household members, activities in the fields, fever cases and treatment seeking for recent fever episodes were recorded. Fever incidence rates were lower in the shamba compared to the villages and moving to the shamba did not increase the risk of having a fever episode. Children aged 1-4 years, who usually spend a considerable amount of time in the shamba with their caretakers, were more likely to have a fever than adults. Despite the long distances to health services, 55.8% (37.9-72.8) of the fever episodes were treated at a health facility, while home-management was less common (37%, 17.4-50.5). Living in the shamba does not appear to result in a higher fever-risk. Mosquito nets usage and treatment of fever in health facilities reflect awareness of malaria. Inability to obtain drugs in the fields may contribute to less irrational use of drugs but may pose an additional burden on poor farming households. A comprehensive approach is needed to improve access to treatment while at the same time assuring rational use of medicines and protecting fragile livelihoods.
This in-depth country case study aimed to explain Malawi's success in improving child survival. The authors estimated child and neonatal mortality for the years 2000-14 using five district-representative household surveys. The study included recalculation of coverage indicators for that period, and used the Lives Saved Tool (LiST) to attribute the child lives saved in the years from 2000 to 2013 to various interventions. They documented the adoption and implementation of policies and programmes affecting the health of women and children, and developed estimates of financing. The estimated mortality rate in children younger than 5 years declined substantially in the study period, from 247 deaths per 1000 livebirths in 1990 to 71 deaths in 2013, with an annual rate of decline of 5·4%. The most rapid mortality decline occurred in the 1-59 months age group; neonatal mortality declined more slowly, representing an annual rate of decline of 3·3%. Nearly half of the coverage indicators increased by more than 20 percentage points between 2000 and 2014. Results from the LiST analysis show that about 280 000 children's lives were saved between 2000 and 2013, attributable to interventions including treatment for diarrhoea, pneumonia, and malaria (23%), insecticide-treated bednets (20%), vaccines (17%), reductions in wasting (11%) and stunting (9%), facility birth care (7%), and prevention and treatment of HIV (7%). The funding allocated to the health sector increased substantially, particularly to child health and HIV and from external sources, albeit below internationally agreed targets. This case study confirmed that Malawi had achieved MDG 4 for child survival by 2013. The authors’ findings suggest that this was achieved mainly through the scale-up of interventions that are effective against the major causes of child deaths (malaria, pneumonia, and diarrhoea), programmes to reduce child undernutrition and mother-to-child transmission of HIV, and some improvements in the quality of care provided around birth.
This report presents a draft of the proposed Essential Heath Package (EHP) and its costing for Malawi. It is intended to stimulate comment and debate, and to move the process to a final stage whereby the contents can be incorporated into a broader implementation plan for the Ministry of Health and Population (MOHP) and partners. By MOHP, we mean the various departments at headquarters, the technical programmes, and the districts who will ultimately deliver the EHP services.
Malawi's government has set itself a major challenge this year, announcing plans to more than double the number of people receiving antiretroviral (ARV) drugs to half a million by the end of 2010. The country recently adopted new World Health Organization (WHO) guidelines that raise the threshold for ARV therapy from a CD4 count (a measure of immune system strength) of less than 200, to a CD4 count of 350, regardless of whether the patient is displaying symptoms. Some experts argue that starting patients on ARVs earlier could save the government money in the long term by reducing opportunistic infections such as tuberculosis. UNAIDS Country Coordinator, Patrick Brenny, said the targets were reachable, provided the country could mobilise the resources, including money, drugs and manpower. He noted that the Global Fund to Fight AIDS, Tuberculosis and Malaria had expressed willingness to fund implementation of new WHO treatment guidelines. Malawi has just had its funding extended by the Fund for a further six years and is now looking at how to make best use of the money in relation to the new guidelines. Brenny said Malawi was also researching ways to reduce its high dependence on foreign aid, including the possibility of building a local ARV manufacturing plant in partnership with Indian drug companies.
The aim of this study was to assess factors associated with birth-preparedness and complication-readiness as well as the level of male participation in the birth plan among emergency obstetric referrals in rural Uganda. This was a cross-sectional study conducted at Kabale regional hospital maternity ward among 140 women admitted as emergency obstetric referrals in antenatal, labor or the postpartum period. Data was collected on socio-demographics and birth preparedness and what roles spouses were involved in during developing the birth plan. The authors observed that male involvement in birth preparedness and complication readiness for obstetric emergencies is still low. Individual women, their spouses, their families and their communities need to be empowered to contribute positively to making pregnancy safer by making and implementing a birth plan.
MamaYe is a campaign initiated by Evidence for Action, a multi-year programme which aims to improve maternal and newborn survival in sub-Saharan Africa. It is led by African experts in the six countries, Nigeria, Ghana, Sierra Leone, Ethiopia, Malawi and Tanzania and supported by experts in academic and other institutions specialising in maternal and newborn health. MamaYe has produced a factsheet to summarise the evidence on Malawi’s blood services, including how much blood is collected and how much is needed. Just over one third of blood needed in Malawi is being collected. The factsheet covers the importance of blood for preventing maternal deaths, the 4 key components of World Health Organization’s strategy for safe and effective use of blood and achievements in Malawi in blood donation and availability. The factsheet also reviews continued challenges for availability of blood in Malawi and an overview of Malawi’s blood transfusion services, including: the organisation of the blood transfusion services; blood supply; donor population; blood use towards maternal, newborn and child health; and blood safety and screening.