Annett Hoppe Rapid Assessment for District-Based Malaria Prevention During Pregnancy: Assessing the Disease Burden after Implementing a Program of Intermittent Preventive Treatment in Koupéla District, Burkina Faso
The burden of malaria is tremendous in Burkina Faso, a fact reflected in the high under-5 mortality rate of more than 200 deaths per 1,000 live births (UNICEF). Malaria infection (both symptomatic and asymptomatic) is especially dangerous to pregnant women and children. In addition to being associated with maternal health problems such as anemia, malaria infection during pregnancy can have harmful effects on the developing fetus. In areas of stable malaria transmission, where women have partial immunity to malaria and malaria infection is usually asymptomatic, placental malaria infection is strongly associated with low birth weight, which is in-turn associated with a higher risk of infant mortality. In 2001, an assessment of the burden of malaria infection in pregnant women was completed in Koupéla, Burkina Faso, in collaboration with the Ministry of Health of Burkina Faso/CNRFP (Centre National de Recherche et Formation sur le Paludisme), CDC and JHPIEGO Corporation. This initial assessment found that peripheral and placental malaria, anemia, and low birth weight were common, and were not significantly reduced by chloroquine prophylaxis. Following this assessment the Burkina Faso Ministry of Health piloted a new malaria prevention strategy of intermittent preventive treatment (IPT) with 3 doses of sulfadoxine pyrimethamine (SP) at all antenatal care facilities in Koupéla district. I completed my practicum in Burkina Faso working on a follow-up assessment, a collaboration between the Burkina Faso Ministry of Health, CDC, and JHPIEGO, which evaluated the effectiveness of this new malaria prevention program. The assessment was conducted at two delivery units and six antenatal care clinics located in Koupéla district. To accurately compare these new results to the baseline assessment we focused on the same outcome measures, including maternal anemia, placental parasitemia, and low birth weight. We also conducted the assessment during the same time frame (June-November) in order to compare comparable points in the seasonal variation of malaria transmission. All enrolled women were administered a questionnaire regarding socio-demographic characteristics, health during the current pregnancy with emphasis on febrile illnesses, and malaria prevention strategies used. We also collected specimens for maternal hemoglobin determination (antenatal care assessment only) as well as peripheral malaria parasitemia (antenatal care and delivery unit assessments) and placental parasitemia (delivery unit assessment only). In addition, we measured maternal height and mid-upper arm circumference at delivery. Newborns were weighed and gestational age determined by Ballard examination. Data collection for the assessment will conclude in early November. Data analysis is scheduled for late 2004, and dissemination of the results to decision makers is scheduled to occur in Burkina Faso in February 2005. I was part of the local assessment team, collecting data, monitoring the data collection process, procuring supplies and communicating relevant information from the field site to the three collaborating institutions. This assessment was conducted to provide useful data to the Burkina Faso MoH who will decide, primarily based on the results of this assessment, whether the program of IPT with SP should be implemented in other districts of Burkina Faso. This was an incredible opportunity giving me insight into the world of international research and policy. I would like to extend many thanks to the CDC’s Malaria Branch, especially, Dr. Robert Newman, Dr. Monica Parise, and Dr. Kwame Asamoa for offering me such an exciting opportunity. Thank you also to distinct individuals at CNRFP, JHPIEGO-USA, and JHPIEGO-Burkina Faso, to the Hubert Charitable Trust and the GFE committee.
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