title: From evidence to action? Challenges to policy change and programme delivery for malaria in pregnancy.
abstract: This paper discusses the factors that influence whether strategies for preventing and treating malaria in pregnancy are successfully translated into national policy and programme implementation, and identifies key operational research issues. Countries require guidance on how to assess the effectiveness of intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine-pyrimethamine in the context of increasing sulfadoxine-pyrimethamine resistance. At the same time, data on the safety and efficacy of alternatives to sulfadoxine-pyrimethamine for prevention and treatment are urgently needed. Systematic examination of the cultural and operational constraints to delivery and uptake of IPTp with sulfadoxine-pyrimethamine and use of insecticide-treated nets would provide a rational basis for strategies aimed at improving coverage. Standardised methodology must be used to monitor IPTp coverage and to compare different approaches for scaling-up the delivery of insecticide-treated nets to pregnant women. Adequate budgetary provision for the implementation of policy and for operational research to improve programme delivery should be included in national applications to the Global Fund to Fight AIDS, Tuberculosis and Malaria. The provision of clear policy guidance on malaria in pregnancy and its translation into evidence-based guidelines that are made widely available at a country level are central to improving malaria control in this particularly vulnerable group.
authors.affiliation: Global Malaria Programme, World Health Organization, Geneva, Switzerland. jane.crawley@gmail.com
authors.forename: Jane
authors.initials: J
authors.lastname: Crawley
authors.forename: Jenny
authors.initials: J
authors.lastname: Hill
authors.forename: Juliana
authors.initials: J
authors.lastname: Yartey
authors.forename: Magda
authors.initials: M
authors.lastname: Robalo
authors.forename: Antoine
authors.initials: A
authors.lastname: Serufilira
authors.forename: Antoinette
authors.initials: A
authors.lastname: Ba-Nguz
authors.forename: Elaine
authors.initials: E
authors.lastname: Roman
authors.forename: Ayo
authors.initials: A
authors.lastname: Palmer
authors.forename: Kwame
authors.initials: K
authors.lastname: Asamoa
authors.forename: Richard
authors.initials: R
authors.lastname: Steketee
mesh_terms: D017954:Africa South of the Sahara; D000818:Animals; D000962:Antimalarials / Q000008:administration & dosage / Q000627:therapeutic use*; D003695:Delivery of Health Care; D004338:Drug Combinations; D005260:Female; D006291:Health Policy; D006801:Humans; D016778:Malaria, Falciparum / Q000188:drug therapy / Q000469:parasitology / Q000517:prevention & control*; D010963:Plasmodium falciparum / Q000187:drug effects; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000188:drug therapy / Q000469:parasitology / Q000517:prevention & control*; D011295:Prenatal Care / Q000379:methods / Q000706:statistics & numerical data; D011739:Pyrimethamine / Q000008:administration & dosage / Q000627:therapeutic use*; D013413:Sulfadoxine / Q000008:administration & dosage / Q000627:therapeutic use*; D014944:World Health Organization
chemical_list: D000962:Antimalarials; D004338:Drug Combinations; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D011739:Pyrimethamine