title: Moving malaria in pregnancy programs from neglect to priority: experience from Malawi, Senegal, and Zambia.
abstract: BACKGROUND
  Pregnant women and infants are particularly vulnerable to malaria. National malaria in pregnancy (MIP) programs in Malawi, Senegal, and Zambia were reviewed to identify promising strategies that have helped these countries achieve relatively high coverage of MIP interventions as well as ongoing challenges that have inhibited further progress.
  
  
  METHODS
  We used a systematic case study methodology to assess health system strengths and challenges in the 3 countries, including desk reviews of available reports and literature and key informant interviews with national stakeholders. Data were collected between 2009 and 2011 and analyzed across 8 MIP health systems components: (1) integration of programs and services, (2) policy, (3) commodities, (4) quality assurance, (5) capacity building, (6) community involvement, (7) monitoring and evaluation, and (8) financing. Within each program area, we ranked degree of scale up across 4 stages and synthesized the findings in a MIP table of analysis to reveal common themes related to better practices, remaining bottlenecks, and opportunities to accelerate MIP coverage, strengthen MIP programs, and improve results.
  
  
  RESULTS
  Each of the 3 countries has malaria policies in place that reflect current MIP guidance from the World Health Organization. The 3 countries successfully integrated MIP interventions into a platform of antenatal care services, but coordination at the national level was disjointed. All 3 countries recognized the importance of having a MIP focal person to ensure collaboration and planning at the national level, but only Malawi had appointed one. Commodity stockouts were frequent due to problems at all levels of the logistics system, from quantification to distribution. Lack of support for quality assurance and weak monitoring and evaluation mechanisms across all 3 countries affected optimal coverage.
  
  
  CONCLUSIONS
  MIP programs should address all 8 interconnected MIP health systems areas holistically, in the context of a health systems approach to building successful programs. The MIP table of analysis can be a useful tool for other malaria-endemic countries to review their programs and improve MIP outcomes.
authors.affiliation: Jhpiego, Maternal and Child Health Program (MCHIP) , Baltimore, MD , USA.
authors.forename: Elaine
authors.initials: E
authors.lastname: Roman
authors.affiliation: Jhpiego-Zambia , Lusaka , Zambia.
authors.forename: Michelle
authors.initials: M
authors.lastname: Wallon
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Department of International Health, Health Systems Program , Baltimore, MD , USA.
authors.forename: William
authors.initials: W
authors.lastname: Brieger
authors.affiliation: Jhpiego, Maternal and Child Health Program (MCHIP) , Baltimore, MD , USA.
authors.forename: Aimee
authors.initials: A
authors.lastname: Dickerson
authors.affiliation: Jhpiego-Zambia , Lusaka , Zambia.
authors.forename: Barbara
authors.initials: B
authors.lastname: Rawlins
authors.affiliation: Jhpiego, MCHIP , Washington, DC , USA.
authors.forename: Koki
authors.initials: K
authors.lastname: Agarwal
mesh_terms: D000962:Antimalarials / Q000008:administration & dosage; D057191:Capacity Building; D004338:Drug Combinations; D005260:Female; D006291:Health Policy; D006292:Health Priorities; D006293:Health Promotion / Q000458:organization & administration*; D006801:Humans; D057148:Insecticide-Treated Bednets; D008288:Malaria / Q000188:drug therapy / Q000517:prevention & control*; D008295:Malawi; D008427:Maternal Health Services / Q000458:organization & administration*; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000188:drug therapy / Q000517:prevention & control*; D011739:Pyrimethamine / Q000008:administration & dosage; D011785:Quality Assurance, Health Care; D012675:Senegal; D013413:Sulfadoxine / Q000008:administration & dosage; D015024:Zambia
chemical_list: D000962:Antimalarials; D004338:Drug Combinations; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D011739:Pyrimethamine