Prevention of malaria during pregnancy in West Africa: policy change and the power of subregional action.
BACKGROUND
Despite a broadening consensus about the effectiveness of intermittent preventive treatment (IPTp) in preventing the adverse outcomes of malaria during pregnancy, policy change to IPTp was initially limited to East Africa. In West Africa, where the policy change process for the prevention of malaria during pregnancy started much later, IPTp has been taken up swiftly.


OBJECTIVE
To describe the factors that contributed to the rapid adoption of policies to prevent malaria during pregnancy in West Africa.


CONCLUSIONS
Several factors appear to have accelerated the process: (1) recognition of the extent of the problem of malaria during pregnancy and its adverse consequences; (2) a clear, evidence-based program strategy strongly articulated by an important multilateral organization (World Health Organization); (3) subregionally generated evidence to support the proposed strategy; (4) a subregional forum for dissemination of data and discussion regarding the proposed policy changes; (5) widespread availability of the proposed intervention drug (sulfadoxine-pyrimethamine); (6) technical support from reputable and respected institutions in drafting new policies and planning for implementation; (7) donor support for pilot experiences in integrating proposed policy change into a package of preventive services; and (8) financial support for scaling up the proposed interventions.
Malaria Branch, Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA. rnewman@cdc.gov
Robert D
RD
Newman
Allisyn C
AC
Moran
Kassoum
K
Kayentao
Elizabeth
E
Benga-De
Mathias
M
Yameogo
Oumar
O
Gaye
Ousmane
O
Faye
Youssoufa
Y
Lo
Philippe Marc
PM
Moreira
Ogobara
O
Doumbo
Monica E
ME
Parise
Richard W
RW
Steketee
D000354:Africa, Western / Q000453:epidemiology; D000962:Antimalarials / Q000009:adverse effects / Q000627:therapeutic use*; D002738:Chloroquine / Q000627:therapeutic use; D003144:Communication Barriers; D004338:Drug Combinations; D004351:Drug Resistance; D019317:Evidence-Based Medicine / Q000458:organization & administration; D005260:Female; D005381:Financing, Organized; D006266:Health Education / Q000379:methods; D006291:Health Policy / Q000191:economics; D006801:Humans; D007391:International Cooperation; D007400:Interprofessional Relations; D016778:Malaria, Falciparum / Q000453:epidemiology / Q000517:prevention & control*; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000453:epidemiology / Q000517:prevention & control*; D011739:Pyrimethamine / Q000009:adverse effects / Q000627:therapeutic use; D013413:Sulfadoxine / Q000009:adverse effects / Q000627:therapeutic use
D000962:Antimalarials; D004338:Drug Combinations; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D002738:Chloroquine; D011739:Pyrimethamine