This site uses cookies to deliver our services and to show you relevant ads and presentations. By clicking on "Accept", you acknowledge that you have read and understand our Cookie Policy , Privacy Policy , and our Terms of Use.
X

Download Malaria in Pregnancy-Malaria Foundation International PowerPoint Presentation


Login   OR  Register
X


Iframe embed code :



Presentation url :

X

Description :

Available Malaria in Pregnancy-Malaria Foundation International powerpoint presentation for free download which is uploaded by steve an active user in belonging ppt presentation Health & Wellness category.

Tags :

malaria in pregnancy | malaria | malaria disease | malaria treatment

Home / Health & Wellness / Health & Wellness Presentations / Malaria in Pregnancy-Malaria Foundation International PowerPoint Presentation

Malaria in Pregnancy-Malaria Foundation International PowerPoint Presentation

Ppt Presentation Embed Code   Zoom Ppt Presentation

About This Presentation


Description : Available Malaria in Pregnancy-Malaria Foundation International powerpoint presentation for free dow... Read More

Tags : malaria in pregnancy | malaria | malaria disease | malaria treatment

Published on : Aug 07, 2014
Views : 345 | Downloads : 0


Download Now

Share on Social Media

             

PowerPoint is the world's most popular presentation software which can let you create professional Malaria in Pregnancy-Malaria Foundation International powerpoint presentation easily and in no time. This helps you give your presentation on Malaria in Pregnancy-Malaria Foundation International in a conference, a school lecture, a business proposal, in a webinar and business and professional representations.

The uploader spent his/her valuable time to create this Malaria in Pregnancy-Malaria Foundation International powerpoint presentation slides, to share his/her useful content with the world. This ppt presentation uploaded by worldwideweb in this Health & Wellness category is available for free download,and can be used according to your industries like finance, marketing, education, health and many more.

SlidesFinder.com provides a platform to marketers, presenters and educationists along with being the preferred search engine for professional PowerPoint presentations on the Internet to upload their Malaria in Pregnancy-Malaria Foundation International ppt presentation slides to help them BUILD THEIR CROWD!!

User Presentation
Related Presentation
Free PowerPoint Templates
Slide 1 - Prevention and Control of Malaria during Pregnancy A Workshop for Healthcare Providers
Slide 2 - Prevention and Control of Malaria during Pregnancy A Workshop for Healthcare Providers Prevention and Control of Malaria during Pregnancy 2 Facts about Malaria 300 million cases each year worldwide 9 of 10 cases occur in Africa A person in Africa dies of malaria every 10 seconds Women and young children are most at risk Affects five times as many people as AIDS, leprosy, measles, and tuberculosis combined
Slide 3 - Prevention and Control of Malaria during Pregnancy A Workshop for Healthcare Providers Prevention and Control of Malaria during Pregnancy 2 Facts about Malaria 300 million cases each year worldwide 9 of 10 cases occur in Africa A person in Africa dies of malaria every 10 seconds Women and young children are most at risk Affects five times as many people as AIDS, leprosy, measles, and tuberculosis combined Prevention and Control of Malaria during Pregnancy 3 Facts about Malaria and Pregnancy 30 million African women are pregnant yearly Malaria is more frequent and complicated during pregnancy In malaria-endemic areas, malaria during pregnancy may account for: Up to 15% of maternal anemia 5–14% of low birthweight 30% of “preventable” low birthweight
Slide 4 - Prevention and Control of Malaria during Pregnancy A Workshop for Healthcare Providers Prevention and Control of Malaria during Pregnancy 2 Facts about Malaria 300 million cases each year worldwide 9 of 10 cases occur in Africa A person in Africa dies of malaria every 10 seconds Women and young children are most at risk Affects five times as many people as AIDS, leprosy, measles, and tuberculosis combined Prevention and Control of Malaria during Pregnancy 3 Facts about Malaria and Pregnancy 30 million African women are pregnant yearly Malaria is more frequent and complicated during pregnancy In malaria-endemic areas, malaria during pregnancy may account for: Up to 15% of maternal anemia 5–14% of low birthweight 30% of “preventable” low birthweight Prevention and Control of Malaria during Pregnancy 4 Roll Back Malaria Worldwide partnership Governments, private groups, research organizations, civil society, media Aim to reduce malaria by half by 2010 Free advocacy resources and tools: http://www.rbm.who.int Priority: Prevent poor outcomes caused by malaria in pregnancy Abuja declaration: Goal is for 60% of women in Africa to be sleeping under insecticide-treated nets (ITNs) and getting intermittent preventive treatment (IPT) by 2005
Slide 5 - Prevention and Control of Malaria during Pregnancy A Workshop for Healthcare Providers Prevention and Control of Malaria during Pregnancy 2 Facts about Malaria 300 million cases each year worldwide 9 of 10 cases occur in Africa A person in Africa dies of malaria every 10 seconds Women and young children are most at risk Affects five times as many people as AIDS, leprosy, measles, and tuberculosis combined Prevention and Control of Malaria during Pregnancy 3 Facts about Malaria and Pregnancy 30 million African women are pregnant yearly Malaria is more frequent and complicated during pregnancy In malaria-endemic areas, malaria during pregnancy may account for: Up to 15% of maternal anemia 5–14% of low birthweight 30% of “preventable” low birthweight Prevention and Control of Malaria during Pregnancy 4 Roll Back Malaria Worldwide partnership Governments, private groups, research organizations, civil society, media Aim to reduce malaria by half by 2010 Free advocacy resources and tools: http://www.rbm.who.int Priority: Prevent poor outcomes caused by malaria in pregnancy Abuja declaration: Goal is for 60% of women in Africa to be sleeping under insecticide-treated nets (ITNs) and getting intermittent preventive treatment (IPT) by 2005 Prevention and Control of Malaria during Pregnancy 5 Malaria Prevention and Treatment during Pregnancy Focused antenatal care (ANC) with health education about malaria Use of insecticide-treated nets (ITNs) Intermittent preventive treatment (IPT) Case management of women with symptoms and signs of malaria
Slide 6 - Prevention and Control of Malaria during Pregnancy A Workshop for Healthcare Providers Prevention and Control of Malaria during Pregnancy 2 Facts about Malaria 300 million cases each year worldwide 9 of 10 cases occur in Africa A person in Africa dies of malaria every 10 seconds Women and young children are most at risk Affects five times as many people as AIDS, leprosy, measles, and tuberculosis combined Prevention and Control of Malaria during Pregnancy 3 Facts about Malaria and Pregnancy 30 million African women are pregnant yearly Malaria is more frequent and complicated during pregnancy In malaria-endemic areas, malaria during pregnancy may account for: Up to 15% of maternal anemia 5–14% of low birthweight 30% of “preventable” low birthweight Prevention and Control of Malaria during Pregnancy 4 Roll Back Malaria Worldwide partnership Governments, private groups, research organizations, civil society, media Aim to reduce malaria by half by 2010 Free advocacy resources and tools: http://www.rbm.who.int Priority: Prevent poor outcomes caused by malaria in pregnancy Abuja declaration: Goal is for 60% of women in Africa to be sleeping under insecticide-treated nets (ITNs) and getting intermittent preventive treatment (IPT) by 2005 Prevention and Control of Malaria during Pregnancy 5 Malaria Prevention and Treatment during Pregnancy Focused antenatal care (ANC) with health education about malaria Use of insecticide-treated nets (ITNs) Intermittent preventive treatment (IPT) Case management of women with symptoms and signs of malaria Prevention and Control of Malaria during Pregnancy Chapter I: Focused Antenatal Care
Slide 7 - Prevention and Control of Malaria during Pregnancy A Workshop for Healthcare Providers Prevention and Control of Malaria during Pregnancy 2 Facts about Malaria 300 million cases each year worldwide 9 of 10 cases occur in Africa A person in Africa dies of malaria every 10 seconds Women and young children are most at risk Affects five times as many people as AIDS, leprosy, measles, and tuberculosis combined Prevention and Control of Malaria during Pregnancy 3 Facts about Malaria and Pregnancy 30 million African women are pregnant yearly Malaria is more frequent and complicated during pregnancy In malaria-endemic areas, malaria during pregnancy may account for: Up to 15% of maternal anemia 5–14% of low birthweight 30% of “preventable” low birthweight Prevention and Control of Malaria during Pregnancy 4 Roll Back Malaria Worldwide partnership Governments, private groups, research organizations, civil society, media Aim to reduce malaria by half by 2010 Free advocacy resources and tools: http://www.rbm.who.int Priority: Prevent poor outcomes caused by malaria in pregnancy Abuja declaration: Goal is for 60% of women in Africa to be sleeping under insecticide-treated nets (ITNs) and getting intermittent preventive treatment (IPT) by 2005 Prevention and Control of Malaria during Pregnancy 5 Malaria Prevention and Treatment during Pregnancy Focused antenatal care (ANC) with health education about malaria Use of insecticide-treated nets (ITNs) Intermittent preventive treatment (IPT) Case management of women with symptoms and signs of malaria Prevention and Control of Malaria during Pregnancy Chapter I: Focused Antenatal Care Prevention and Control of Malaria during Pregnancy 7 Focused Antenatal Care: Chapter Objectives Describe four main components of focused antenatal care (ANC) Discuss frequency and timing of ANC visits Describe essential elements of a birth plan that includes complication readiness Describe interpersonal skills for effective ANC Describe components of record keeping for ANC
Slide 8 - Prevention and Control of Malaria during Pregnancy A Workshop for Healthcare Providers Prevention and Control of Malaria during Pregnancy 2 Facts about Malaria 300 million cases each year worldwide 9 of 10 cases occur in Africa A person in Africa dies of malaria every 10 seconds Women and young children are most at risk Affects five times as many people as AIDS, leprosy, measles, and tuberculosis combined Prevention and Control of Malaria during Pregnancy 3 Facts about Malaria and Pregnancy 30 million African women are pregnant yearly Malaria is more frequent and complicated during pregnancy In malaria-endemic areas, malaria during pregnancy may account for: Up to 15% of maternal anemia 5–14% of low birthweight 30% of “preventable” low birthweight Prevention and Control of Malaria during Pregnancy 4 Roll Back Malaria Worldwide partnership Governments, private groups, research organizations, civil society, media Aim to reduce malaria by half by 2010 Free advocacy resources and tools: http://www.rbm.who.int Priority: Prevent poor outcomes caused by malaria in pregnancy Abuja declaration: Goal is for 60% of women in Africa to be sleeping under insecticide-treated nets (ITNs) and getting intermittent preventive treatment (IPT) by 2005 Prevention and Control of Malaria during Pregnancy 5 Malaria Prevention and Treatment during Pregnancy Focused antenatal care (ANC) with health education about malaria Use of insecticide-treated nets (ITNs) Intermittent preventive treatment (IPT) Case management of women with symptoms and signs of malaria Prevention and Control of Malaria during Pregnancy Chapter I: Focused Antenatal Care Prevention and Control of Malaria during Pregnancy 7 Focused Antenatal Care: Chapter Objectives Describe four main components of focused antenatal care (ANC) Discuss frequency and timing of ANC visits Describe essential elements of a birth plan that includes complication readiness Describe interpersonal skills for effective ANC Describe components of record keeping for ANC Prevention and Control of Malaria during Pregnancy 8 Focused Antenatal Care An approach to ANC that emphasizes: Evidence-based, goal-directed actions Individualized, woman-centered care Quality vs. quantity of visits Care by skilled providers
Slide 9 - Prevention and Control of Malaria during Pregnancy A Workshop for Healthcare Providers Prevention and Control of Malaria during Pregnancy 2 Facts about Malaria 300 million cases each year worldwide 9 of 10 cases occur in Africa A person in Africa dies of malaria every 10 seconds Women and young children are most at risk Affects five times as many people as AIDS, leprosy, measles, and tuberculosis combined Prevention and Control of Malaria during Pregnancy 3 Facts about Malaria and Pregnancy 30 million African women are pregnant yearly Malaria is more frequent and complicated during pregnancy In malaria-endemic areas, malaria during pregnancy may account for: Up to 15% of maternal anemia 5–14% of low birthweight 30% of “preventable” low birthweight Prevention and Control of Malaria during Pregnancy 4 Roll Back Malaria Worldwide partnership Governments, private groups, research organizations, civil society, media Aim to reduce malaria by half by 2010 Free advocacy resources and tools: http://www.rbm.who.int Priority: Prevent poor outcomes caused by malaria in pregnancy Abuja declaration: Goal is for 60% of women in Africa to be sleeping under insecticide-treated nets (ITNs) and getting intermittent preventive treatment (IPT) by 2005 Prevention and Control of Malaria during Pregnancy 5 Malaria Prevention and Treatment during Pregnancy Focused antenatal care (ANC) with health education about malaria Use of insecticide-treated nets (ITNs) Intermittent preventive treatment (IPT) Case management of women with symptoms and signs of malaria Prevention and Control of Malaria during Pregnancy Chapter I: Focused Antenatal Care Prevention and Control of Malaria during Pregnancy 7 Focused Antenatal Care: Chapter Objectives Describe four main components of focused antenatal care (ANC) Discuss frequency and timing of ANC visits Describe essential elements of a birth plan that includes complication readiness Describe interpersonal skills for effective ANC Describe components of record keeping for ANC Prevention and Control of Malaria during Pregnancy 8 Focused Antenatal Care An approach to ANC that emphasizes: Evidence-based, goal-directed actions Individualized, woman-centered care Quality vs. quantity of visits Care by skilled providers Prevention and Control of Malaria during Pregnancy 9 Goal of Focused Antenatal Care To promote maternal and newborn health and survival through: Early detection and treatment of problems and complications Prevention of complications and disease Birth preparedness and complication readiness Health promotion
Slide 10 - Prevention and Control of Malaria during Pregnancy A Workshop for Healthcare Providers Prevention and Control of Malaria during Pregnancy 2 Facts about Malaria 300 million cases each year worldwide 9 of 10 cases occur in Africa A person in Africa dies of malaria every 10 seconds Women and young children are most at risk Affects five times as many people as AIDS, leprosy, measles, and tuberculosis combined Prevention and Control of Malaria during Pregnancy 3 Facts about Malaria and Pregnancy 30 million African women are pregnant yearly Malaria is more frequent and complicated during pregnancy In malaria-endemic areas, malaria during pregnancy may account for: Up to 15% of maternal anemia 5–14% of low birthweight 30% of “preventable” low birthweight Prevention and Control of Malaria during Pregnancy 4 Roll Back Malaria Worldwide partnership Governments, private groups, research organizations, civil society, media Aim to reduce malaria by half by 2010 Free advocacy resources and tools: http://www.rbm.who.int Priority: Prevent poor outcomes caused by malaria in pregnancy Abuja declaration: Goal is for 60% of women in Africa to be sleeping under insecticide-treated nets (ITNs) and getting intermittent preventive treatment (IPT) by 2005 Prevention and Control of Malaria during Pregnancy 5 Malaria Prevention and Treatment during Pregnancy Focused antenatal care (ANC) with health education about malaria Use of insecticide-treated nets (ITNs) Intermittent preventive treatment (IPT) Case management of women with symptoms and signs of malaria Prevention and Control of Malaria during Pregnancy Chapter I: Focused Antenatal Care Prevention and Control of Malaria during Pregnancy 7 Focused Antenatal Care: Chapter Objectives Describe four main components of focused antenatal care (ANC) Discuss frequency and timing of ANC visits Describe essential elements of a birth plan that includes complication readiness Describe interpersonal skills for effective ANC Describe components of record keeping for ANC Prevention and Control of Malaria during Pregnancy 8 Focused Antenatal Care An approach to ANC that emphasizes: Evidence-based, goal-directed actions Individualized, woman-centered care Quality vs. quantity of visits Care by skilled providers Prevention and Control of Malaria during Pregnancy 9 Goal of Focused Antenatal Care To promote maternal and newborn health and survival through: Early detection and treatment of problems and complications Prevention of complications and disease Birth preparedness and complication readiness Health promotion Prevention and Control of Malaria during Pregnancy 10 Traditional Antenatal Care Emphasizes: Ritualistic, “routine” care vs. evidence-based, goal-directed actions Frequent visits Does not emphasize individual client needs
Slide 11 - Prevention and Control of Malaria during Pregnancy A Workshop for Healthcare Providers Prevention and Control of Malaria during Pregnancy 2 Facts about Malaria 300 million cases each year worldwide 9 of 10 cases occur in Africa A person in Africa dies of malaria every 10 seconds Women and young children are most at risk Affects five times as many people as AIDS, leprosy, measles, and tuberculosis combined Prevention and Control of Malaria during Pregnancy 3 Facts about Malaria and Pregnancy 30 million African women are pregnant yearly Malaria is more frequent and complicated during pregnancy In malaria-endemic areas, malaria during pregnancy may account for: Up to 15% of maternal anemia 5–14% of low birthweight 30% of “preventable” low birthweight Prevention and Control of Malaria during Pregnancy 4 Roll Back Malaria Worldwide partnership Governments, private groups, research organizations, civil society, media Aim to reduce malaria by half by 2010 Free advocacy resources and tools: http://www.rbm.who.int Priority: Prevent poor outcomes caused by malaria in pregnancy Abuja declaration: Goal is for 60% of women in Africa to be sleeping under insecticide-treated nets (ITNs) and getting intermittent preventive treatment (IPT) by 2005 Prevention and Control of Malaria during Pregnancy 5 Malaria Prevention and Treatment during Pregnancy Focused antenatal care (ANC) with health education about malaria Use of insecticide-treated nets (ITNs) Intermittent preventive treatment (IPT) Case management of women with symptoms and signs of malaria Prevention and Control of Malaria during Pregnancy Chapter I: Focused Antenatal Care Prevention and Control of Malaria during Pregnancy 7 Focused Antenatal Care: Chapter Objectives Describe four main components of focused antenatal care (ANC) Discuss frequency and timing of ANC visits Describe essential elements of a birth plan that includes complication readiness Describe interpersonal skills for effective ANC Describe components of record keeping for ANC Prevention and Control of Malaria during Pregnancy 8 Focused Antenatal Care An approach to ANC that emphasizes: Evidence-based, goal-directed actions Individualized, woman-centered care Quality vs. quantity of visits Care by skilled providers Prevention and Control of Malaria during Pregnancy 9 Goal of Focused Antenatal Care To promote maternal and newborn health and survival through: Early detection and treatment of problems and complications Prevention of complications and disease Birth preparedness and complication readiness Health promotion Prevention and Control of Malaria during Pregnancy 10 Traditional Antenatal Care Emphasizes: Ritualistic, “routine” care vs. evidence-based, goal-directed actions Frequent visits Does not emphasize individual client needs Prevention and Control of Malaria during Pregnancy 11 No Longer Recommended Numerous, routine visits Burden to women and healthcare system Routine measurements and examinations: Maternal height and weight Ankle edema Fetal position before 36 weeks Care based on risk assessment
Slide 12 - Prevention and Control of Malaria during Pregnancy A Workshop for Healthcare Providers Prevention and Control of Malaria during Pregnancy 2 Facts about Malaria 300 million cases each year worldwide 9 of 10 cases occur in Africa A person in Africa dies of malaria every 10 seconds Women and young children are most at risk Affects five times as many people as AIDS, leprosy, measles, and tuberculosis combined Prevention and Control of Malaria during Pregnancy 3 Facts about Malaria and Pregnancy 30 million African women are pregnant yearly Malaria is more frequent and complicated during pregnancy In malaria-endemic areas, malaria during pregnancy may account for: Up to 15% of maternal anemia 5–14% of low birthweight 30% of “preventable” low birthweight Prevention and Control of Malaria during Pregnancy 4 Roll Back Malaria Worldwide partnership Governments, private groups, research organizations, civil society, media Aim to reduce malaria by half by 2010 Free advocacy resources and tools: http://www.rbm.who.int Priority: Prevent poor outcomes caused by malaria in pregnancy Abuja declaration: Goal is for 60% of women in Africa to be sleeping under insecticide-treated nets (ITNs) and getting intermittent preventive treatment (IPT) by 2005 Prevention and Control of Malaria during Pregnancy 5 Malaria Prevention and Treatment during Pregnancy Focused antenatal care (ANC) with health education about malaria Use of insecticide-treated nets (ITNs) Intermittent preventive treatment (IPT) Case management of women with symptoms and signs of malaria Prevention and Control of Malaria during Pregnancy Chapter I: Focused Antenatal Care Prevention and Control of Malaria during Pregnancy 7 Focused Antenatal Care: Chapter Objectives Describe four main components of focused antenatal care (ANC) Discuss frequency and timing of ANC visits Describe essential elements of a birth plan that includes complication readiness Describe interpersonal skills for effective ANC Describe components of record keeping for ANC Prevention and Control of Malaria during Pregnancy 8 Focused Antenatal Care An approach to ANC that emphasizes: Evidence-based, goal-directed actions Individualized, woman-centered care Quality vs. quantity of visits Care by skilled providers Prevention and Control of Malaria during Pregnancy 9 Goal of Focused Antenatal Care To promote maternal and newborn health and survival through: Early detection and treatment of problems and complications Prevention of complications and disease Birth preparedness and complication readiness Health promotion Prevention and Control of Malaria during Pregnancy 10 Traditional Antenatal Care Emphasizes: Ritualistic, “routine” care vs. evidence-based, goal-directed actions Frequent visits Does not emphasize individual client needs Prevention and Control of Malaria during Pregnancy 11 No Longer Recommended Numerous, routine visits Burden to women and healthcare system Routine measurements and examinations: Maternal height and weight Ankle edema Fetal position before 36 weeks Care based on risk assessment Prevention and Control of Malaria during Pregnancy 12 Risk Approach Not an effective ANC strategy because: Complications cannot be predicted—all pregnant women are at risk for developing complications Risk factors are usually not direct cause of complications Many “low risk” women develop complications Have false sense of security Do not know how to recognize/respond to problems Most “high risk” women give birth without complications Inefficient use of scarce resources
Slide 13 - Prevention and Control of Malaria during Pregnancy A Workshop for Healthcare Providers Prevention and Control of Malaria during Pregnancy 2 Facts about Malaria 300 million cases each year worldwide 9 of 10 cases occur in Africa A person in Africa dies of malaria every 10 seconds Women and young children are most at risk Affects five times as many people as AIDS, leprosy, measles, and tuberculosis combined Prevention and Control of Malaria during Pregnancy 3 Facts about Malaria and Pregnancy 30 million African women are pregnant yearly Malaria is more frequent and complicated during pregnancy In malaria-endemic areas, malaria during pregnancy may account for: Up to 15% of maternal anemia 5–14% of low birthweight 30% of “preventable” low birthweight Prevention and Control of Malaria during Pregnancy 4 Roll Back Malaria Worldwide partnership Governments, private groups, research organizations, civil society, media Aim to reduce malaria by half by 2010 Free advocacy resources and tools: http://www.rbm.who.int Priority: Prevent poor outcomes caused by malaria in pregnancy Abuja declaration: Goal is for 60% of women in Africa to be sleeping under insecticide-treated nets (ITNs) and getting intermittent preventive treatment (IPT) by 2005 Prevention and Control of Malaria during Pregnancy 5 Malaria Prevention and Treatment during Pregnancy Focused antenatal care (ANC) with health education about malaria Use of insecticide-treated nets (ITNs) Intermittent preventive treatment (IPT) Case management of women with symptoms and signs of malaria Prevention and Control of Malaria during Pregnancy Chapter I: Focused Antenatal Care Prevention and Control of Malaria during Pregnancy 7 Focused Antenatal Care: Chapter Objectives Describe four main components of focused antenatal care (ANC) Discuss frequency and timing of ANC visits Describe essential elements of a birth plan that includes complication readiness Describe interpersonal skills for effective ANC Describe components of record keeping for ANC Prevention and Control of Malaria during Pregnancy 8 Focused Antenatal Care An approach to ANC that emphasizes: Evidence-based, goal-directed actions Individualized, woman-centered care Quality vs. quantity of visits Care by skilled providers Prevention and Control of Malaria during Pregnancy 9 Goal of Focused Antenatal Care To promote maternal and newborn health and survival through: Early detection and treatment of problems and complications Prevention of complications and disease Birth preparedness and complication readiness Health promotion Prevention and Control of Malaria during Pregnancy 10 Traditional Antenatal Care Emphasizes: Ritualistic, “routine” care vs. evidence-based, goal-directed actions Frequent visits Does not emphasize individual client needs Prevention and Control of Malaria during Pregnancy 11 No Longer Recommended Numerous, routine visits Burden to women and healthcare system Routine measurements and examinations: Maternal height and weight Ankle edema Fetal position before 36 weeks Care based on risk assessment Prevention and Control of Malaria during Pregnancy 12 Risk Approach Not an effective ANC strategy because: Complications cannot be predicted—all pregnant women are at risk for developing complications Risk factors are usually not direct cause of complications Many “low risk” women develop complications Have false sense of security Do not know how to recognize/respond to problems Most “high risk” women give birth without complications Inefficient use of scarce resources Prevention and Control of Malaria during Pregnancy 13 Focused Antenatal Care Services Evidence-based, goal-directed actions: Address most prevalent health issues affecting women and newborns Adjusted for specific populations/regions Appropriate to gestational age Based on firm rationale
Slide 14 - Prevention and Control of Malaria during Pregnancy A Workshop for Healthcare Providers Prevention and Control of Malaria during Pregnancy 2 Facts about Malaria 300 million cases each year worldwide 9 of 10 cases occur in Africa A person in Africa dies of malaria every 10 seconds Women and young children are most at risk Affects five times as many people as AIDS, leprosy, measles, and tuberculosis combined Prevention and Control of Malaria during Pregnancy 3 Facts about Malaria and Pregnancy 30 million African women are pregnant yearly Malaria is more frequent and complicated during pregnancy In malaria-endemic areas, malaria during pregnancy may account for: Up to 15% of maternal anemia 5–14% of low birthweight 30% of “preventable” low birthweight Prevention and Control of Malaria during Pregnancy 4 Roll Back Malaria Worldwide partnership Governments, private groups, research organizations, civil society, media Aim to reduce malaria by half by 2010 Free advocacy resources and tools: http://www.rbm.who.int Priority: Prevent poor outcomes caused by malaria in pregnancy Abuja declaration: Goal is for 60% of women in Africa to be sleeping under insecticide-treated nets (ITNs) and getting intermittent preventive treatment (IPT) by 2005 Prevention and Control of Malaria during Pregnancy 5 Malaria Prevention and Treatment during Pregnancy Focused antenatal care (ANC) with health education about malaria Use of insecticide-treated nets (ITNs) Intermittent preventive treatment (IPT) Case management of women with symptoms and signs of malaria Prevention and Control of Malaria during Pregnancy Chapter I: Focused Antenatal Care Prevention and Control of Malaria during Pregnancy 7 Focused Antenatal Care: Chapter Objectives Describe four main components of focused antenatal care (ANC) Discuss frequency and timing of ANC visits Describe essential elements of a birth plan that includes complication readiness Describe interpersonal skills for effective ANC Describe components of record keeping for ANC Prevention and Control of Malaria during Pregnancy 8 Focused Antenatal Care An approach to ANC that emphasizes: Evidence-based, goal-directed actions Individualized, woman-centered care Quality vs. quantity of visits Care by skilled providers Prevention and Control of Malaria during Pregnancy 9 Goal of Focused Antenatal Care To promote maternal and newborn health and survival through: Early detection and treatment of problems and complications Prevention of complications and disease Birth preparedness and complication readiness Health promotion Prevention and Control of Malaria during Pregnancy 10 Traditional Antenatal Care Emphasizes: Ritualistic, “routine” care vs. evidence-based, goal-directed actions Frequent visits Does not emphasize individual client needs Prevention and Control of Malaria during Pregnancy 11 No Longer Recommended Numerous, routine visits Burden to women and healthcare system Routine measurements and examinations: Maternal height and weight Ankle edema Fetal position before 36 weeks Care based on risk assessment Prevention and Control of Malaria during Pregnancy 12 Risk Approach Not an effective ANC strategy because: Complications cannot be predicted—all pregnant women are at risk for developing complications Risk factors are usually not direct cause of complications Many “low risk” women develop complications Have false sense of security Do not know how to recognize/respond to problems Most “high risk” women give birth without complications Inefficient use of scarce resources Prevention and Control of Malaria during Pregnancy 13 Focused Antenatal Care Services Evidence-based, goal-directed actions: Address most prevalent health issues affecting women and newborns Adjusted for specific populations/regions Appropriate to gestational age Based on firm rationale Prevention and Control of Malaria during Pregnancy 14 Focused Antenatal Care Services (cont’d.) Individualized, woman-centered care based on each woman’s: Specific needs and concerns Circumstances History, physical examination, testing Available resources
Slide 15 - Prevention and Control of Malaria during Pregnancy A Workshop for Healthcare Providers Prevention and Control of Malaria during Pregnancy 2 Facts about Malaria 300 million cases each year worldwide 9 of 10 cases occur in Africa A person in Africa dies of malaria every 10 seconds Women and young children are most at risk Affects five times as many people as AIDS, leprosy, measles, and tuberculosis combined Prevention and Control of Malaria during Pregnancy 3 Facts about Malaria and Pregnancy 30 million African women are pregnant yearly Malaria is more frequent and complicated during pregnancy In malaria-endemic areas, malaria during pregnancy may account for: Up to 15% of maternal anemia 5–14% of low birthweight 30% of “preventable” low birthweight Prevention and Control of Malaria during Pregnancy 4 Roll Back Malaria Worldwide partnership Governments, private groups, research organizations, civil society, media Aim to reduce malaria by half by 2010 Free advocacy resources and tools: http://www.rbm.who.int Priority: Prevent poor outcomes caused by malaria in pregnancy Abuja declaration: Goal is for 60% of women in Africa to be sleeping under insecticide-treated nets (ITNs) and getting intermittent preventive treatment (IPT) by 2005 Prevention and Control of Malaria during Pregnancy 5 Malaria Prevention and Treatment during Pregnancy Focused antenatal care (ANC) with health education about malaria Use of insecticide-treated nets (ITNs) Intermittent preventive treatment (IPT) Case management of women with symptoms and signs of malaria Prevention and Control of Malaria during Pregnancy Chapter I: Focused Antenatal Care Prevention and Control of Malaria during Pregnancy 7 Focused Antenatal Care: Chapter Objectives Describe four main components of focused antenatal care (ANC) Discuss frequency and timing of ANC visits Describe essential elements of a birth plan that includes complication readiness Describe interpersonal skills for effective ANC Describe components of record keeping for ANC Prevention and Control of Malaria during Pregnancy 8 Focused Antenatal Care An approach to ANC that emphasizes: Evidence-based, goal-directed actions Individualized, woman-centered care Quality vs. quantity of visits Care by skilled providers Prevention and Control of Malaria during Pregnancy 9 Goal of Focused Antenatal Care To promote maternal and newborn health and survival through: Early detection and treatment of problems and complications Prevention of complications and disease Birth preparedness and complication readiness Health promotion Prevention and Control of Malaria during Pregnancy 10 Traditional Antenatal Care Emphasizes: Ritualistic, “routine” care vs. evidence-based, goal-directed actions Frequent visits Does not emphasize individual client needs Prevention and Control of Malaria during Pregnancy 11 No Longer Recommended Numerous, routine visits Burden to women and healthcare system Routine measurements and examinations: Maternal height and weight Ankle edema Fetal position before 36 weeks Care based on risk assessment Prevention and Control of Malaria during Pregnancy 12 Risk Approach Not an effective ANC strategy because: Complications cannot be predicted—all pregnant women are at risk for developing complications Risk factors are usually not direct cause of complications Many “low risk” women develop complications Have false sense of security Do not know how to recognize/respond to problems Most “high risk” women give birth without complications Inefficient use of scarce resources Prevention and Control of Malaria during Pregnancy 13 Focused Antenatal Care Services Evidence-based, goal-directed actions: Address most prevalent health issues affecting women and newborns Adjusted for specific populations/regions Appropriate to gestational age Based on firm rationale Prevention and Control of Malaria during Pregnancy 14 Focused Antenatal Care Services (cont’d.) Individualized, woman-centered care based on each woman’s: Specific needs and concerns Circumstances History, physical examination, testing Available resources Prevention and Control of Malaria during Pregnancy 15 Focused Antenatal Care Services (cont’d.) Quality vs. quantity of ANC visits: WHO multi-center study Number of visits reduced without affecting outcome for mother or baby Recommendations Content and quality vs. number of visits Goal-oriented care Minimum of four visits
Slide 16 - Prevention and Control of Malaria during Pregnancy A Workshop for Healthcare Providers Prevention and Control of Malaria during Pregnancy 2 Facts about Malaria 300 million cases each year worldwide 9 of 10 cases occur in Africa A person in Africa dies of malaria every 10 seconds Women and young children are most at risk Affects five times as many people as AIDS, leprosy, measles, and tuberculosis combined Prevention and Control of Malaria during Pregnancy 3 Facts about Malaria and Pregnancy 30 million African women are pregnant yearly Malaria is more frequent and complicated during pregnancy In malaria-endemic areas, malaria during pregnancy may account for: Up to 15% of maternal anemia 5–14% of low birthweight 30% of “preventable” low birthweight Prevention and Control of Malaria during Pregnancy 4 Roll Back Malaria Worldwide partnership Governments, private groups, research organizations, civil society, media Aim to reduce malaria by half by 2010 Free advocacy resources and tools: http://www.rbm.who.int Priority: Prevent poor outcomes caused by malaria in pregnancy Abuja declaration: Goal is for 60% of women in Africa to be sleeping under insecticide-treated nets (ITNs) and getting intermittent preventive treatment (IPT) by 2005 Prevention and Control of Malaria during Pregnancy 5 Malaria Prevention and Treatment during Pregnancy Focused antenatal care (ANC) with health education about malaria Use of insecticide-treated nets (ITNs) Intermittent preventive treatment (IPT) Case management of women with symptoms and signs of malaria Prevention and Control of Malaria during Pregnancy Chapter I: Focused Antenatal Care Prevention and Control of Malaria during Pregnancy 7 Focused Antenatal Care: Chapter Objectives Describe four main components of focused antenatal care (ANC) Discuss frequency and timing of ANC visits Describe essential elements of a birth plan that includes complication readiness Describe interpersonal skills for effective ANC Describe components of record keeping for ANC Prevention and Control of Malaria during Pregnancy 8 Focused Antenatal Care An approach to ANC that emphasizes: Evidence-based, goal-directed actions Individualized, woman-centered care Quality vs. quantity of visits Care by skilled providers Prevention and Control of Malaria during Pregnancy 9 Goal of Focused Antenatal Care To promote maternal and newborn health and survival through: Early detection and treatment of problems and complications Prevention of complications and disease Birth preparedness and complication readiness Health promotion Prevention and Control of Malaria during Pregnancy 10 Traditional Antenatal Care Emphasizes: Ritualistic, “routine” care vs. evidence-based, goal-directed actions Frequent visits Does not emphasize individual client needs Prevention and Control of Malaria during Pregnancy 11 No Longer Recommended Numerous, routine visits Burden to women and healthcare system Routine measurements and examinations: Maternal height and weight Ankle edema Fetal position before 36 weeks Care based on risk assessment Prevention and Control of Malaria during Pregnancy 12 Risk Approach Not an effective ANC strategy because: Complications cannot be predicted—all pregnant women are at risk for developing complications Risk factors are usually not direct cause of complications Many “low risk” women develop complications Have false sense of security Do not know how to recognize/respond to problems Most “high risk” women give birth without complications Inefficient use of scarce resources Prevention and Control of Malaria during Pregnancy 13 Focused Antenatal Care Services Evidence-based, goal-directed actions: Address most prevalent health issues affecting women and newborns Adjusted for specific populations/regions Appropriate to gestational age Based on firm rationale Prevention and Control of Malaria during Pregnancy 14 Focused Antenatal Care Services (cont’d.) Individualized, woman-centered care based on each woman’s: Specific needs and concerns Circumstances History, physical examination, testing Available resources Prevention and Control of Malaria during Pregnancy 15 Focused Antenatal Care Services (cont’d.) Quality vs. quantity of ANC visits: WHO multi-center study Number of visits reduced without affecting outcome for mother or baby Recommendations Content and quality vs. number of visits Goal-oriented care Minimum of four visits Prevention and Control of Malaria during Pregnancy 16 First visit: By 16 weeks or when woman first thinks she is pregnant Second visit: At 24–28 weeks or at least once in second trimester Third visit: At 32 weeks Fourth visit: At 36 weeks Other visits: If complication occurs, followup or referral is needed, woman wants to see provider, or provider changes frequency based on findings (history, exam, testing) or local policy Scheduling and Timing of ANC Visits
Slide 17 - Prevention and Control of Malaria during Pregnancy A Workshop for Healthcare Providers Prevention and Control of Malaria during Pregnancy 2 Facts about Malaria 300 million cases each year worldwide 9 of 10 cases occur in Africa A person in Africa dies of malaria every 10 seconds Women and young children are most at risk Affects five times as many people as AIDS, leprosy, measles, and tuberculosis combined Prevention and Control of Malaria during Pregnancy 3 Facts about Malaria and Pregnancy 30 million African women are pregnant yearly Malaria is more frequent and complicated during pregnancy In malaria-endemic areas, malaria during pregnancy may account for: Up to 15% of maternal anemia 5–14% of low birthweight 30% of “preventable” low birthweight Prevention and Control of Malaria during Pregnancy 4 Roll Back Malaria Worldwide partnership Governments, private groups, research organizations, civil society, media Aim to reduce malaria by half by 2010 Free advocacy resources and tools: http://www.rbm.who.int Priority: Prevent poor outcomes caused by malaria in pregnancy Abuja declaration: Goal is for 60% of women in Africa to be sleeping under insecticide-treated nets (ITNs) and getting intermittent preventive treatment (IPT) by 2005 Prevention and Control of Malaria during Pregnancy 5 Malaria Prevention and Treatment during Pregnancy Focused antenatal care (ANC) with health education about malaria Use of insecticide-treated nets (ITNs) Intermittent preventive treatment (IPT) Case management of women with symptoms and signs of malaria Prevention and Control of Malaria during Pregnancy Chapter I: Focused Antenatal Care Prevention and Control of Malaria during Pregnancy 7 Focused Antenatal Care: Chapter Objectives Describe four main components of focused antenatal care (ANC) Discuss frequency and timing of ANC visits Describe essential elements of a birth plan that includes complication readiness Describe interpersonal skills for effective ANC Describe components of record keeping for ANC Prevention and Control of Malaria during Pregnancy 8 Focused Antenatal Care An approach to ANC that emphasizes: Evidence-based, goal-directed actions Individualized, woman-centered care Quality vs. quantity of visits Care by skilled providers Prevention and Control of Malaria during Pregnancy 9 Goal of Focused Antenatal Care To promote maternal and newborn health and survival through: Early detection and treatment of problems and complications Prevention of complications and disease Birth preparedness and complication readiness Health promotion Prevention and Control of Malaria during Pregnancy 10 Traditional Antenatal Care Emphasizes: Ritualistic, “routine” care vs. evidence-based, goal-directed actions Frequent visits Does not emphasize individual client needs Prevention and Control of Malaria during Pregnancy 11 No Longer Recommended Numerous, routine visits Burden to women and healthcare system Routine measurements and examinations: Maternal height and weight Ankle edema Fetal position before 36 weeks Care based on risk assessment Prevention and Control of Malaria during Pregnancy 12 Risk Approach Not an effective ANC strategy because: Complications cannot be predicted—all pregnant women are at risk for developing complications Risk factors are usually not direct cause of complications Many “low risk” women develop complications Have false sense of security Do not know how to recognize/respond to problems Most “high risk” women give birth without complications Inefficient use of scarce resources Prevention and Control of Malaria during Pregnancy 13 Focused Antenatal Care Services Evidence-based, goal-directed actions: Address most prevalent health issues affecting women and newborns Adjusted for specific populations/regions Appropriate to gestational age Based on firm rationale Prevention and Control of Malaria during Pregnancy 14 Focused Antenatal Care Services (cont’d.) Individualized, woman-centered care based on each woman’s: Specific needs and concerns Circumstances History, physical examination, testing Available resources Prevention and Control of Malaria during Pregnancy 15 Focused Antenatal Care Services (cont’d.) Quality vs. quantity of ANC visits: WHO multi-center study Number of visits reduced without affecting outcome for mother or baby Recommendations Content and quality vs. number of visits Goal-oriented care Minimum of four visits Prevention and Control of Malaria during Pregnancy 16 First visit: By 16 weeks or when woman first thinks she is pregnant Second visit: At 24–28 weeks or at least once in second trimester Third visit: At 32 weeks Fourth visit: At 36 weeks Other visits: If complication occurs, followup or referral is needed, woman wants to see provider, or provider changes frequency based on findings (history, exam, testing) or local policy Scheduling and Timing of ANC Visits Prevention and Control of Malaria during Pregnancy 17 Focused Antenatal Care Services (cont’d.) Care by a skilled provider who: Has formal training and experience Has knowledge, skills, and qualifications to deliver safe, effective maternal and newborn healthcare Practices in home, hospital, health center May be a midwife, nurse, doctor, clinical officer, etc.
Slide 18 - Prevention and Control of Malaria during Pregnancy A Workshop for Healthcare Providers Prevention and Control of Malaria during Pregnancy 2 Facts about Malaria 300 million cases each year worldwide 9 of 10 cases occur in Africa A person in Africa dies of malaria every 10 seconds Women and young children are most at risk Affects five times as many people as AIDS, leprosy, measles, and tuberculosis combined Prevention and Control of Malaria during Pregnancy 3 Facts about Malaria and Pregnancy 30 million African women are pregnant yearly Malaria is more frequent and complicated during pregnancy In malaria-endemic areas, malaria during pregnancy may account for: Up to 15% of maternal anemia 5–14% of low birthweight 30% of “preventable” low birthweight Prevention and Control of Malaria during Pregnancy 4 Roll Back Malaria Worldwide partnership Governments, private groups, research organizations, civil society, media Aim to reduce malaria by half by 2010 Free advocacy resources and tools: http://www.rbm.who.int Priority: Prevent poor outcomes caused by malaria in pregnancy Abuja declaration: Goal is for 60% of women in Africa to be sleeping under insecticide-treated nets (ITNs) and getting intermittent preventive treatment (IPT) by 2005 Prevention and Control of Malaria during Pregnancy 5 Malaria Prevention and Treatment during Pregnancy Focused antenatal care (ANC) with health education about malaria Use of insecticide-treated nets (ITNs) Intermittent preventive treatment (IPT) Case management of women with symptoms and signs of malaria Prevention and Control of Malaria during Pregnancy Chapter I: Focused Antenatal Care Prevention and Control of Malaria during Pregnancy 7 Focused Antenatal Care: Chapter Objectives Describe four main components of focused antenatal care (ANC) Discuss frequency and timing of ANC visits Describe essential elements of a birth plan that includes complication readiness Describe interpersonal skills for effective ANC Describe components of record keeping for ANC Prevention and Control of Malaria during Pregnancy 8 Focused Antenatal Care An approach to ANC that emphasizes: Evidence-based, goal-directed actions Individualized, woman-centered care Quality vs. quantity of visits Care by skilled providers Prevention and Control of Malaria during Pregnancy 9 Goal of Focused Antenatal Care To promote maternal and newborn health and survival through: Early detection and treatment of problems and complications Prevention of complications and disease Birth preparedness and complication readiness Health promotion Prevention and Control of Malaria during Pregnancy 10 Traditional Antenatal Care Emphasizes: Ritualistic, “routine” care vs. evidence-based, goal-directed actions Frequent visits Does not emphasize individual client needs Prevention and Control of Malaria during Pregnancy 11 No Longer Recommended Numerous, routine visits Burden to women and healthcare system Routine measurements and examinations: Maternal height and weight Ankle edema Fetal position before 36 weeks Care based on risk assessment Prevention and Control of Malaria during Pregnancy 12 Risk Approach Not an effective ANC strategy because: Complications cannot be predicted—all pregnant women are at risk for developing complications Risk factors are usually not direct cause of complications Many “low risk” women develop complications Have false sense of security Do not know how to recognize/respond to problems Most “high risk” women give birth without complications Inefficient use of scarce resources Prevention and Control of Malaria during Pregnancy 13 Focused Antenatal Care Services Evidence-based, goal-directed actions: Address most prevalent health issues affecting women and newborns Adjusted for specific populations/regions Appropriate to gestational age Based on firm rationale Prevention and Control of Malaria during Pregnancy 14 Focused Antenatal Care Services (cont’d.) Individualized, woman-centered care based on each woman’s: Specific needs and concerns Circumstances History, physical examination, testing Available resources Prevention and Control of Malaria during Pregnancy 15 Focused Antenatal Care Services (cont’d.) Quality vs. quantity of ANC visits: WHO multi-center study Number of visits reduced without affecting outcome for mother or baby Recommendations Content and quality vs. number of visits Goal-oriented care Minimum of four visits Prevention and Control of Malaria during Pregnancy 16 First visit: By 16 weeks or when woman first thinks she is pregnant Second visit: At 24–28 weeks or at least once in second trimester Third visit: At 32 weeks Fourth visit: At 36 weeks Other visits: If complication occurs, followup or referral is needed, woman wants to see provider, or provider changes frequency based on findings (history, exam, testing) or local policy Scheduling and Timing of ANC Visits Prevention and Control of Malaria during Pregnancy 17 Focused Antenatal Care Services (cont’d.) Care by a skilled provider who: Has formal training and experience Has knowledge, skills, and qualifications to deliver safe, effective maternal and newborn healthcare Practices in home, hospital, health center May be a midwife, nurse, doctor, clinical officer, etc. Prevention and Control of Malaria during Pregnancy 18 Early Detection and Treatment Malaria—history and physical exam Fever and accompanying signs/symptoms Region Complicated vs. uncomplicated cases Severe anemia—physical exam, testing Pre-eclampsia/eclampsia—measurement of blood pressure HIV—voluntary counseling and testing Sexually transmitted infections, including syphilis— testing
Slide 19 - Prevention and Control of Malaria during Pregnancy A Workshop for Healthcare Providers Prevention and Control of Malaria during Pregnancy 2 Facts about Malaria 300 million cases each year worldwide 9 of 10 cases occur in Africa A person in Africa dies of malaria every 10 seconds Women and young children are most at risk Affects five times as many people as AIDS, leprosy, measles, and tuberculosis combined Prevention and Control of Malaria during Pregnancy 3 Facts about Malaria and Pregnancy 30 million African women are pregnant yearly Malaria is more frequent and complicated during pregnancy In malaria-endemic areas, malaria during pregnancy may account for: Up to 15% of maternal anemia 5–14% of low birthweight 30% of “preventable” low birthweight Prevention and Control of Malaria during Pregnancy 4 Roll Back Malaria Worldwide partnership Governments, private groups, research organizations, civil society, media Aim to reduce malaria by half by 2010 Free advocacy resources and tools: http://www.rbm.who.int Priority: Prevent poor outcomes caused by malaria in pregnancy Abuja declaration: Goal is for 60% of women in Africa to be sleeping under insecticide-treated nets (ITNs) and getting intermittent preventive treatment (IPT) by 2005 Prevention and Control of Malaria during Pregnancy 5 Malaria Prevention and Treatment during Pregnancy Focused antenatal care (ANC) with health education about malaria Use of insecticide-treated nets (ITNs) Intermittent preventive treatment (IPT) Case management of women with symptoms and signs of malaria Prevention and Control of Malaria during Pregnancy Chapter I: Focused Antenatal Care Prevention and Control of Malaria during Pregnancy 7 Focused Antenatal Care: Chapter Objectives Describe four main components of focused antenatal care (ANC) Discuss frequency and timing of ANC visits Describe essential elements of a birth plan that includes complication readiness Describe interpersonal skills for effective ANC Describe components of record keeping for ANC Prevention and Control of Malaria during Pregnancy 8 Focused Antenatal Care An approach to ANC that emphasizes: Evidence-based, goal-directed actions Individualized, woman-centered care Quality vs. quantity of visits Care by skilled providers Prevention and Control of Malaria during Pregnancy 9 Goal of Focused Antenatal Care To promote maternal and newborn health and survival through: Early detection and treatment of problems and complications Prevention of complications and disease Birth preparedness and complication readiness Health promotion Prevention and Control of Malaria during Pregnancy 10 Traditional Antenatal Care Emphasizes: Ritualistic, “routine” care vs. evidence-based, goal-directed actions Frequent visits Does not emphasize individual client needs Prevention and Control of Malaria during Pregnancy 11 No Longer Recommended Numerous, routine visits Burden to women and healthcare system Routine measurements and examinations: Maternal height and weight Ankle edema Fetal position before 36 weeks Care based on risk assessment Prevention and Control of Malaria during Pregnancy 12 Risk Approach Not an effective ANC strategy because: Complications cannot be predicted—all pregnant women are at risk for developing complications Risk factors are usually not direct cause of complications Many “low risk” women develop complications Have false sense of security Do not know how to recognize/respond to problems Most “high risk” women give birth without complications Inefficient use of scarce resources Prevention and Control of Malaria during Pregnancy 13 Focused Antenatal Care Services Evidence-based, goal-directed actions: Address most prevalent health issues affecting women and newborns Adjusted for specific populations/regions Appropriate to gestational age Based on firm rationale Prevention and Control of Malaria during Pregnancy 14 Focused Antenatal Care Services (cont’d.) Individualized, woman-centered care based on each woman’s: Specific needs and concerns Circumstances History, physical examination, testing Available resources Prevention and Control of Malaria during Pregnancy 15 Focused Antenatal Care Services (cont’d.) Quality vs. quantity of ANC visits: WHO multi-center study Number of visits reduced without affecting outcome for mother or baby Recommendations Content and quality vs. number of visits Goal-oriented care Minimum of four visits Prevention and Control of Malaria during Pregnancy 16 First visit: By 16 weeks or when woman first thinks she is pregnant Second visit: At 24–28 weeks or at least once in second trimester Third visit: At 32 weeks Fourth visit: At 36 weeks Other visits: If complication occurs, followup or referral is needed, woman wants to see provider, or provider changes frequency based on findings (history, exam, testing) or local policy Scheduling and Timing of ANC Visits Prevention and Control of Malaria during Pregnancy 17 Focused Antenatal Care Services (cont’d.) Care by a skilled provider who: Has formal training and experience Has knowledge, skills, and qualifications to deliver safe, effective maternal and newborn healthcare Practices in home, hospital, health center May be a midwife, nurse, doctor, clinical officer, etc. Prevention and Control of Malaria during Pregnancy 18 Early Detection and Treatment Malaria—history and physical exam Fever and accompanying signs/symptoms Region Complicated vs. uncomplicated cases Severe anemia—physical exam, testing Pre-eclampsia/eclampsia—measurement of blood pressure HIV—voluntary counseling and testing Sexually transmitted infections, including syphilis— testing Prevention and Control of Malaria during Pregnancy 19 Prevention: Key Preventive Measures Malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Tetanus toxoid, iron/folate supplements Country/region-specific interventions as appropriate Vitamin A supplements Iodine supplements Presumptive treatment for hookworm
Slide 20 - Prevention and Control of Malaria during Pregnancy A Workshop for Healthcare Providers Prevention and Control of Malaria during Pregnancy 2 Facts about Malaria 300 million cases each year worldwide 9 of 10 cases occur in Africa A person in Africa dies of malaria every 10 seconds Women and young children are most at risk Affects five times as many people as AIDS, leprosy, measles, and tuberculosis combined Prevention and Control of Malaria during Pregnancy 3 Facts about Malaria and Pregnancy 30 million African women are pregnant yearly Malaria is more frequent and complicated during pregnancy In malaria-endemic areas, malaria during pregnancy may account for: Up to 15% of maternal anemia 5–14% of low birthweight 30% of “preventable” low birthweight Prevention and Control of Malaria during Pregnancy 4 Roll Back Malaria Worldwide partnership Governments, private groups, research organizations, civil society, media Aim to reduce malaria by half by 2010 Free advocacy resources and tools: http://www.rbm.who.int Priority: Prevent poor outcomes caused by malaria in pregnancy Abuja declaration: Goal is for 60% of women in Africa to be sleeping under insecticide-treated nets (ITNs) and getting intermittent preventive treatment (IPT) by 2005 Prevention and Control of Malaria during Pregnancy 5 Malaria Prevention and Treatment during Pregnancy Focused antenatal care (ANC) with health education about malaria Use of insecticide-treated nets (ITNs) Intermittent preventive treatment (IPT) Case management of women with symptoms and signs of malaria Prevention and Control of Malaria during Pregnancy Chapter I: Focused Antenatal Care Prevention and Control of Malaria during Pregnancy 7 Focused Antenatal Care: Chapter Objectives Describe four main components of focused antenatal care (ANC) Discuss frequency and timing of ANC visits Describe essential elements of a birth plan that includes complication readiness Describe interpersonal skills for effective ANC Describe components of record keeping for ANC Prevention and Control of Malaria during Pregnancy 8 Focused Antenatal Care An approach to ANC that emphasizes: Evidence-based, goal-directed actions Individualized, woman-centered care Quality vs. quantity of visits Care by skilled providers Prevention and Control of Malaria during Pregnancy 9 Goal of Focused Antenatal Care To promote maternal and newborn health and survival through: Early detection and treatment of problems and complications Prevention of complications and disease Birth preparedness and complication readiness Health promotion Prevention and Control of Malaria during Pregnancy 10 Traditional Antenatal Care Emphasizes: Ritualistic, “routine” care vs. evidence-based, goal-directed actions Frequent visits Does not emphasize individual client needs Prevention and Control of Malaria during Pregnancy 11 No Longer Recommended Numerous, routine visits Burden to women and healthcare system Routine measurements and examinations: Maternal height and weight Ankle edema Fetal position before 36 weeks Care based on risk assessment Prevention and Control of Malaria during Pregnancy 12 Risk Approach Not an effective ANC strategy because: Complications cannot be predicted—all pregnant women are at risk for developing complications Risk factors are usually not direct cause of complications Many “low risk” women develop complications Have false sense of security Do not know how to recognize/respond to problems Most “high risk” women give birth without complications Inefficient use of scarce resources Prevention and Control of Malaria during Pregnancy 13 Focused Antenatal Care Services Evidence-based, goal-directed actions: Address most prevalent health issues affecting women and newborns Adjusted for specific populations/regions Appropriate to gestational age Based on firm rationale Prevention and Control of Malaria during Pregnancy 14 Focused Antenatal Care Services (cont’d.) Individualized, woman-centered care based on each woman’s: Specific needs and concerns Circumstances History, physical examination, testing Available resources Prevention and Control of Malaria during Pregnancy 15 Focused Antenatal Care Services (cont’d.) Quality vs. quantity of ANC visits: WHO multi-center study Number of visits reduced without affecting outcome for mother or baby Recommendations Content and quality vs. number of visits Goal-oriented care Minimum of four visits Prevention and Control of Malaria during Pregnancy 16 First visit: By 16 weeks or when woman first thinks she is pregnant Second visit: At 24–28 weeks or at least once in second trimester Third visit: At 32 weeks Fourth visit: At 36 weeks Other visits: If complication occurs, followup or referral is needed, woman wants to see provider, or provider changes frequency based on findings (history, exam, testing) or local policy Scheduling and Timing of ANC Visits Prevention and Control of Malaria during Pregnancy 17 Focused Antenatal Care Services (cont’d.) Care by a skilled provider who: Has formal training and experience Has knowledge, skills, and qualifications to deliver safe, effective maternal and newborn healthcare Practices in home, hospital, health center May be a midwife, nurse, doctor, clinical officer, etc. Prevention and Control of Malaria during Pregnancy 18 Early Detection and Treatment Malaria—history and physical exam Fever and accompanying signs/symptoms Region Complicated vs. uncomplicated cases Severe anemia—physical exam, testing Pre-eclampsia/eclampsia—measurement of blood pressure HIV—voluntary counseling and testing Sexually transmitted infections, including syphilis— testing Prevention and Control of Malaria during Pregnancy 19 Prevention: Key Preventive Measures Malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Tetanus toxoid, iron/folate supplements Country/region-specific interventions as appropriate Vitamin A supplements Iodine supplements Presumptive treatment for hookworm Prevention and Control of Malaria during Pregnancy 20 Birth Preparedness and Complication Readiness: Objectives Develop birth plan—exact plan for normal birth and possible complications: Arrangements made in advance by woman and family (with help of skilled provider) Usually not a written document Reviewed/revised at every visit Minimize disorganization at time of birth or in an emergency Ensure timely and appropriate care
Slide 21 - Prevention and Control of Malaria during Pregnancy A Workshop for Healthcare Providers Prevention and Control of Malaria during Pregnancy 2 Facts about Malaria 300 million cases each year worldwide 9 of 10 cases occur in Africa A person in Africa dies of malaria every 10 seconds Women and young children are most at risk Affects five times as many people as AIDS, leprosy, measles, and tuberculosis combined Prevention and Control of Malaria during Pregnancy 3 Facts about Malaria and Pregnancy 30 million African women are pregnant yearly Malaria is more frequent and complicated during pregnancy In malaria-endemic areas, malaria during pregnancy may account for: Up to 15% of maternal anemia 5–14% of low birthweight 30% of “preventable” low birthweight Prevention and Control of Malaria during Pregnancy 4 Roll Back Malaria Worldwide partnership Governments, private groups, research organizations, civil society, media Aim to reduce malaria by half by 2010 Free advocacy resources and tools: http://www.rbm.who.int Priority: Prevent poor outcomes caused by malaria in pregnancy Abuja declaration: Goal is for 60% of women in Africa to be sleeping under insecticide-treated nets (ITNs) and getting intermittent preventive treatment (IPT) by 2005 Prevention and Control of Malaria during Pregnancy 5 Malaria Prevention and Treatment during Pregnancy Focused antenatal care (ANC) with health education about malaria Use of insecticide-treated nets (ITNs) Intermittent preventive treatment (IPT) Case management of women with symptoms and signs of malaria Prevention and Control of Malaria during Pregnancy Chapter I: Focused Antenatal Care Prevention and Control of Malaria during Pregnancy 7 Focused Antenatal Care: Chapter Objectives Describe four main components of focused antenatal care (ANC) Discuss frequency and timing of ANC visits Describe essential elements of a birth plan that includes complication readiness Describe interpersonal skills for effective ANC Describe components of record keeping for ANC Prevention and Control of Malaria during Pregnancy 8 Focused Antenatal Care An approach to ANC that emphasizes: Evidence-based, goal-directed actions Individualized, woman-centered care Quality vs. quantity of visits Care by skilled providers Prevention and Control of Malaria during Pregnancy 9 Goal of Focused Antenatal Care To promote maternal and newborn health and survival through: Early detection and treatment of problems and complications Prevention of complications and disease Birth preparedness and complication readiness Health promotion Prevention and Control of Malaria during Pregnancy 10 Traditional Antenatal Care Emphasizes: Ritualistic, “routine” care vs. evidence-based, goal-directed actions Frequent visits Does not emphasize individual client needs Prevention and Control of Malaria during Pregnancy 11 No Longer Recommended Numerous, routine visits Burden to women and healthcare system Routine measurements and examinations: Maternal height and weight Ankle edema Fetal position before 36 weeks Care based on risk assessment Prevention and Control of Malaria during Pregnancy 12 Risk Approach Not an effective ANC strategy because: Complications cannot be predicted—all pregnant women are at risk for developing complications Risk factors are usually not direct cause of complications Many “low risk” women develop complications Have false sense of security Do not know how to recognize/respond to problems Most “high risk” women give birth without complications Inefficient use of scarce resources Prevention and Control of Malaria during Pregnancy 13 Focused Antenatal Care Services Evidence-based, goal-directed actions: Address most prevalent health issues affecting women and newborns Adjusted for specific populations/regions Appropriate to gestational age Based on firm rationale Prevention and Control of Malaria during Pregnancy 14 Focused Antenatal Care Services (cont’d.) Individualized, woman-centered care based on each woman’s: Specific needs and concerns Circumstances History, physical examination, testing Available resources Prevention and Control of Malaria during Pregnancy 15 Focused Antenatal Care Services (cont’d.) Quality vs. quantity of ANC visits: WHO multi-center study Number of visits reduced without affecting outcome for mother or baby Recommendations Content and quality vs. number of visits Goal-oriented care Minimum of four visits Prevention and Control of Malaria during Pregnancy 16 First visit: By 16 weeks or when woman first thinks she is pregnant Second visit: At 24–28 weeks or at least once in second trimester Third visit: At 32 weeks Fourth visit: At 36 weeks Other visits: If complication occurs, followup or referral is needed, woman wants to see provider, or provider changes frequency based on findings (history, exam, testing) or local policy Scheduling and Timing of ANC Visits Prevention and Control of Malaria during Pregnancy 17 Focused Antenatal Care Services (cont’d.) Care by a skilled provider who: Has formal training and experience Has knowledge, skills, and qualifications to deliver safe, effective maternal and newborn healthcare Practices in home, hospital, health center May be a midwife, nurse, doctor, clinical officer, etc. Prevention and Control of Malaria during Pregnancy 18 Early Detection and Treatment Malaria—history and physical exam Fever and accompanying signs/symptoms Region Complicated vs. uncomplicated cases Severe anemia—physical exam, testing Pre-eclampsia/eclampsia—measurement of blood pressure HIV—voluntary counseling and testing Sexually transmitted infections, including syphilis— testing Prevention and Control of Malaria during Pregnancy 19 Prevention: Key Preventive Measures Malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Tetanus toxoid, iron/folate supplements Country/region-specific interventions as appropriate Vitamin A supplements Iodine supplements Presumptive treatment for hookworm Prevention and Control of Malaria during Pregnancy 20 Birth Preparedness and Complication Readiness: Objectives Develop birth plan—exact plan for normal birth and possible complications: Arrangements made in advance by woman and family (with help of skilled provider) Usually not a written document Reviewed/revised at every visit Minimize disorganization at time of birth or in an emergency Ensure timely and appropriate care Prevention and Control of Malaria during Pregnancy 21 Essential Elements of a Birth Plan Facility or Place of Birth: Home or health facility for birth, appropriate facility for emergencies Skilled Provider: To attend birth Provider/Facility Contact Information Transportation: Reliable, accessible, especially for odd hours Funds: Personal savings, emergency funds Decision-Making: Who will make decisions, especially in an emergency
Slide 22 - Prevention and Control of Malaria during Pregnancy A Workshop for Healthcare Providers Prevention and Control of Malaria during Pregnancy 2 Facts about Malaria 300 million cases each year worldwide 9 of 10 cases occur in Africa A person in Africa dies of malaria every 10 seconds Women and young children are most at risk Affects five times as many people as AIDS, leprosy, measles, and tuberculosis combined Prevention and Control of Malaria during Pregnancy 3 Facts about Malaria and Pregnancy 30 million African women are pregnant yearly Malaria is more frequent and complicated during pregnancy In malaria-endemic areas, malaria during pregnancy may account for: Up to 15% of maternal anemia 5–14% of low birthweight 30% of “preventable” low birthweight Prevention and Control of Malaria during Pregnancy 4 Roll Back Malaria Worldwide partnership Governments, private groups, research organizations, civil society, media Aim to reduce malaria by half by 2010 Free advocacy resources and tools: http://www.rbm.who.int Priority: Prevent poor outcomes caused by malaria in pregnancy Abuja declaration: Goal is for 60% of women in Africa to be sleeping under insecticide-treated nets (ITNs) and getting intermittent preventive treatment (IPT) by 2005 Prevention and Control of Malaria during Pregnancy 5 Malaria Prevention and Treatment during Pregnancy Focused antenatal care (ANC) with health education about malaria Use of insecticide-treated nets (ITNs) Intermittent preventive treatment (IPT) Case management of women with symptoms and signs of malaria Prevention and Control of Malaria during Pregnancy Chapter I: Focused Antenatal Care Prevention and Control of Malaria during Pregnancy 7 Focused Antenatal Care: Chapter Objectives Describe four main components of focused antenatal care (ANC) Discuss frequency and timing of ANC visits Describe essential elements of a birth plan that includes complication readiness Describe interpersonal skills for effective ANC Describe components of record keeping for ANC Prevention and Control of Malaria during Pregnancy 8 Focused Antenatal Care An approach to ANC that emphasizes: Evidence-based, goal-directed actions Individualized, woman-centered care Quality vs. quantity of visits Care by skilled providers Prevention and Control of Malaria during Pregnancy 9 Goal of Focused Antenatal Care To promote maternal and newborn health and survival through: Early detection and treatment of problems and complications Prevention of complications and disease Birth preparedness and complication readiness Health promotion Prevention and Control of Malaria during Pregnancy 10 Traditional Antenatal Care Emphasizes: Ritualistic, “routine” care vs. evidence-based, goal-directed actions Frequent visits Does not emphasize individual client needs Prevention and Control of Malaria during Pregnancy 11 No Longer Recommended Numerous, routine visits Burden to women and healthcare system Routine measurements and examinations: Maternal height and weight Ankle edema Fetal position before 36 weeks Care based on risk assessment Prevention and Control of Malaria during Pregnancy 12 Risk Approach Not an effective ANC strategy because: Complications cannot be predicted—all pregnant women are at risk for developing complications Risk factors are usually not direct cause of complications Many “low risk” women develop complications Have false sense of security Do not know how to recognize/respond to problems Most “high risk” women give birth without complications Inefficient use of scarce resources Prevention and Control of Malaria during Pregnancy 13 Focused Antenatal Care Services Evidence-based, goal-directed actions: Address most prevalent health issues affecting women and newborns Adjusted for specific populations/regions Appropriate to gestational age Based on firm rationale Prevention and Control of Malaria during Pregnancy 14 Focused Antenatal Care Services (cont’d.) Individualized, woman-centered care based on each woman’s: Specific needs and concerns Circumstances History, physical examination, testing Available resources Prevention and Control of Malaria during Pregnancy 15 Focused Antenatal Care Services (cont’d.) Quality vs. quantity of ANC visits: WHO multi-center study Number of visits reduced without affecting outcome for mother or baby Recommendations Content and quality vs. number of visits Goal-oriented care Minimum of four visits Prevention and Control of Malaria during Pregnancy 16 First visit: By 16 weeks or when woman first thinks she is pregnant Second visit: At 24–28 weeks or at least once in second trimester Third visit: At 32 weeks Fourth visit: At 36 weeks Other visits: If complication occurs, followup or referral is needed, woman wants to see provider, or provider changes frequency based on findings (history, exam, testing) or local policy Scheduling and Timing of ANC Visits Prevention and Control of Malaria during Pregnancy 17 Focused Antenatal Care Services (cont’d.) Care by a skilled provider who: Has formal training and experience Has knowledge, skills, and qualifications to deliver safe, effective maternal and newborn healthcare Practices in home, hospital, health center May be a midwife, nurse, doctor, clinical officer, etc. Prevention and Control of Malaria during Pregnancy 18 Early Detection and Treatment Malaria—history and physical exam Fever and accompanying signs/symptoms Region Complicated vs. uncomplicated cases Severe anemia—physical exam, testing Pre-eclampsia/eclampsia—measurement of blood pressure HIV—voluntary counseling and testing Sexually transmitted infections, including syphilis— testing Prevention and Control of Malaria during Pregnancy 19 Prevention: Key Preventive Measures Malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Tetanus toxoid, iron/folate supplements Country/region-specific interventions as appropriate Vitamin A supplements Iodine supplements Presumptive treatment for hookworm Prevention and Control of Malaria during Pregnancy 20 Birth Preparedness and Complication Readiness: Objectives Develop birth plan—exact plan for normal birth and possible complications: Arrangements made in advance by woman and family (with help of skilled provider) Usually not a written document Reviewed/revised at every visit Minimize disorganization at time of birth or in an emergency Ensure timely and appropriate care Prevention and Control of Malaria during Pregnancy 21 Essential Elements of a Birth Plan Facility or Place of Birth: Home or health facility for birth, appropriate facility for emergencies Skilled Provider: To attend birth Provider/Facility Contact Information Transportation: Reliable, accessible, especially for odd hours Funds: Personal savings, emergency funds Decision-Making: Who will make decisions, especially in an emergency Prevention and Control of Malaria during Pregnancy 22 Essential Elements of a Birth Plan (cont’d.) Family and Community Support: Care for family in woman’s absence and birth companion during labor Blood Donor: In case of emergency Needed Items: For clean and safe birth and for newborn care Danger Signs/Signs of Advanced Labor
Slide 23 - Prevention and Control of Malaria during Pregnancy A Workshop for Healthcare Providers Prevention and Control of Malaria during Pregnancy 2 Facts about Malaria 300 million cases each year worldwide 9 of 10 cases occur in Africa A person in Africa dies of malaria every 10 seconds Women and young children are most at risk Affects five times as many people as AIDS, leprosy, measles, and tuberculosis combined Prevention and Control of Malaria during Pregnancy 3 Facts about Malaria and Pregnancy 30 million African women are pregnant yearly Malaria is more frequent and complicated during pregnancy In malaria-endemic areas, malaria during pregnancy may account for: Up to 15% of maternal anemia 5–14% of low birthweight 30% of “preventable” low birthweight Prevention and Control of Malaria during Pregnancy 4 Roll Back Malaria Worldwide partnership Governments, private groups, research organizations, civil society, media Aim to reduce malaria by half by 2010 Free advocacy resources and tools: http://www.rbm.who.int Priority: Prevent poor outcomes caused by malaria in pregnancy Abuja declaration: Goal is for 60% of women in Africa to be sleeping under insecticide-treated nets (ITNs) and getting intermittent preventive treatment (IPT) by 2005 Prevention and Control of Malaria during Pregnancy 5 Malaria Prevention and Treatment during Pregnancy Focused antenatal care (ANC) with health education about malaria Use of insecticide-treated nets (ITNs) Intermittent preventive treatment (IPT) Case management of women with symptoms and signs of malaria Prevention and Control of Malaria during Pregnancy Chapter I: Focused Antenatal Care Prevention and Control of Malaria during Pregnancy 7 Focused Antenatal Care: Chapter Objectives Describe four main components of focused antenatal care (ANC) Discuss frequency and timing of ANC visits Describe essential elements of a birth plan that includes complication readiness Describe interpersonal skills for effective ANC Describe components of record keeping for ANC Prevention and Control of Malaria during Pregnancy 8 Focused Antenatal Care An approach to ANC that emphasizes: Evidence-based, goal-directed actions Individualized, woman-centered care Quality vs. quantity of visits Care by skilled providers Prevention and Control of Malaria during Pregnancy 9 Goal of Focused Antenatal Care To promote maternal and newborn health and survival through: Early detection and treatment of problems and complications Prevention of complications and disease Birth preparedness and complication readiness Health promotion Prevention and Control of Malaria during Pregnancy 10 Traditional Antenatal Care Emphasizes: Ritualistic, “routine” care vs. evidence-based, goal-directed actions Frequent visits Does not emphasize individual client needs Prevention and Control of Malaria during Pregnancy 11 No Longer Recommended Numerous, routine visits Burden to women and healthcare system Routine measurements and examinations: Maternal height and weight Ankle edema Fetal position before 36 weeks Care based on risk assessment Prevention and Control of Malaria during Pregnancy 12 Risk Approach Not an effective ANC strategy because: Complications cannot be predicted—all pregnant women are at risk for developing complications Risk factors are usually not direct cause of complications Many “low risk” women develop complications Have false sense of security Do not know how to recognize/respond to problems Most “high risk” women give birth without complications Inefficient use of scarce resources Prevention and Control of Malaria during Pregnancy 13 Focused Antenatal Care Services Evidence-based, goal-directed actions: Address most prevalent health issues affecting women and newborns Adjusted for specific populations/regions Appropriate to gestational age Based on firm rationale Prevention and Control of Malaria during Pregnancy 14 Focused Antenatal Care Services (cont’d.) Individualized, woman-centered care based on each woman’s: Specific needs and concerns Circumstances History, physical examination, testing Available resources Prevention and Control of Malaria during Pregnancy 15 Focused Antenatal Care Services (cont’d.) Quality vs. quantity of ANC visits: WHO multi-center study Number of visits reduced without affecting outcome for mother or baby Recommendations Content and quality vs. number of visits Goal-oriented care Minimum of four visits Prevention and Control of Malaria during Pregnancy 16 First visit: By 16 weeks or when woman first thinks she is pregnant Second visit: At 24–28 weeks or at least once in second trimester Third visit: At 32 weeks Fourth visit: At 36 weeks Other visits: If complication occurs, followup or referral is needed, woman wants to see provider, or provider changes frequency based on findings (history, exam, testing) or local policy Scheduling and Timing of ANC Visits Prevention and Control of Malaria during Pregnancy 17 Focused Antenatal Care Services (cont’d.) Care by a skilled provider who: Has formal training and experience Has knowledge, skills, and qualifications to deliver safe, effective maternal and newborn healthcare Practices in home, hospital, health center May be a midwife, nurse, doctor, clinical officer, etc. Prevention and Control of Malaria during Pregnancy 18 Early Detection and Treatment Malaria—history and physical exam Fever and accompanying signs/symptoms Region Complicated vs. uncomplicated cases Severe anemia—physical exam, testing Pre-eclampsia/eclampsia—measurement of blood pressure HIV—voluntary counseling and testing Sexually transmitted infections, including syphilis— testing Prevention and Control of Malaria during Pregnancy 19 Prevention: Key Preventive Measures Malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Tetanus toxoid, iron/folate supplements Country/region-specific interventions as appropriate Vitamin A supplements Iodine supplements Presumptive treatment for hookworm Prevention and Control of Malaria during Pregnancy 20 Birth Preparedness and Complication Readiness: Objectives Develop birth plan—exact plan for normal birth and possible complications: Arrangements made in advance by woman and family (with help of skilled provider) Usually not a written document Reviewed/revised at every visit Minimize disorganization at time of birth or in an emergency Ensure timely and appropriate care Prevention and Control of Malaria during Pregnancy 21 Essential Elements of a Birth Plan Facility or Place of Birth: Home or health facility for birth, appropriate facility for emergencies Skilled Provider: To attend birth Provider/Facility Contact Information Transportation: Reliable, accessible, especially for odd hours Funds: Personal savings, emergency funds Decision-Making: Who will make decisions, especially in an emergency Prevention and Control of Malaria during Pregnancy 22 Essential Elements of a Birth Plan (cont’d.) Family and Community Support: Care for family in woman’s absence and birth companion during labor Blood Donor: In case of emergency Needed Items: For clean and safe birth and for newborn care Danger Signs/Signs of Advanced Labor Prevention and Control of Malaria during Pregnancy 23 Danger Signs of Pregnancy Vaginal bleeding Difficulty breathing Fever Severe abdominal pain Severe headache/blurred vision Convulsions/loss of consciousness Labor pains before 37 weeks
Slide 24 - Prevention and Control of Malaria during Pregnancy A Workshop for Healthcare Providers Prevention and Control of Malaria during Pregnancy 2 Facts about Malaria 300 million cases each year worldwide 9 of 10 cases occur in Africa A person in Africa dies of malaria every 10 seconds Women and young children are most at risk Affects five times as many people as AIDS, leprosy, measles, and tuberculosis combined Prevention and Control of Malaria during Pregnancy 3 Facts about Malaria and Pregnancy 30 million African women are pregnant yearly Malaria is more frequent and complicated during pregnancy In malaria-endemic areas, malaria during pregnancy may account for: Up to 15% of maternal anemia 5–14% of low birthweight 30% of “preventable” low birthweight Prevention and Control of Malaria during Pregnancy 4 Roll Back Malaria Worldwide partnership Governments, private groups, research organizations, civil society, media Aim to reduce malaria by half by 2010 Free advocacy resources and tools: http://www.rbm.who.int Priority: Prevent poor outcomes caused by malaria in pregnancy Abuja declaration: Goal is for 60% of women in Africa to be sleeping under insecticide-treated nets (ITNs) and getting intermittent preventive treatment (IPT) by 2005 Prevention and Control of Malaria during Pregnancy 5 Malaria Prevention and Treatment during Pregnancy Focused antenatal care (ANC) with health education about malaria Use of insecticide-treated nets (ITNs) Intermittent preventive treatment (IPT) Case management of women with symptoms and signs of malaria Prevention and Control of Malaria during Pregnancy Chapter I: Focused Antenatal Care Prevention and Control of Malaria during Pregnancy 7 Focused Antenatal Care: Chapter Objectives Describe four main components of focused antenatal care (ANC) Discuss frequency and timing of ANC visits Describe essential elements of a birth plan that includes complication readiness Describe interpersonal skills for effective ANC Describe components of record keeping for ANC Prevention and Control of Malaria during Pregnancy 8 Focused Antenatal Care An approach to ANC that emphasizes: Evidence-based, goal-directed actions Individualized, woman-centered care Quality vs. quantity of visits Care by skilled providers Prevention and Control of Malaria during Pregnancy 9 Goal of Focused Antenatal Care To promote maternal and newborn health and survival through: Early detection and treatment of problems and complications Prevention of complications and disease Birth preparedness and complication readiness Health promotion Prevention and Control of Malaria during Pregnancy 10 Traditional Antenatal Care Emphasizes: Ritualistic, “routine” care vs. evidence-based, goal-directed actions Frequent visits Does not emphasize individual client needs Prevention and Control of Malaria during Pregnancy 11 No Longer Recommended Numerous, routine visits Burden to women and healthcare system Routine measurements and examinations: Maternal height and weight Ankle edema Fetal position before 36 weeks Care based on risk assessment Prevention and Control of Malaria during Pregnancy 12 Risk Approach Not an effective ANC strategy because: Complications cannot be predicted—all pregnant women are at risk for developing complications Risk factors are usually not direct cause of complications Many “low risk” women develop complications Have false sense of security Do not know how to recognize/respond to problems Most “high risk” women give birth without complications Inefficient use of scarce resources Prevention and Control of Malaria during Pregnancy 13 Focused Antenatal Care Services Evidence-based, goal-directed actions: Address most prevalent health issues affecting women and newborns Adjusted for specific populations/regions Appropriate to gestational age Based on firm rationale Prevention and Control of Malaria during Pregnancy 14 Focused Antenatal Care Services (cont’d.) Individualized, woman-centered care based on each woman’s: Specific needs and concerns Circumstances History, physical examination, testing Available resources Prevention and Control of Malaria during Pregnancy 15 Focused Antenatal Care Services (cont’d.) Quality vs. quantity of ANC visits: WHO multi-center study Number of visits reduced without affecting outcome for mother or baby Recommendations Content and quality vs. number of visits Goal-oriented care Minimum of four visits Prevention and Control of Malaria during Pregnancy 16 First visit: By 16 weeks or when woman first thinks she is pregnant Second visit: At 24–28 weeks or at least once in second trimester Third visit: At 32 weeks Fourth visit: At 36 weeks Other visits: If complication occurs, followup or referral is needed, woman wants to see provider, or provider changes frequency based on findings (history, exam, testing) or local policy Scheduling and Timing of ANC Visits Prevention and Control of Malaria during Pregnancy 17 Focused Antenatal Care Services (cont’d.) Care by a skilled provider who: Has formal training and experience Has knowledge, skills, and qualifications to deliver safe, effective maternal and newborn healthcare Practices in home, hospital, health center May be a midwife, nurse, doctor, clinical officer, etc. Prevention and Control of Malaria during Pregnancy 18 Early Detection and Treatment Malaria—history and physical exam Fever and accompanying signs/symptoms Region Complicated vs. uncomplicated cases Severe anemia—physical exam, testing Pre-eclampsia/eclampsia—measurement of blood pressure HIV—voluntary counseling and testing Sexually transmitted infections, including syphilis— testing Prevention and Control of Malaria during Pregnancy 19 Prevention: Key Preventive Measures Malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Tetanus toxoid, iron/folate supplements Country/region-specific interventions as appropriate Vitamin A supplements Iodine supplements Presumptive treatment for hookworm Prevention and Control of Malaria during Pregnancy 20 Birth Preparedness and Complication Readiness: Objectives Develop birth plan—exact plan for normal birth and possible complications: Arrangements made in advance by woman and family (with help of skilled provider) Usually not a written document Reviewed/revised at every visit Minimize disorganization at time of birth or in an emergency Ensure timely and appropriate care Prevention and Control of Malaria during Pregnancy 21 Essential Elements of a Birth Plan Facility or Place of Birth: Home or health facility for birth, appropriate facility for emergencies Skilled Provider: To attend birth Provider/Facility Contact Information Transportation: Reliable, accessible, especially for odd hours Funds: Personal savings, emergency funds Decision-Making: Who will make decisions, especially in an emergency Prevention and Control of Malaria during Pregnancy 22 Essential Elements of a Birth Plan (cont’d.) Family and Community Support: Care for family in woman’s absence and birth companion during labor Blood Donor: In case of emergency Needed Items: For clean and safe birth and for newborn care Danger Signs/Signs of Advanced Labor Prevention and Control of Malaria during Pregnancy 23 Danger Signs of Pregnancy Vaginal bleeding Difficulty breathing Fever Severe abdominal pain Severe headache/blurred vision Convulsions/loss of consciousness Labor pains before 37 weeks Prevention and Control of Malaria during Pregnancy 24 Health Education: Objectives Inform and educate the woman with health messages and counseling appropriate to: Individual needs, concerns, circumstances Gestational age Most prevalent health issues Support the woman in making decisions and solving actual or anticipated problems Involve partner and family in supporting/adopting healthy practices
Slide 25 - Prevention and Control of Malaria during Pregnancy A Workshop for Healthcare Providers Prevention and Control of Malaria during Pregnancy 2 Facts about Malaria 300 million cases each year worldwide 9 of 10 cases occur in Africa A person in Africa dies of malaria every 10 seconds Women and young children are most at risk Affects five times as many people as AIDS, leprosy, measles, and tuberculosis combined Prevention and Control of Malaria during Pregnancy 3 Facts about Malaria and Pregnancy 30 million African women are pregnant yearly Malaria is more frequent and complicated during pregnancy In malaria-endemic areas, malaria during pregnancy may account for: Up to 15% of maternal anemia 5–14% of low birthweight 30% of “preventable” low birthweight Prevention and Control of Malaria during Pregnancy 4 Roll Back Malaria Worldwide partnership Governments, private groups, research organizations, civil society, media Aim to reduce malaria by half by 2010 Free advocacy resources and tools: http://www.rbm.who.int Priority: Prevent poor outcomes caused by malaria in pregnancy Abuja declaration: Goal is for 60% of women in Africa to be sleeping under insecticide-treated nets (ITNs) and getting intermittent preventive treatment (IPT) by 2005 Prevention and Control of Malaria during Pregnancy 5 Malaria Prevention and Treatment during Pregnancy Focused antenatal care (ANC) with health education about malaria Use of insecticide-treated nets (ITNs) Intermittent preventive treatment (IPT) Case management of women with symptoms and signs of malaria Prevention and Control of Malaria during Pregnancy Chapter I: Focused Antenatal Care Prevention and Control of Malaria during Pregnancy 7 Focused Antenatal Care: Chapter Objectives Describe four main components of focused antenatal care (ANC) Discuss frequency and timing of ANC visits Describe essential elements of a birth plan that includes complication readiness Describe interpersonal skills for effective ANC Describe components of record keeping for ANC Prevention and Control of Malaria during Pregnancy 8 Focused Antenatal Care An approach to ANC that emphasizes: Evidence-based, goal-directed actions Individualized, woman-centered care Quality vs. quantity of visits Care by skilled providers Prevention and Control of Malaria during Pregnancy 9 Goal of Focused Antenatal Care To promote maternal and newborn health and survival through: Early detection and treatment of problems and complications Prevention of complications and disease Birth preparedness and complication readiness Health promotion Prevention and Control of Malaria during Pregnancy 10 Traditional Antenatal Care Emphasizes: Ritualistic, “routine” care vs. evidence-based, goal-directed actions Frequent visits Does not emphasize individual client needs Prevention and Control of Malaria during Pregnancy 11 No Longer Recommended Numerous, routine visits Burden to women and healthcare system Routine measurements and examinations: Maternal height and weight Ankle edema Fetal position before 36 weeks Care based on risk assessment Prevention and Control of Malaria during Pregnancy 12 Risk Approach Not an effective ANC strategy because: Complications cannot be predicted—all pregnant women are at risk for developing complications Risk factors are usually not direct cause of complications Many “low risk” women develop complications Have false sense of security Do not know how to recognize/respond to problems Most “high risk” women give birth without complications Inefficient use of scarce resources Prevention and Control of Malaria during Pregnancy 13 Focused Antenatal Care Services Evidence-based, goal-directed actions: Address most prevalent health issues affecting women and newborns Adjusted for specific populations/regions Appropriate to gestational age Based on firm rationale Prevention and Control of Malaria during Pregnancy 14 Focused Antenatal Care Services (cont’d.) Individualized, woman-centered care based on each woman’s: Specific needs and concerns Circumstances History, physical examination, testing Available resources Prevention and Control of Malaria during Pregnancy 15 Focused Antenatal Care Services (cont’d.) Quality vs. quantity of ANC visits: WHO multi-center study Number of visits reduced without affecting outcome for mother or baby Recommendations Content and quality vs. number of visits Goal-oriented care Minimum of four visits Prevention and Control of Malaria during Pregnancy 16 First visit: By 16 weeks or when woman first thinks she is pregnant Second visit: At 24–28 weeks or at least once in second trimester Third visit: At 32 weeks Fourth visit: At 36 weeks Other visits: If complication occurs, followup or referral is needed, woman wants to see provider, or provider changes frequency based on findings (history, exam, testing) or local policy Scheduling and Timing of ANC Visits Prevention and Control of Malaria during Pregnancy 17 Focused Antenatal Care Services (cont’d.) Care by a skilled provider who: Has formal training and experience Has knowledge, skills, and qualifications to deliver safe, effective maternal and newborn healthcare Practices in home, hospital, health center May be a midwife, nurse, doctor, clinical officer, etc. Prevention and Control of Malaria during Pregnancy 18 Early Detection and Treatment Malaria—history and physical exam Fever and accompanying signs/symptoms Region Complicated vs. uncomplicated cases Severe anemia—physical exam, testing Pre-eclampsia/eclampsia—measurement of blood pressure HIV—voluntary counseling and testing Sexually transmitted infections, including syphilis— testing Prevention and Control of Malaria during Pregnancy 19 Prevention: Key Preventive Measures Malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Tetanus toxoid, iron/folate supplements Country/region-specific interventions as appropriate Vitamin A supplements Iodine supplements Presumptive treatment for hookworm Prevention and Control of Malaria during Pregnancy 20 Birth Preparedness and Complication Readiness: Objectives Develop birth plan—exact plan for normal birth and possible complications: Arrangements made in advance by woman and family (with help of skilled provider) Usually not a written document Reviewed/revised at every visit Minimize disorganization at time of birth or in an emergency Ensure timely and appropriate care Prevention and Control of Malaria during Pregnancy 21 Essential Elements of a Birth Plan Facility or Place of Birth: Home or health facility for birth, appropriate facility for emergencies Skilled Provider: To attend birth Provider/Facility Contact Information Transportation: Reliable, accessible, especially for odd hours Funds: Personal savings, emergency funds Decision-Making: Who will make decisions, especially in an emergency Prevention and Control of Malaria during Pregnancy 22 Essential Elements of a Birth Plan (cont’d.) Family and Community Support: Care for family in woman’s absence and birth companion during labor Blood Donor: In case of emergency Needed Items: For clean and safe birth and for newborn care Danger Signs/Signs of Advanced Labor Prevention and Control of Malaria during Pregnancy 23 Danger Signs of Pregnancy Vaginal bleeding Difficulty breathing Fever Severe abdominal pain Severe headache/blurred vision Convulsions/loss of consciousness Labor pains before 37 weeks Prevention and Control of Malaria during Pregnancy 24 Health Education: Objectives Inform and educate the woman with health messages and counseling appropriate to: Individual needs, concerns, circumstances Gestational age Most prevalent health issues Support the woman in making decisions and solving actual or anticipated problems Involve partner and family in supporting/adopting healthy practices Prevention and Control of Malaria during Pregnancy 25 Health Education: Topics Addressed Prevention of malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Other methods Other important issues to be discussed include: Nutrition Care for common discomforts Use of potentially harmful substances Hygiene Rest and activity
Slide 26 - Prevention and Control of Malaria during Pregnancy A Workshop for Healthcare Providers Prevention and Control of Malaria during Pregnancy 2 Facts about Malaria 300 million cases each year worldwide 9 of 10 cases occur in Africa A person in Africa dies of malaria every 10 seconds Women and young children are most at risk Affects five times as many people as AIDS, leprosy, measles, and tuberculosis combined Prevention and Control of Malaria during Pregnancy 3 Facts about Malaria and Pregnancy 30 million African women are pregnant yearly Malaria is more frequent and complicated during pregnancy In malaria-endemic areas, malaria during pregnancy may account for: Up to 15% of maternal anemia 5–14% of low birthweight 30% of “preventable” low birthweight Prevention and Control of Malaria during Pregnancy 4 Roll Back Malaria Worldwide partnership Governments, private groups, research organizations, civil society, media Aim to reduce malaria by half by 2010 Free advocacy resources and tools: http://www.rbm.who.int Priority: Prevent poor outcomes caused by malaria in pregnancy Abuja declaration: Goal is for 60% of women in Africa to be sleeping under insecticide-treated nets (ITNs) and getting intermittent preventive treatment (IPT) by 2005 Prevention and Control of Malaria during Pregnancy 5 Malaria Prevention and Treatment during Pregnancy Focused antenatal care (ANC) with health education about malaria Use of insecticide-treated nets (ITNs) Intermittent preventive treatment (IPT) Case management of women with symptoms and signs of malaria Prevention and Control of Malaria during Pregnancy Chapter I: Focused Antenatal Care Prevention and Control of Malaria during Pregnancy 7 Focused Antenatal Care: Chapter Objectives Describe four main components of focused antenatal care (ANC) Discuss frequency and timing of ANC visits Describe essential elements of a birth plan that includes complication readiness Describe interpersonal skills for effective ANC Describe components of record keeping for ANC Prevention and Control of Malaria during Pregnancy 8 Focused Antenatal Care An approach to ANC that emphasizes: Evidence-based, goal-directed actions Individualized, woman-centered care Quality vs. quantity of visits Care by skilled providers Prevention and Control of Malaria during Pregnancy 9 Goal of Focused Antenatal Care To promote maternal and newborn health and survival through: Early detection and treatment of problems and complications Prevention of complications and disease Birth preparedness and complication readiness Health promotion Prevention and Control of Malaria during Pregnancy 10 Traditional Antenatal Care Emphasizes: Ritualistic, “routine” care vs. evidence-based, goal-directed actions Frequent visits Does not emphasize individual client needs Prevention and Control of Malaria during Pregnancy 11 No Longer Recommended Numerous, routine visits Burden to women and healthcare system Routine measurements and examinations: Maternal height and weight Ankle edema Fetal position before 36 weeks Care based on risk assessment Prevention and Control of Malaria during Pregnancy 12 Risk Approach Not an effective ANC strategy because: Complications cannot be predicted—all pregnant women are at risk for developing complications Risk factors are usually not direct cause of complications Many “low risk” women develop complications Have false sense of security Do not know how to recognize/respond to problems Most “high risk” women give birth without complications Inefficient use of scarce resources Prevention and Control of Malaria during Pregnancy 13 Focused Antenatal Care Services Evidence-based, goal-directed actions: Address most prevalent health issues affecting women and newborns Adjusted for specific populations/regions Appropriate to gestational age Based on firm rationale Prevention and Control of Malaria during Pregnancy 14 Focused Antenatal Care Services (cont’d.) Individualized, woman-centered care based on each woman’s: Specific needs and concerns Circumstances History, physical examination, testing Available resources Prevention and Control of Malaria during Pregnancy 15 Focused Antenatal Care Services (cont’d.) Quality vs. quantity of ANC visits: WHO multi-center study Number of visits reduced without affecting outcome for mother or baby Recommendations Content and quality vs. number of visits Goal-oriented care Minimum of four visits Prevention and Control of Malaria during Pregnancy 16 First visit: By 16 weeks or when woman first thinks she is pregnant Second visit: At 24–28 weeks or at least once in second trimester Third visit: At 32 weeks Fourth visit: At 36 weeks Other visits: If complication occurs, followup or referral is needed, woman wants to see provider, or provider changes frequency based on findings (history, exam, testing) or local policy Scheduling and Timing of ANC Visits Prevention and Control of Malaria during Pregnancy 17 Focused Antenatal Care Services (cont’d.) Care by a skilled provider who: Has formal training and experience Has knowledge, skills, and qualifications to deliver safe, effective maternal and newborn healthcare Practices in home, hospital, health center May be a midwife, nurse, doctor, clinical officer, etc. Prevention and Control of Malaria during Pregnancy 18 Early Detection and Treatment Malaria—history and physical exam Fever and accompanying signs/symptoms Region Complicated vs. uncomplicated cases Severe anemia—physical exam, testing Pre-eclampsia/eclampsia—measurement of blood pressure HIV—voluntary counseling and testing Sexually transmitted infections, including syphilis— testing Prevention and Control of Malaria during Pregnancy 19 Prevention: Key Preventive Measures Malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Tetanus toxoid, iron/folate supplements Country/region-specific interventions as appropriate Vitamin A supplements Iodine supplements Presumptive treatment for hookworm Prevention and Control of Malaria during Pregnancy 20 Birth Preparedness and Complication Readiness: Objectives Develop birth plan—exact plan for normal birth and possible complications: Arrangements made in advance by woman and family (with help of skilled provider) Usually not a written document Reviewed/revised at every visit Minimize disorganization at time of birth or in an emergency Ensure timely and appropriate care Prevention and Control of Malaria during Pregnancy 21 Essential Elements of a Birth Plan Facility or Place of Birth: Home or health facility for birth, appropriate facility for emergencies Skilled Provider: To attend birth Provider/Facility Contact Information Transportation: Reliable, accessible, especially for odd hours Funds: Personal savings, emergency funds Decision-Making: Who will make decisions, especially in an emergency Prevention and Control of Malaria during Pregnancy 22 Essential Elements of a Birth Plan (cont’d.) Family and Community Support: Care for family in woman’s absence and birth companion during labor Blood Donor: In case of emergency Needed Items: For clean and safe birth and for newborn care Danger Signs/Signs of Advanced Labor Prevention and Control of Malaria during Pregnancy 23 Danger Signs of Pregnancy Vaginal bleeding Difficulty breathing Fever Severe abdominal pain Severe headache/blurred vision Convulsions/loss of consciousness Labor pains before 37 weeks Prevention and Control of Malaria during Pregnancy 24 Health Education: Objectives Inform and educate the woman with health messages and counseling appropriate to: Individual needs, concerns, circumstances Gestational age Most prevalent health issues Support the woman in making decisions and solving actual or anticipated problems Involve partner and family in supporting/adopting healthy practices Prevention and Control of Malaria during Pregnancy 25 Health Education: Topics Addressed Prevention of malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Other methods Other important issues to be discussed include: Nutrition Care for common discomforts Use of potentially harmful substances Hygiene Rest and activity Prevention and Control of Malaria during Pregnancy 26 Health Education: Topics Addressed (cont’d.) Sexual relations and safer sex Early and exclusive breastfeeding Prevention of tetanus and anemia Voluntary counseling and testing for HIV Prevention of other endemic diseases/deficiencies
Slide 27 - Prevention and Control of Malaria during Pregnancy A Workshop for Healthcare Providers Prevention and Control of Malaria during Pregnancy 2 Facts about Malaria 300 million cases each year worldwide 9 of 10 cases occur in Africa A person in Africa dies of malaria every 10 seconds Women and young children are most at risk Affects five times as many people as AIDS, leprosy, measles, and tuberculosis combined Prevention and Control of Malaria during Pregnancy 3 Facts about Malaria and Pregnancy 30 million African women are pregnant yearly Malaria is more frequent and complicated during pregnancy In malaria-endemic areas, malaria during pregnancy may account for: Up to 15% of maternal anemia 5–14% of low birthweight 30% of “preventable” low birthweight Prevention and Control of Malaria during Pregnancy 4 Roll Back Malaria Worldwide partnership Governments, private groups, research organizations, civil society, media Aim to reduce malaria by half by 2010 Free advocacy resources and tools: http://www.rbm.who.int Priority: Prevent poor outcomes caused by malaria in pregnancy Abuja declaration: Goal is for 60% of women in Africa to be sleeping under insecticide-treated nets (ITNs) and getting intermittent preventive treatment (IPT) by 2005 Prevention and Control of Malaria during Pregnancy 5 Malaria Prevention and Treatment during Pregnancy Focused antenatal care (ANC) with health education about malaria Use of insecticide-treated nets (ITNs) Intermittent preventive treatment (IPT) Case management of women with symptoms and signs of malaria Prevention and Control of Malaria during Pregnancy Chapter I: Focused Antenatal Care Prevention and Control of Malaria during Pregnancy 7 Focused Antenatal Care: Chapter Objectives Describe four main components of focused antenatal care (ANC) Discuss frequency and timing of ANC visits Describe essential elements of a birth plan that includes complication readiness Describe interpersonal skills for effective ANC Describe components of record keeping for ANC Prevention and Control of Malaria during Pregnancy 8 Focused Antenatal Care An approach to ANC that emphasizes: Evidence-based, goal-directed actions Individualized, woman-centered care Quality vs. quantity of visits Care by skilled providers Prevention and Control of Malaria during Pregnancy 9 Goal of Focused Antenatal Care To promote maternal and newborn health and survival through: Early detection and treatment of problems and complications Prevention of complications and disease Birth preparedness and complication readiness Health promotion Prevention and Control of Malaria during Pregnancy 10 Traditional Antenatal Care Emphasizes: Ritualistic, “routine” care vs. evidence-based, goal-directed actions Frequent visits Does not emphasize individual client needs Prevention and Control of Malaria during Pregnancy 11 No Longer Recommended Numerous, routine visits Burden to women and healthcare system Routine measurements and examinations: Maternal height and weight Ankle edema Fetal position before 36 weeks Care based on risk assessment Prevention and Control of Malaria during Pregnancy 12 Risk Approach Not an effective ANC strategy because: Complications cannot be predicted—all pregnant women are at risk for developing complications Risk factors are usually not direct cause of complications Many “low risk” women develop complications Have false sense of security Do not know how to recognize/respond to problems Most “high risk” women give birth without complications Inefficient use of scarce resources Prevention and Control of Malaria during Pregnancy 13 Focused Antenatal Care Services Evidence-based, goal-directed actions: Address most prevalent health issues affecting women and newborns Adjusted for specific populations/regions Appropriate to gestational age Based on firm rationale Prevention and Control of Malaria during Pregnancy 14 Focused Antenatal Care Services (cont’d.) Individualized, woman-centered care based on each woman’s: Specific needs and concerns Circumstances History, physical examination, testing Available resources Prevention and Control of Malaria during Pregnancy 15 Focused Antenatal Care Services (cont’d.) Quality vs. quantity of ANC visits: WHO multi-center study Number of visits reduced without affecting outcome for mother or baby Recommendations Content and quality vs. number of visits Goal-oriented care Minimum of four visits Prevention and Control of Malaria during Pregnancy 16 First visit: By 16 weeks or when woman first thinks she is pregnant Second visit: At 24–28 weeks or at least once in second trimester Third visit: At 32 weeks Fourth visit: At 36 weeks Other visits: If complication occurs, followup or referral is needed, woman wants to see provider, or provider changes frequency based on findings (history, exam, testing) or local policy Scheduling and Timing of ANC Visits Prevention and Control of Malaria during Pregnancy 17 Focused Antenatal Care Services (cont’d.) Care by a skilled provider who: Has formal training and experience Has knowledge, skills, and qualifications to deliver safe, effective maternal and newborn healthcare Practices in home, hospital, health center May be a midwife, nurse, doctor, clinical officer, etc. Prevention and Control of Malaria during Pregnancy 18 Early Detection and Treatment Malaria—history and physical exam Fever and accompanying signs/symptoms Region Complicated vs. uncomplicated cases Severe anemia—physical exam, testing Pre-eclampsia/eclampsia—measurement of blood pressure HIV—voluntary counseling and testing Sexually transmitted infections, including syphilis— testing Prevention and Control of Malaria during Pregnancy 19 Prevention: Key Preventive Measures Malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Tetanus toxoid, iron/folate supplements Country/region-specific interventions as appropriate Vitamin A supplements Iodine supplements Presumptive treatment for hookworm Prevention and Control of Malaria during Pregnancy 20 Birth Preparedness and Complication Readiness: Objectives Develop birth plan—exact plan for normal birth and possible complications: Arrangements made in advance by woman and family (with help of skilled provider) Usually not a written document Reviewed/revised at every visit Minimize disorganization at time of birth or in an emergency Ensure timely and appropriate care Prevention and Control of Malaria during Pregnancy 21 Essential Elements of a Birth Plan Facility or Place of Birth: Home or health facility for birth, appropriate facility for emergencies Skilled Provider: To attend birth Provider/Facility Contact Information Transportation: Reliable, accessible, especially for odd hours Funds: Personal savings, emergency funds Decision-Making: Who will make decisions, especially in an emergency Prevention and Control of Malaria during Pregnancy 22 Essential Elements of a Birth Plan (cont’d.) Family and Community Support: Care for family in woman’s absence and birth companion during labor Blood Donor: In case of emergency Needed Items: For clean and safe birth and for newborn care Danger Signs/Signs of Advanced Labor Prevention and Control of Malaria during Pregnancy 23 Danger Signs of Pregnancy Vaginal bleeding Difficulty breathing Fever Severe abdominal pain Severe headache/blurred vision Convulsions/loss of consciousness Labor pains before 37 weeks Prevention and Control of Malaria during Pregnancy 24 Health Education: Objectives Inform and educate the woman with health messages and counseling appropriate to: Individual needs, concerns, circumstances Gestational age Most prevalent health issues Support the woman in making decisions and solving actual or anticipated problems Involve partner and family in supporting/adopting healthy practices Prevention and Control of Malaria during Pregnancy 25 Health Education: Topics Addressed Prevention of malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Other methods Other important issues to be discussed include: Nutrition Care for common discomforts Use of potentially harmful substances Hygiene Rest and activity Prevention and Control of Malaria during Pregnancy 26 Health Education: Topics Addressed (cont’d.) Sexual relations and safer sex Early and exclusive breastfeeding Prevention of tetanus and anemia Voluntary counseling and testing for HIV Prevention of other endemic diseases/deficiencies Prevention and Control of Malaria during Pregnancy 27 Interpersonal Skills Speak in a quiet, gentle tone of voice Listen to woman/family and respond appropriately Encourage them to ask questions and express concerns Allow them to demonstrate understanding of information provided Explain all procedures/actions and obtain permission before proceeding Show respect for cultural beliefs and social norms Be empathetic and nonjudgmental Avoid distractions while conducting the visit
Slide 28 - Prevention and Control of Malaria during Pregnancy A Workshop for Healthcare Providers Prevention and Control of Malaria during Pregnancy 2 Facts about Malaria 300 million cases each year worldwide 9 of 10 cases occur in Africa A person in Africa dies of malaria every 10 seconds Women and young children are most at risk Affects five times as many people as AIDS, leprosy, measles, and tuberculosis combined Prevention and Control of Malaria during Pregnancy 3 Facts about Malaria and Pregnancy 30 million African women are pregnant yearly Malaria is more frequent and complicated during pregnancy In malaria-endemic areas, malaria during pregnancy may account for: Up to 15% of maternal anemia 5–14% of low birthweight 30% of “preventable” low birthweight Prevention and Control of Malaria during Pregnancy 4 Roll Back Malaria Worldwide partnership Governments, private groups, research organizations, civil society, media Aim to reduce malaria by half by 2010 Free advocacy resources and tools: http://www.rbm.who.int Priority: Prevent poor outcomes caused by malaria in pregnancy Abuja declaration: Goal is for 60% of women in Africa to be sleeping under insecticide-treated nets (ITNs) and getting intermittent preventive treatment (IPT) by 2005 Prevention and Control of Malaria during Pregnancy 5 Malaria Prevention and Treatment during Pregnancy Focused antenatal care (ANC) with health education about malaria Use of insecticide-treated nets (ITNs) Intermittent preventive treatment (IPT) Case management of women with symptoms and signs of malaria Prevention and Control of Malaria during Pregnancy Chapter I: Focused Antenatal Care Prevention and Control of Malaria during Pregnancy 7 Focused Antenatal Care: Chapter Objectives Describe four main components of focused antenatal care (ANC) Discuss frequency and timing of ANC visits Describe essential elements of a birth plan that includes complication readiness Describe interpersonal skills for effective ANC Describe components of record keeping for ANC Prevention and Control of Malaria during Pregnancy 8 Focused Antenatal Care An approach to ANC that emphasizes: Evidence-based, goal-directed actions Individualized, woman-centered care Quality vs. quantity of visits Care by skilled providers Prevention and Control of Malaria during Pregnancy 9 Goal of Focused Antenatal Care To promote maternal and newborn health and survival through: Early detection and treatment of problems and complications Prevention of complications and disease Birth preparedness and complication readiness Health promotion Prevention and Control of Malaria during Pregnancy 10 Traditional Antenatal Care Emphasizes: Ritualistic, “routine” care vs. evidence-based, goal-directed actions Frequent visits Does not emphasize individual client needs Prevention and Control of Malaria during Pregnancy 11 No Longer Recommended Numerous, routine visits Burden to women and healthcare system Routine measurements and examinations: Maternal height and weight Ankle edema Fetal position before 36 weeks Care based on risk assessment Prevention and Control of Malaria during Pregnancy 12 Risk Approach Not an effective ANC strategy because: Complications cannot be predicted—all pregnant women are at risk for developing complications Risk factors are usually not direct cause of complications Many “low risk” women develop complications Have false sense of security Do not know how to recognize/respond to problems Most “high risk” women give birth without complications Inefficient use of scarce resources Prevention and Control of Malaria during Pregnancy 13 Focused Antenatal Care Services Evidence-based, goal-directed actions: Address most prevalent health issues affecting women and newborns Adjusted for specific populations/regions Appropriate to gestational age Based on firm rationale Prevention and Control of Malaria during Pregnancy 14 Focused Antenatal Care Services (cont’d.) Individualized, woman-centered care based on each woman’s: Specific needs and concerns Circumstances History, physical examination, testing Available resources Prevention and Control of Malaria during Pregnancy 15 Focused Antenatal Care Services (cont’d.) Quality vs. quantity of ANC visits: WHO multi-center study Number of visits reduced without affecting outcome for mother or baby Recommendations Content and quality vs. number of visits Goal-oriented care Minimum of four visits Prevention and Control of Malaria during Pregnancy 16 First visit: By 16 weeks or when woman first thinks she is pregnant Second visit: At 24–28 weeks or at least once in second trimester Third visit: At 32 weeks Fourth visit: At 36 weeks Other visits: If complication occurs, followup or referral is needed, woman wants to see provider, or provider changes frequency based on findings (history, exam, testing) or local policy Scheduling and Timing of ANC Visits Prevention and Control of Malaria during Pregnancy 17 Focused Antenatal Care Services (cont’d.) Care by a skilled provider who: Has formal training and experience Has knowledge, skills, and qualifications to deliver safe, effective maternal and newborn healthcare Practices in home, hospital, health center May be a midwife, nurse, doctor, clinical officer, etc. Prevention and Control of Malaria during Pregnancy 18 Early Detection and Treatment Malaria—history and physical exam Fever and accompanying signs/symptoms Region Complicated vs. uncomplicated cases Severe anemia—physical exam, testing Pre-eclampsia/eclampsia—measurement of blood pressure HIV—voluntary counseling and testing Sexually transmitted infections, including syphilis— testing Prevention and Control of Malaria during Pregnancy 19 Prevention: Key Preventive Measures Malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Tetanus toxoid, iron/folate supplements Country/region-specific interventions as appropriate Vitamin A supplements Iodine supplements Presumptive treatment for hookworm Prevention and Control of Malaria during Pregnancy 20 Birth Preparedness and Complication Readiness: Objectives Develop birth plan—exact plan for normal birth and possible complications: Arrangements made in advance by woman and family (with help of skilled provider) Usually not a written document Reviewed/revised at every visit Minimize disorganization at time of birth or in an emergency Ensure timely and appropriate care Prevention and Control of Malaria during Pregnancy 21 Essential Elements of a Birth Plan Facility or Place of Birth: Home or health facility for birth, appropriate facility for emergencies Skilled Provider: To attend birth Provider/Facility Contact Information Transportation: Reliable, accessible, especially for odd hours Funds: Personal savings, emergency funds Decision-Making: Who will make decisions, especially in an emergency Prevention and Control of Malaria during Pregnancy 22 Essential Elements of a Birth Plan (cont’d.) Family and Community Support: Care for family in woman’s absence and birth companion during labor Blood Donor: In case of emergency Needed Items: For clean and safe birth and for newborn care Danger Signs/Signs of Advanced Labor Prevention and Control of Malaria during Pregnancy 23 Danger Signs of Pregnancy Vaginal bleeding Difficulty breathing Fever Severe abdominal pain Severe headache/blurred vision Convulsions/loss of consciousness Labor pains before 37 weeks Prevention and Control of Malaria during Pregnancy 24 Health Education: Objectives Inform and educate the woman with health messages and counseling appropriate to: Individual needs, concerns, circumstances Gestational age Most prevalent health issues Support the woman in making decisions and solving actual or anticipated problems Involve partner and family in supporting/adopting healthy practices Prevention and Control of Malaria during Pregnancy 25 Health Education: Topics Addressed Prevention of malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Other methods Other important issues to be discussed include: Nutrition Care for common discomforts Use of potentially harmful substances Hygiene Rest and activity Prevention and Control of Malaria during Pregnancy 26 Health Education: Topics Addressed (cont’d.) Sexual relations and safer sex Early and exclusive breastfeeding Prevention of tetanus and anemia Voluntary counseling and testing for HIV Prevention of other endemic diseases/deficiencies Prevention and Control of Malaria during Pregnancy 27 Interpersonal Skills Speak in a quiet, gentle tone of voice Listen to woman/family and respond appropriately Encourage them to ask questions and express concerns Allow them to demonstrate understanding of information provided Explain all procedures/actions and obtain permission before proceeding Show respect for cultural beliefs and social norms Be empathetic and nonjudgmental Avoid distractions while conducting the visit Prevention and Control of Malaria during Pregnancy 28 Record Keeping First ANC Visit History Physical examination Testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs Date of next ANC visit Subsequent ANC Visits Interim history Targeted physical examination, testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs (and relevant information on how client obtained and used ITN) Date of next ANC visit Record all information on the ANC chart and clinic card:
Slide 29 - Prevention and Control of Malaria during Pregnancy A Workshop for Healthcare Providers Prevention and Control of Malaria during Pregnancy 2 Facts about Malaria 300 million cases each year worldwide 9 of 10 cases occur in Africa A person in Africa dies of malaria every 10 seconds Women and young children are most at risk Affects five times as many people as AIDS, leprosy, measles, and tuberculosis combined Prevention and Control of Malaria during Pregnancy 3 Facts about Malaria and Pregnancy 30 million African women are pregnant yearly Malaria is more frequent and complicated during pregnancy In malaria-endemic areas, malaria during pregnancy may account for: Up to 15% of maternal anemia 5–14% of low birthweight 30% of “preventable” low birthweight Prevention and Control of Malaria during Pregnancy 4 Roll Back Malaria Worldwide partnership Governments, private groups, research organizations, civil society, media Aim to reduce malaria by half by 2010 Free advocacy resources and tools: http://www.rbm.who.int Priority: Prevent poor outcomes caused by malaria in pregnancy Abuja declaration: Goal is for 60% of women in Africa to be sleeping under insecticide-treated nets (ITNs) and getting intermittent preventive treatment (IPT) by 2005 Prevention and Control of Malaria during Pregnancy 5 Malaria Prevention and Treatment during Pregnancy Focused antenatal care (ANC) with health education about malaria Use of insecticide-treated nets (ITNs) Intermittent preventive treatment (IPT) Case management of women with symptoms and signs of malaria Prevention and Control of Malaria during Pregnancy Chapter I: Focused Antenatal Care Prevention and Control of Malaria during Pregnancy 7 Focused Antenatal Care: Chapter Objectives Describe four main components of focused antenatal care (ANC) Discuss frequency and timing of ANC visits Describe essential elements of a birth plan that includes complication readiness Describe interpersonal skills for effective ANC Describe components of record keeping for ANC Prevention and Control of Malaria during Pregnancy 8 Focused Antenatal Care An approach to ANC that emphasizes: Evidence-based, goal-directed actions Individualized, woman-centered care Quality vs. quantity of visits Care by skilled providers Prevention and Control of Malaria during Pregnancy 9 Goal of Focused Antenatal Care To promote maternal and newborn health and survival through: Early detection and treatment of problems and complications Prevention of complications and disease Birth preparedness and complication readiness Health promotion Prevention and Control of Malaria during Pregnancy 10 Traditional Antenatal Care Emphasizes: Ritualistic, “routine” care vs. evidence-based, goal-directed actions Frequent visits Does not emphasize individual client needs Prevention and Control of Malaria during Pregnancy 11 No Longer Recommended Numerous, routine visits Burden to women and healthcare system Routine measurements and examinations: Maternal height and weight Ankle edema Fetal position before 36 weeks Care based on risk assessment Prevention and Control of Malaria during Pregnancy 12 Risk Approach Not an effective ANC strategy because: Complications cannot be predicted—all pregnant women are at risk for developing complications Risk factors are usually not direct cause of complications Many “low risk” women develop complications Have false sense of security Do not know how to recognize/respond to problems Most “high risk” women give birth without complications Inefficient use of scarce resources Prevention and Control of Malaria during Pregnancy 13 Focused Antenatal Care Services Evidence-based, goal-directed actions: Address most prevalent health issues affecting women and newborns Adjusted for specific populations/regions Appropriate to gestational age Based on firm rationale Prevention and Control of Malaria during Pregnancy 14 Focused Antenatal Care Services (cont’d.) Individualized, woman-centered care based on each woman’s: Specific needs and concerns Circumstances History, physical examination, testing Available resources Prevention and Control of Malaria during Pregnancy 15 Focused Antenatal Care Services (cont’d.) Quality vs. quantity of ANC visits: WHO multi-center study Number of visits reduced without affecting outcome for mother or baby Recommendations Content and quality vs. number of visits Goal-oriented care Minimum of four visits Prevention and Control of Malaria during Pregnancy 16 First visit: By 16 weeks or when woman first thinks she is pregnant Second visit: At 24–28 weeks or at least once in second trimester Third visit: At 32 weeks Fourth visit: At 36 weeks Other visits: If complication occurs, followup or referral is needed, woman wants to see provider, or provider changes frequency based on findings (history, exam, testing) or local policy Scheduling and Timing of ANC Visits Prevention and Control of Malaria during Pregnancy 17 Focused Antenatal Care Services (cont’d.) Care by a skilled provider who: Has formal training and experience Has knowledge, skills, and qualifications to deliver safe, effective maternal and newborn healthcare Practices in home, hospital, health center May be a midwife, nurse, doctor, clinical officer, etc. Prevention and Control of Malaria during Pregnancy 18 Early Detection and Treatment Malaria—history and physical exam Fever and accompanying signs/symptoms Region Complicated vs. uncomplicated cases Severe anemia—physical exam, testing Pre-eclampsia/eclampsia—measurement of blood pressure HIV—voluntary counseling and testing Sexually transmitted infections, including syphilis— testing Prevention and Control of Malaria during Pregnancy 19 Prevention: Key Preventive Measures Malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Tetanus toxoid, iron/folate supplements Country/region-specific interventions as appropriate Vitamin A supplements Iodine supplements Presumptive treatment for hookworm Prevention and Control of Malaria during Pregnancy 20 Birth Preparedness and Complication Readiness: Objectives Develop birth plan—exact plan for normal birth and possible complications: Arrangements made in advance by woman and family (with help of skilled provider) Usually not a written document Reviewed/revised at every visit Minimize disorganization at time of birth or in an emergency Ensure timely and appropriate care Prevention and Control of Malaria during Pregnancy 21 Essential Elements of a Birth Plan Facility or Place of Birth: Home or health facility for birth, appropriate facility for emergencies Skilled Provider: To attend birth Provider/Facility Contact Information Transportation: Reliable, accessible, especially for odd hours Funds: Personal savings, emergency funds Decision-Making: Who will make decisions, especially in an emergency Prevention and Control of Malaria during Pregnancy 22 Essential Elements of a Birth Plan (cont’d.) Family and Community Support: Care for family in woman’s absence and birth companion during labor Blood Donor: In case of emergency Needed Items: For clean and safe birth and for newborn care Danger Signs/Signs of Advanced Labor Prevention and Control of Malaria during Pregnancy 23 Danger Signs of Pregnancy Vaginal bleeding Difficulty breathing Fever Severe abdominal pain Severe headache/blurred vision Convulsions/loss of consciousness Labor pains before 37 weeks Prevention and Control of Malaria during Pregnancy 24 Health Education: Objectives Inform and educate the woman with health messages and counseling appropriate to: Individual needs, concerns, circumstances Gestational age Most prevalent health issues Support the woman in making decisions and solving actual or anticipated problems Involve partner and family in supporting/adopting healthy practices Prevention and Control of Malaria during Pregnancy 25 Health Education: Topics Addressed Prevention of malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Other methods Other important issues to be discussed include: Nutrition Care for common discomforts Use of potentially harmful substances Hygiene Rest and activity Prevention and Control of Malaria during Pregnancy 26 Health Education: Topics Addressed (cont’d.) Sexual relations and safer sex Early and exclusive breastfeeding Prevention of tetanus and anemia Voluntary counseling and testing for HIV Prevention of other endemic diseases/deficiencies Prevention and Control of Malaria during Pregnancy 27 Interpersonal Skills Speak in a quiet, gentle tone of voice Listen to woman/family and respond appropriately Encourage them to ask questions and express concerns Allow them to demonstrate understanding of information provided Explain all procedures/actions and obtain permission before proceeding Show respect for cultural beliefs and social norms Be empathetic and nonjudgmental Avoid distractions while conducting the visit Prevention and Control of Malaria during Pregnancy 28 Record Keeping First ANC Visit History Physical examination Testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs Date of next ANC visit Subsequent ANC Visits Interim history Targeted physical examination, testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs (and relevant information on how client obtained and used ITN) Date of next ANC visit Record all information on the ANC chart and clinic card: Prevention and Control of Malaria during Pregnancy Chapter II: Malaria Transmission
Slide 30 - Prevention and Control of Malaria during Pregnancy A Workshop for Healthcare Providers Prevention and Control of Malaria during Pregnancy 2 Facts about Malaria 300 million cases each year worldwide 9 of 10 cases occur in Africa A person in Africa dies of malaria every 10 seconds Women and young children are most at risk Affects five times as many people as AIDS, leprosy, measles, and tuberculosis combined Prevention and Control of Malaria during Pregnancy 3 Facts about Malaria and Pregnancy 30 million African women are pregnant yearly Malaria is more frequent and complicated during pregnancy In malaria-endemic areas, malaria during pregnancy may account for: Up to 15% of maternal anemia 5–14% of low birthweight 30% of “preventable” low birthweight Prevention and Control of Malaria during Pregnancy 4 Roll Back Malaria Worldwide partnership Governments, private groups, research organizations, civil society, media Aim to reduce malaria by half by 2010 Free advocacy resources and tools: http://www.rbm.who.int Priority: Prevent poor outcomes caused by malaria in pregnancy Abuja declaration: Goal is for 60% of women in Africa to be sleeping under insecticide-treated nets (ITNs) and getting intermittent preventive treatment (IPT) by 2005 Prevention and Control of Malaria during Pregnancy 5 Malaria Prevention and Treatment during Pregnancy Focused antenatal care (ANC) with health education about malaria Use of insecticide-treated nets (ITNs) Intermittent preventive treatment (IPT) Case management of women with symptoms and signs of malaria Prevention and Control of Malaria during Pregnancy Chapter I: Focused Antenatal Care Prevention and Control of Malaria during Pregnancy 7 Focused Antenatal Care: Chapter Objectives Describe four main components of focused antenatal care (ANC) Discuss frequency and timing of ANC visits Describe essential elements of a birth plan that includes complication readiness Describe interpersonal skills for effective ANC Describe components of record keeping for ANC Prevention and Control of Malaria during Pregnancy 8 Focused Antenatal Care An approach to ANC that emphasizes: Evidence-based, goal-directed actions Individualized, woman-centered care Quality vs. quantity of visits Care by skilled providers Prevention and Control of Malaria during Pregnancy 9 Goal of Focused Antenatal Care To promote maternal and newborn health and survival through: Early detection and treatment of problems and complications Prevention of complications and disease Birth preparedness and complication readiness Health promotion Prevention and Control of Malaria during Pregnancy 10 Traditional Antenatal Care Emphasizes: Ritualistic, “routine” care vs. evidence-based, goal-directed actions Frequent visits Does not emphasize individual client needs Prevention and Control of Malaria during Pregnancy 11 No Longer Recommended Numerous, routine visits Burden to women and healthcare system Routine measurements and examinations: Maternal height and weight Ankle edema Fetal position before 36 weeks Care based on risk assessment Prevention and Control of Malaria during Pregnancy 12 Risk Approach Not an effective ANC strategy because: Complications cannot be predicted—all pregnant women are at risk for developing complications Risk factors are usually not direct cause of complications Many “low risk” women develop complications Have false sense of security Do not know how to recognize/respond to problems Most “high risk” women give birth without complications Inefficient use of scarce resources Prevention and Control of Malaria during Pregnancy 13 Focused Antenatal Care Services Evidence-based, goal-directed actions: Address most prevalent health issues affecting women and newborns Adjusted for specific populations/regions Appropriate to gestational age Based on firm rationale Prevention and Control of Malaria during Pregnancy 14 Focused Antenatal Care Services (cont’d.) Individualized, woman-centered care based on each woman’s: Specific needs and concerns Circumstances History, physical examination, testing Available resources Prevention and Control of Malaria during Pregnancy 15 Focused Antenatal Care Services (cont’d.) Quality vs. quantity of ANC visits: WHO multi-center study Number of visits reduced without affecting outcome for mother or baby Recommendations Content and quality vs. number of visits Goal-oriented care Minimum of four visits Prevention and Control of Malaria during Pregnancy 16 First visit: By 16 weeks or when woman first thinks she is pregnant Second visit: At 24–28 weeks or at least once in second trimester Third visit: At 32 weeks Fourth visit: At 36 weeks Other visits: If complication occurs, followup or referral is needed, woman wants to see provider, or provider changes frequency based on findings (history, exam, testing) or local policy Scheduling and Timing of ANC Visits Prevention and Control of Malaria during Pregnancy 17 Focused Antenatal Care Services (cont’d.) Care by a skilled provider who: Has formal training and experience Has knowledge, skills, and qualifications to deliver safe, effective maternal and newborn healthcare Practices in home, hospital, health center May be a midwife, nurse, doctor, clinical officer, etc. Prevention and Control of Malaria during Pregnancy 18 Early Detection and Treatment Malaria—history and physical exam Fever and accompanying signs/symptoms Region Complicated vs. uncomplicated cases Severe anemia—physical exam, testing Pre-eclampsia/eclampsia—measurement of blood pressure HIV—voluntary counseling and testing Sexually transmitted infections, including syphilis— testing Prevention and Control of Malaria during Pregnancy 19 Prevention: Key Preventive Measures Malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Tetanus toxoid, iron/folate supplements Country/region-specific interventions as appropriate Vitamin A supplements Iodine supplements Presumptive treatment for hookworm Prevention and Control of Malaria during Pregnancy 20 Birth Preparedness and Complication Readiness: Objectives Develop birth plan—exact plan for normal birth and possible complications: Arrangements made in advance by woman and family (with help of skilled provider) Usually not a written document Reviewed/revised at every visit Minimize disorganization at time of birth or in an emergency Ensure timely and appropriate care Prevention and Control of Malaria during Pregnancy 21 Essential Elements of a Birth Plan Facility or Place of Birth: Home or health facility for birth, appropriate facility for emergencies Skilled Provider: To attend birth Provider/Facility Contact Information Transportation: Reliable, accessible, especially for odd hours Funds: Personal savings, emergency funds Decision-Making: Who will make decisions, especially in an emergency Prevention and Control of Malaria during Pregnancy 22 Essential Elements of a Birth Plan (cont’d.) Family and Community Support: Care for family in woman’s absence and birth companion during labor Blood Donor: In case of emergency Needed Items: For clean and safe birth and for newborn care Danger Signs/Signs of Advanced Labor Prevention and Control of Malaria during Pregnancy 23 Danger Signs of Pregnancy Vaginal bleeding Difficulty breathing Fever Severe abdominal pain Severe headache/blurred vision Convulsions/loss of consciousness Labor pains before 37 weeks Prevention and Control of Malaria during Pregnancy 24 Health Education: Objectives Inform and educate the woman with health messages and counseling appropriate to: Individual needs, concerns, circumstances Gestational age Most prevalent health issues Support the woman in making decisions and solving actual or anticipated problems Involve partner and family in supporting/adopting healthy practices Prevention and Control of Malaria during Pregnancy 25 Health Education: Topics Addressed Prevention of malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Other methods Other important issues to be discussed include: Nutrition Care for common discomforts Use of potentially harmful substances Hygiene Rest and activity Prevention and Control of Malaria during Pregnancy 26 Health Education: Topics Addressed (cont’d.) Sexual relations and safer sex Early and exclusive breastfeeding Prevention of tetanus and anemia Voluntary counseling and testing for HIV Prevention of other endemic diseases/deficiencies Prevention and Control of Malaria during Pregnancy 27 Interpersonal Skills Speak in a quiet, gentle tone of voice Listen to woman/family and respond appropriately Encourage them to ask questions and express concerns Allow them to demonstrate understanding of information provided Explain all procedures/actions and obtain permission before proceeding Show respect for cultural beliefs and social norms Be empathetic and nonjudgmental Avoid distractions while conducting the visit Prevention and Control of Malaria during Pregnancy 28 Record Keeping First ANC Visit History Physical examination Testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs Date of next ANC visit Subsequent ANC Visits Interim history Targeted physical examination, testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs (and relevant information on how client obtained and used ITN) Date of next ANC visit Record all information on the ANC chart and clinic card: Prevention and Control of Malaria during Pregnancy Chapter II: Malaria Transmission Prevention and Control of Malaria during Pregnancy 30 Malaria Transmission: Chapter Objectives Define malaria and how it is transmitted Describe extent of malaria in Africa Identify groups at highest risk of malaria infection List effects of malaria on pregnant women and their unborn babies Describe effects of malaria on pregnant women with HIV/AIDS
Slide 31 - Prevention and Control of Malaria during Pregnancy A Workshop for Healthcare Providers Prevention and Control of Malaria during Pregnancy 2 Facts about Malaria 300 million cases each year worldwide 9 of 10 cases occur in Africa A person in Africa dies of malaria every 10 seconds Women and young children are most at risk Affects five times as many people as AIDS, leprosy, measles, and tuberculosis combined Prevention and Control of Malaria during Pregnancy 3 Facts about Malaria and Pregnancy 30 million African women are pregnant yearly Malaria is more frequent and complicated during pregnancy In malaria-endemic areas, malaria during pregnancy may account for: Up to 15% of maternal anemia 5–14% of low birthweight 30% of “preventable” low birthweight Prevention and Control of Malaria during Pregnancy 4 Roll Back Malaria Worldwide partnership Governments, private groups, research organizations, civil society, media Aim to reduce malaria by half by 2010 Free advocacy resources and tools: http://www.rbm.who.int Priority: Prevent poor outcomes caused by malaria in pregnancy Abuja declaration: Goal is for 60% of women in Africa to be sleeping under insecticide-treated nets (ITNs) and getting intermittent preventive treatment (IPT) by 2005 Prevention and Control of Malaria during Pregnancy 5 Malaria Prevention and Treatment during Pregnancy Focused antenatal care (ANC) with health education about malaria Use of insecticide-treated nets (ITNs) Intermittent preventive treatment (IPT) Case management of women with symptoms and signs of malaria Prevention and Control of Malaria during Pregnancy Chapter I: Focused Antenatal Care Prevention and Control of Malaria during Pregnancy 7 Focused Antenatal Care: Chapter Objectives Describe four main components of focused antenatal care (ANC) Discuss frequency and timing of ANC visits Describe essential elements of a birth plan that includes complication readiness Describe interpersonal skills for effective ANC Describe components of record keeping for ANC Prevention and Control of Malaria during Pregnancy 8 Focused Antenatal Care An approach to ANC that emphasizes: Evidence-based, goal-directed actions Individualized, woman-centered care Quality vs. quantity of visits Care by skilled providers Prevention and Control of Malaria during Pregnancy 9 Goal of Focused Antenatal Care To promote maternal and newborn health and survival through: Early detection and treatment of problems and complications Prevention of complications and disease Birth preparedness and complication readiness Health promotion Prevention and Control of Malaria during Pregnancy 10 Traditional Antenatal Care Emphasizes: Ritualistic, “routine” care vs. evidence-based, goal-directed actions Frequent visits Does not emphasize individual client needs Prevention and Control of Malaria during Pregnancy 11 No Longer Recommended Numerous, routine visits Burden to women and healthcare system Routine measurements and examinations: Maternal height and weight Ankle edema Fetal position before 36 weeks Care based on risk assessment Prevention and Control of Malaria during Pregnancy 12 Risk Approach Not an effective ANC strategy because: Complications cannot be predicted—all pregnant women are at risk for developing complications Risk factors are usually not direct cause of complications Many “low risk” women develop complications Have false sense of security Do not know how to recognize/respond to problems Most “high risk” women give birth without complications Inefficient use of scarce resources Prevention and Control of Malaria during Pregnancy 13 Focused Antenatal Care Services Evidence-based, goal-directed actions: Address most prevalent health issues affecting women and newborns Adjusted for specific populations/regions Appropriate to gestational age Based on firm rationale Prevention and Control of Malaria during Pregnancy 14 Focused Antenatal Care Services (cont’d.) Individualized, woman-centered care based on each woman’s: Specific needs and concerns Circumstances History, physical examination, testing Available resources Prevention and Control of Malaria during Pregnancy 15 Focused Antenatal Care Services (cont’d.) Quality vs. quantity of ANC visits: WHO multi-center study Number of visits reduced without affecting outcome for mother or baby Recommendations Content and quality vs. number of visits Goal-oriented care Minimum of four visits Prevention and Control of Malaria during Pregnancy 16 First visit: By 16 weeks or when woman first thinks she is pregnant Second visit: At 24–28 weeks or at least once in second trimester Third visit: At 32 weeks Fourth visit: At 36 weeks Other visits: If complication occurs, followup or referral is needed, woman wants to see provider, or provider changes frequency based on findings (history, exam, testing) or local policy Scheduling and Timing of ANC Visits Prevention and Control of Malaria during Pregnancy 17 Focused Antenatal Care Services (cont’d.) Care by a skilled provider who: Has formal training and experience Has knowledge, skills, and qualifications to deliver safe, effective maternal and newborn healthcare Practices in home, hospital, health center May be a midwife, nurse, doctor, clinical officer, etc. Prevention and Control of Malaria during Pregnancy 18 Early Detection and Treatment Malaria—history and physical exam Fever and accompanying signs/symptoms Region Complicated vs. uncomplicated cases Severe anemia—physical exam, testing Pre-eclampsia/eclampsia—measurement of blood pressure HIV—voluntary counseling and testing Sexually transmitted infections, including syphilis— testing Prevention and Control of Malaria during Pregnancy 19 Prevention: Key Preventive Measures Malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Tetanus toxoid, iron/folate supplements Country/region-specific interventions as appropriate Vitamin A supplements Iodine supplements Presumptive treatment for hookworm Prevention and Control of Malaria during Pregnancy 20 Birth Preparedness and Complication Readiness: Objectives Develop birth plan—exact plan for normal birth and possible complications: Arrangements made in advance by woman and family (with help of skilled provider) Usually not a written document Reviewed/revised at every visit Minimize disorganization at time of birth or in an emergency Ensure timely and appropriate care Prevention and Control of Malaria during Pregnancy 21 Essential Elements of a Birth Plan Facility or Place of Birth: Home or health facility for birth, appropriate facility for emergencies Skilled Provider: To attend birth Provider/Facility Contact Information Transportation: Reliable, accessible, especially for odd hours Funds: Personal savings, emergency funds Decision-Making: Who will make decisions, especially in an emergency Prevention and Control of Malaria during Pregnancy 22 Essential Elements of a Birth Plan (cont’d.) Family and Community Support: Care for family in woman’s absence and birth companion during labor Blood Donor: In case of emergency Needed Items: For clean and safe birth and for newborn care Danger Signs/Signs of Advanced Labor Prevention and Control of Malaria during Pregnancy 23 Danger Signs of Pregnancy Vaginal bleeding Difficulty breathing Fever Severe abdominal pain Severe headache/blurred vision Convulsions/loss of consciousness Labor pains before 37 weeks Prevention and Control of Malaria during Pregnancy 24 Health Education: Objectives Inform and educate the woman with health messages and counseling appropriate to: Individual needs, concerns, circumstances Gestational age Most prevalent health issues Support the woman in making decisions and solving actual or anticipated problems Involve partner and family in supporting/adopting healthy practices Prevention and Control of Malaria during Pregnancy 25 Health Education: Topics Addressed Prevention of malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Other methods Other important issues to be discussed include: Nutrition Care for common discomforts Use of potentially harmful substances Hygiene Rest and activity Prevention and Control of Malaria during Pregnancy 26 Health Education: Topics Addressed (cont’d.) Sexual relations and safer sex Early and exclusive breastfeeding Prevention of tetanus and anemia Voluntary counseling and testing for HIV Prevention of other endemic diseases/deficiencies Prevention and Control of Malaria during Pregnancy 27 Interpersonal Skills Speak in a quiet, gentle tone of voice Listen to woman/family and respond appropriately Encourage them to ask questions and express concerns Allow them to demonstrate understanding of information provided Explain all procedures/actions and obtain permission before proceeding Show respect for cultural beliefs and social norms Be empathetic and nonjudgmental Avoid distractions while conducting the visit Prevention and Control of Malaria during Pregnancy 28 Record Keeping First ANC Visit History Physical examination Testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs Date of next ANC visit Subsequent ANC Visits Interim history Targeted physical examination, testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs (and relevant information on how client obtained and used ITN) Date of next ANC visit Record all information on the ANC chart and clinic card: Prevention and Control of Malaria during Pregnancy Chapter II: Malaria Transmission Prevention and Control of Malaria during Pregnancy 30 Malaria Transmission: Chapter Objectives Define malaria and how it is transmitted Describe extent of malaria in Africa Identify groups at highest risk of malaria infection List effects of malaria on pregnant women and their unborn babies Describe effects of malaria on pregnant women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 31 Malaria Transmission Caused by Plasmodium parasites Spread by female Anopheles mosquitoes infected with parasites Anopheles mosquitoes usually active at night Infected mosquito bites a person Malaria parasites reproduce in human blood Mosquito bites infected person, and goes on to bite and infect another person
Slide 32 - Prevention and Control of Malaria during Pregnancy A Workshop for Healthcare Providers Prevention and Control of Malaria during Pregnancy 2 Facts about Malaria 300 million cases each year worldwide 9 of 10 cases occur in Africa A person in Africa dies of malaria every 10 seconds Women and young children are most at risk Affects five times as many people as AIDS, leprosy, measles, and tuberculosis combined Prevention and Control of Malaria during Pregnancy 3 Facts about Malaria and Pregnancy 30 million African women are pregnant yearly Malaria is more frequent and complicated during pregnancy In malaria-endemic areas, malaria during pregnancy may account for: Up to 15% of maternal anemia 5–14% of low birthweight 30% of “preventable” low birthweight Prevention and Control of Malaria during Pregnancy 4 Roll Back Malaria Worldwide partnership Governments, private groups, research organizations, civil society, media Aim to reduce malaria by half by 2010 Free advocacy resources and tools: http://www.rbm.who.int Priority: Prevent poor outcomes caused by malaria in pregnancy Abuja declaration: Goal is for 60% of women in Africa to be sleeping under insecticide-treated nets (ITNs) and getting intermittent preventive treatment (IPT) by 2005 Prevention and Control of Malaria during Pregnancy 5 Malaria Prevention and Treatment during Pregnancy Focused antenatal care (ANC) with health education about malaria Use of insecticide-treated nets (ITNs) Intermittent preventive treatment (IPT) Case management of women with symptoms and signs of malaria Prevention and Control of Malaria during Pregnancy Chapter I: Focused Antenatal Care Prevention and Control of Malaria during Pregnancy 7 Focused Antenatal Care: Chapter Objectives Describe four main components of focused antenatal care (ANC) Discuss frequency and timing of ANC visits Describe essential elements of a birth plan that includes complication readiness Describe interpersonal skills for effective ANC Describe components of record keeping for ANC Prevention and Control of Malaria during Pregnancy 8 Focused Antenatal Care An approach to ANC that emphasizes: Evidence-based, goal-directed actions Individualized, woman-centered care Quality vs. quantity of visits Care by skilled providers Prevention and Control of Malaria during Pregnancy 9 Goal of Focused Antenatal Care To promote maternal and newborn health and survival through: Early detection and treatment of problems and complications Prevention of complications and disease Birth preparedness and complication readiness Health promotion Prevention and Control of Malaria during Pregnancy 10 Traditional Antenatal Care Emphasizes: Ritualistic, “routine” care vs. evidence-based, goal-directed actions Frequent visits Does not emphasize individual client needs Prevention and Control of Malaria during Pregnancy 11 No Longer Recommended Numerous, routine visits Burden to women and healthcare system Routine measurements and examinations: Maternal height and weight Ankle edema Fetal position before 36 weeks Care based on risk assessment Prevention and Control of Malaria during Pregnancy 12 Risk Approach Not an effective ANC strategy because: Complications cannot be predicted—all pregnant women are at risk for developing complications Risk factors are usually not direct cause of complications Many “low risk” women develop complications Have false sense of security Do not know how to recognize/respond to problems Most “high risk” women give birth without complications Inefficient use of scarce resources Prevention and Control of Malaria during Pregnancy 13 Focused Antenatal Care Services Evidence-based, goal-directed actions: Address most prevalent health issues affecting women and newborns Adjusted for specific populations/regions Appropriate to gestational age Based on firm rationale Prevention and Control of Malaria during Pregnancy 14 Focused Antenatal Care Services (cont’d.) Individualized, woman-centered care based on each woman’s: Specific needs and concerns Circumstances History, physical examination, testing Available resources Prevention and Control of Malaria during Pregnancy 15 Focused Antenatal Care Services (cont’d.) Quality vs. quantity of ANC visits: WHO multi-center study Number of visits reduced without affecting outcome for mother or baby Recommendations Content and quality vs. number of visits Goal-oriented care Minimum of four visits Prevention and Control of Malaria during Pregnancy 16 First visit: By 16 weeks or when woman first thinks she is pregnant Second visit: At 24–28 weeks or at least once in second trimester Third visit: At 32 weeks Fourth visit: At 36 weeks Other visits: If complication occurs, followup or referral is needed, woman wants to see provider, or provider changes frequency based on findings (history, exam, testing) or local policy Scheduling and Timing of ANC Visits Prevention and Control of Malaria during Pregnancy 17 Focused Antenatal Care Services (cont’d.) Care by a skilled provider who: Has formal training and experience Has knowledge, skills, and qualifications to deliver safe, effective maternal and newborn healthcare Practices in home, hospital, health center May be a midwife, nurse, doctor, clinical officer, etc. Prevention and Control of Malaria during Pregnancy 18 Early Detection and Treatment Malaria—history and physical exam Fever and accompanying signs/symptoms Region Complicated vs. uncomplicated cases Severe anemia—physical exam, testing Pre-eclampsia/eclampsia—measurement of blood pressure HIV—voluntary counseling and testing Sexually transmitted infections, including syphilis— testing Prevention and Control of Malaria during Pregnancy 19 Prevention: Key Preventive Measures Malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Tetanus toxoid, iron/folate supplements Country/region-specific interventions as appropriate Vitamin A supplements Iodine supplements Presumptive treatment for hookworm Prevention and Control of Malaria during Pregnancy 20 Birth Preparedness and Complication Readiness: Objectives Develop birth plan—exact plan for normal birth and possible complications: Arrangements made in advance by woman and family (with help of skilled provider) Usually not a written document Reviewed/revised at every visit Minimize disorganization at time of birth or in an emergency Ensure timely and appropriate care Prevention and Control of Malaria during Pregnancy 21 Essential Elements of a Birth Plan Facility or Place of Birth: Home or health facility for birth, appropriate facility for emergencies Skilled Provider: To attend birth Provider/Facility Contact Information Transportation: Reliable, accessible, especially for odd hours Funds: Personal savings, emergency funds Decision-Making: Who will make decisions, especially in an emergency Prevention and Control of Malaria during Pregnancy 22 Essential Elements of a Birth Plan (cont’d.) Family and Community Support: Care for family in woman’s absence and birth companion during labor Blood Donor: In case of emergency Needed Items: For clean and safe birth and for newborn care Danger Signs/Signs of Advanced Labor Prevention and Control of Malaria during Pregnancy 23 Danger Signs of Pregnancy Vaginal bleeding Difficulty breathing Fever Severe abdominal pain Severe headache/blurred vision Convulsions/loss of consciousness Labor pains before 37 weeks Prevention and Control of Malaria during Pregnancy 24 Health Education: Objectives Inform and educate the woman with health messages and counseling appropriate to: Individual needs, concerns, circumstances Gestational age Most prevalent health issues Support the woman in making decisions and solving actual or anticipated problems Involve partner and family in supporting/adopting healthy practices Prevention and Control of Malaria during Pregnancy 25 Health Education: Topics Addressed Prevention of malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Other methods Other important issues to be discussed include: Nutrition Care for common discomforts Use of potentially harmful substances Hygiene Rest and activity Prevention and Control of Malaria during Pregnancy 26 Health Education: Topics Addressed (cont’d.) Sexual relations and safer sex Early and exclusive breastfeeding Prevention of tetanus and anemia Voluntary counseling and testing for HIV Prevention of other endemic diseases/deficiencies Prevention and Control of Malaria during Pregnancy 27 Interpersonal Skills Speak in a quiet, gentle tone of voice Listen to woman/family and respond appropriately Encourage them to ask questions and express concerns Allow them to demonstrate understanding of information provided Explain all procedures/actions and obtain permission before proceeding Show respect for cultural beliefs and social norms Be empathetic and nonjudgmental Avoid distractions while conducting the visit Prevention and Control of Malaria during Pregnancy 28 Record Keeping First ANC Visit History Physical examination Testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs Date of next ANC visit Subsequent ANC Visits Interim history Targeted physical examination, testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs (and relevant information on how client obtained and used ITN) Date of next ANC visit Record all information on the ANC chart and clinic card: Prevention and Control of Malaria during Pregnancy Chapter II: Malaria Transmission Prevention and Control of Malaria during Pregnancy 30 Malaria Transmission: Chapter Objectives Define malaria and how it is transmitted Describe extent of malaria in Africa Identify groups at highest risk of malaria infection List effects of malaria on pregnant women and their unborn babies Describe effects of malaria on pregnant women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 31 Malaria Transmission Caused by Plasmodium parasites Spread by female Anopheles mosquitoes infected with parasites Anopheles mosquitoes usually active at night Infected mosquito bites a person Malaria parasites reproduce in human blood Mosquito bites infected person, and goes on to bite and infect another person Prevention and Control of Malaria during Pregnancy 32 Populations Most Affected by Malaria Children under 5 years of age Pregnant women Unborn babies Immigrants from low-transmission areas HIV-infected persons
Slide 33 - Prevention and Control of Malaria during Pregnancy A Workshop for Healthcare Providers Prevention and Control of Malaria during Pregnancy 2 Facts about Malaria 300 million cases each year worldwide 9 of 10 cases occur in Africa A person in Africa dies of malaria every 10 seconds Women and young children are most at risk Affects five times as many people as AIDS, leprosy, measles, and tuberculosis combined Prevention and Control of Malaria during Pregnancy 3 Facts about Malaria and Pregnancy 30 million African women are pregnant yearly Malaria is more frequent and complicated during pregnancy In malaria-endemic areas, malaria during pregnancy may account for: Up to 15% of maternal anemia 5–14% of low birthweight 30% of “preventable” low birthweight Prevention and Control of Malaria during Pregnancy 4 Roll Back Malaria Worldwide partnership Governments, private groups, research organizations, civil society, media Aim to reduce malaria by half by 2010 Free advocacy resources and tools: http://www.rbm.who.int Priority: Prevent poor outcomes caused by malaria in pregnancy Abuja declaration: Goal is for 60% of women in Africa to be sleeping under insecticide-treated nets (ITNs) and getting intermittent preventive treatment (IPT) by 2005 Prevention and Control of Malaria during Pregnancy 5 Malaria Prevention and Treatment during Pregnancy Focused antenatal care (ANC) with health education about malaria Use of insecticide-treated nets (ITNs) Intermittent preventive treatment (IPT) Case management of women with symptoms and signs of malaria Prevention and Control of Malaria during Pregnancy Chapter I: Focused Antenatal Care Prevention and Control of Malaria during Pregnancy 7 Focused Antenatal Care: Chapter Objectives Describe four main components of focused antenatal care (ANC) Discuss frequency and timing of ANC visits Describe essential elements of a birth plan that includes complication readiness Describe interpersonal skills for effective ANC Describe components of record keeping for ANC Prevention and Control of Malaria during Pregnancy 8 Focused Antenatal Care An approach to ANC that emphasizes: Evidence-based, goal-directed actions Individualized, woman-centered care Quality vs. quantity of visits Care by skilled providers Prevention and Control of Malaria during Pregnancy 9 Goal of Focused Antenatal Care To promote maternal and newborn health and survival through: Early detection and treatment of problems and complications Prevention of complications and disease Birth preparedness and complication readiness Health promotion Prevention and Control of Malaria during Pregnancy 10 Traditional Antenatal Care Emphasizes: Ritualistic, “routine” care vs. evidence-based, goal-directed actions Frequent visits Does not emphasize individual client needs Prevention and Control of Malaria during Pregnancy 11 No Longer Recommended Numerous, routine visits Burden to women and healthcare system Routine measurements and examinations: Maternal height and weight Ankle edema Fetal position before 36 weeks Care based on risk assessment Prevention and Control of Malaria during Pregnancy 12 Risk Approach Not an effective ANC strategy because: Complications cannot be predicted—all pregnant women are at risk for developing complications Risk factors are usually not direct cause of complications Many “low risk” women develop complications Have false sense of security Do not know how to recognize/respond to problems Most “high risk” women give birth without complications Inefficient use of scarce resources Prevention and Control of Malaria during Pregnancy 13 Focused Antenatal Care Services Evidence-based, goal-directed actions: Address most prevalent health issues affecting women and newborns Adjusted for specific populations/regions Appropriate to gestational age Based on firm rationale Prevention and Control of Malaria during Pregnancy 14 Focused Antenatal Care Services (cont’d.) Individualized, woman-centered care based on each woman’s: Specific needs and concerns Circumstances History, physical examination, testing Available resources Prevention and Control of Malaria during Pregnancy 15 Focused Antenatal Care Services (cont’d.) Quality vs. quantity of ANC visits: WHO multi-center study Number of visits reduced without affecting outcome for mother or baby Recommendations Content and quality vs. number of visits Goal-oriented care Minimum of four visits Prevention and Control of Malaria during Pregnancy 16 First visit: By 16 weeks or when woman first thinks she is pregnant Second visit: At 24–28 weeks or at least once in second trimester Third visit: At 32 weeks Fourth visit: At 36 weeks Other visits: If complication occurs, followup or referral is needed, woman wants to see provider, or provider changes frequency based on findings (history, exam, testing) or local policy Scheduling and Timing of ANC Visits Prevention and Control of Malaria during Pregnancy 17 Focused Antenatal Care Services (cont’d.) Care by a skilled provider who: Has formal training and experience Has knowledge, skills, and qualifications to deliver safe, effective maternal and newborn healthcare Practices in home, hospital, health center May be a midwife, nurse, doctor, clinical officer, etc. Prevention and Control of Malaria during Pregnancy 18 Early Detection and Treatment Malaria—history and physical exam Fever and accompanying signs/symptoms Region Complicated vs. uncomplicated cases Severe anemia—physical exam, testing Pre-eclampsia/eclampsia—measurement of blood pressure HIV—voluntary counseling and testing Sexually transmitted infections, including syphilis— testing Prevention and Control of Malaria during Pregnancy 19 Prevention: Key Preventive Measures Malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Tetanus toxoid, iron/folate supplements Country/region-specific interventions as appropriate Vitamin A supplements Iodine supplements Presumptive treatment for hookworm Prevention and Control of Malaria during Pregnancy 20 Birth Preparedness and Complication Readiness: Objectives Develop birth plan—exact plan for normal birth and possible complications: Arrangements made in advance by woman and family (with help of skilled provider) Usually not a written document Reviewed/revised at every visit Minimize disorganization at time of birth or in an emergency Ensure timely and appropriate care Prevention and Control of Malaria during Pregnancy 21 Essential Elements of a Birth Plan Facility or Place of Birth: Home or health facility for birth, appropriate facility for emergencies Skilled Provider: To attend birth Provider/Facility Contact Information Transportation: Reliable, accessible, especially for odd hours Funds: Personal savings, emergency funds Decision-Making: Who will make decisions, especially in an emergency Prevention and Control of Malaria during Pregnancy 22 Essential Elements of a Birth Plan (cont’d.) Family and Community Support: Care for family in woman’s absence and birth companion during labor Blood Donor: In case of emergency Needed Items: For clean and safe birth and for newborn care Danger Signs/Signs of Advanced Labor Prevention and Control of Malaria during Pregnancy 23 Danger Signs of Pregnancy Vaginal bleeding Difficulty breathing Fever Severe abdominal pain Severe headache/blurred vision Convulsions/loss of consciousness Labor pains before 37 weeks Prevention and Control of Malaria during Pregnancy 24 Health Education: Objectives Inform and educate the woman with health messages and counseling appropriate to: Individual needs, concerns, circumstances Gestational age Most prevalent health issues Support the woman in making decisions and solving actual or anticipated problems Involve partner and family in supporting/adopting healthy practices Prevention and Control of Malaria during Pregnancy 25 Health Education: Topics Addressed Prevention of malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Other methods Other important issues to be discussed include: Nutrition Care for common discomforts Use of potentially harmful substances Hygiene Rest and activity Prevention and Control of Malaria during Pregnancy 26 Health Education: Topics Addressed (cont’d.) Sexual relations and safer sex Early and exclusive breastfeeding Prevention of tetanus and anemia Voluntary counseling and testing for HIV Prevention of other endemic diseases/deficiencies Prevention and Control of Malaria during Pregnancy 27 Interpersonal Skills Speak in a quiet, gentle tone of voice Listen to woman/family and respond appropriately Encourage them to ask questions and express concerns Allow them to demonstrate understanding of information provided Explain all procedures/actions and obtain permission before proceeding Show respect for cultural beliefs and social norms Be empathetic and nonjudgmental Avoid distractions while conducting the visit Prevention and Control of Malaria during Pregnancy 28 Record Keeping First ANC Visit History Physical examination Testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs Date of next ANC visit Subsequent ANC Visits Interim history Targeted physical examination, testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs (and relevant information on how client obtained and used ITN) Date of next ANC visit Record all information on the ANC chart and clinic card: Prevention and Control of Malaria during Pregnancy Chapter II: Malaria Transmission Prevention and Control of Malaria during Pregnancy 30 Malaria Transmission: Chapter Objectives Define malaria and how it is transmitted Describe extent of malaria in Africa Identify groups at highest risk of malaria infection List effects of malaria on pregnant women and their unborn babies Describe effects of malaria on pregnant women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 31 Malaria Transmission Caused by Plasmodium parasites Spread by female Anopheles mosquitoes infected with parasites Anopheles mosquitoes usually active at night Infected mosquito bites a person Malaria parasites reproduce in human blood Mosquito bites infected person, and goes on to bite and infect another person Prevention and Control of Malaria during Pregnancy 32 Populations Most Affected by Malaria Children under 5 years of age Pregnant women Unborn babies Immigrants from low-transmission areas HIV-infected persons Prevention and Control of Malaria during Pregnancy 33 Effects of Malaria on Pregnant Women All pregnant women in malaria-endemic areas are at risk Parasites attack and destroy red blood cells Malaria causes up to 15% of anemia in pregnancy Can cause severe anemia In Africa, anemia due to malaria causes up to 10,000 maternal deaths per year
Slide 34 - Prevention and Control of Malaria during Pregnancy A Workshop for Healthcare Providers Prevention and Control of Malaria during Pregnancy 2 Facts about Malaria 300 million cases each year worldwide 9 of 10 cases occur in Africa A person in Africa dies of malaria every 10 seconds Women and young children are most at risk Affects five times as many people as AIDS, leprosy, measles, and tuberculosis combined Prevention and Control of Malaria during Pregnancy 3 Facts about Malaria and Pregnancy 30 million African women are pregnant yearly Malaria is more frequent and complicated during pregnancy In malaria-endemic areas, malaria during pregnancy may account for: Up to 15% of maternal anemia 5–14% of low birthweight 30% of “preventable” low birthweight Prevention and Control of Malaria during Pregnancy 4 Roll Back Malaria Worldwide partnership Governments, private groups, research organizations, civil society, media Aim to reduce malaria by half by 2010 Free advocacy resources and tools: http://www.rbm.who.int Priority: Prevent poor outcomes caused by malaria in pregnancy Abuja declaration: Goal is for 60% of women in Africa to be sleeping under insecticide-treated nets (ITNs) and getting intermittent preventive treatment (IPT) by 2005 Prevention and Control of Malaria during Pregnancy 5 Malaria Prevention and Treatment during Pregnancy Focused antenatal care (ANC) with health education about malaria Use of insecticide-treated nets (ITNs) Intermittent preventive treatment (IPT) Case management of women with symptoms and signs of malaria Prevention and Control of Malaria during Pregnancy Chapter I: Focused Antenatal Care Prevention and Control of Malaria during Pregnancy 7 Focused Antenatal Care: Chapter Objectives Describe four main components of focused antenatal care (ANC) Discuss frequency and timing of ANC visits Describe essential elements of a birth plan that includes complication readiness Describe interpersonal skills for effective ANC Describe components of record keeping for ANC Prevention and Control of Malaria during Pregnancy 8 Focused Antenatal Care An approach to ANC that emphasizes: Evidence-based, goal-directed actions Individualized, woman-centered care Quality vs. quantity of visits Care by skilled providers Prevention and Control of Malaria during Pregnancy 9 Goal of Focused Antenatal Care To promote maternal and newborn health and survival through: Early detection and treatment of problems and complications Prevention of complications and disease Birth preparedness and complication readiness Health promotion Prevention and Control of Malaria during Pregnancy 10 Traditional Antenatal Care Emphasizes: Ritualistic, “routine” care vs. evidence-based, goal-directed actions Frequent visits Does not emphasize individual client needs Prevention and Control of Malaria during Pregnancy 11 No Longer Recommended Numerous, routine visits Burden to women and healthcare system Routine measurements and examinations: Maternal height and weight Ankle edema Fetal position before 36 weeks Care based on risk assessment Prevention and Control of Malaria during Pregnancy 12 Risk Approach Not an effective ANC strategy because: Complications cannot be predicted—all pregnant women are at risk for developing complications Risk factors are usually not direct cause of complications Many “low risk” women develop complications Have false sense of security Do not know how to recognize/respond to problems Most “high risk” women give birth without complications Inefficient use of scarce resources Prevention and Control of Malaria during Pregnancy 13 Focused Antenatal Care Services Evidence-based, goal-directed actions: Address most prevalent health issues affecting women and newborns Adjusted for specific populations/regions Appropriate to gestational age Based on firm rationale Prevention and Control of Malaria during Pregnancy 14 Focused Antenatal Care Services (cont’d.) Individualized, woman-centered care based on each woman’s: Specific needs and concerns Circumstances History, physical examination, testing Available resources Prevention and Control of Malaria during Pregnancy 15 Focused Antenatal Care Services (cont’d.) Quality vs. quantity of ANC visits: WHO multi-center study Number of visits reduced without affecting outcome for mother or baby Recommendations Content and quality vs. number of visits Goal-oriented care Minimum of four visits Prevention and Control of Malaria during Pregnancy 16 First visit: By 16 weeks or when woman first thinks she is pregnant Second visit: At 24–28 weeks or at least once in second trimester Third visit: At 32 weeks Fourth visit: At 36 weeks Other visits: If complication occurs, followup or referral is needed, woman wants to see provider, or provider changes frequency based on findings (history, exam, testing) or local policy Scheduling and Timing of ANC Visits Prevention and Control of Malaria during Pregnancy 17 Focused Antenatal Care Services (cont’d.) Care by a skilled provider who: Has formal training and experience Has knowledge, skills, and qualifications to deliver safe, effective maternal and newborn healthcare Practices in home, hospital, health center May be a midwife, nurse, doctor, clinical officer, etc. Prevention and Control of Malaria during Pregnancy 18 Early Detection and Treatment Malaria—history and physical exam Fever and accompanying signs/symptoms Region Complicated vs. uncomplicated cases Severe anemia—physical exam, testing Pre-eclampsia/eclampsia—measurement of blood pressure HIV—voluntary counseling and testing Sexually transmitted infections, including syphilis— testing Prevention and Control of Malaria during Pregnancy 19 Prevention: Key Preventive Measures Malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Tetanus toxoid, iron/folate supplements Country/region-specific interventions as appropriate Vitamin A supplements Iodine supplements Presumptive treatment for hookworm Prevention and Control of Malaria during Pregnancy 20 Birth Preparedness and Complication Readiness: Objectives Develop birth plan—exact plan for normal birth and possible complications: Arrangements made in advance by woman and family (with help of skilled provider) Usually not a written document Reviewed/revised at every visit Minimize disorganization at time of birth or in an emergency Ensure timely and appropriate care Prevention and Control of Malaria during Pregnancy 21 Essential Elements of a Birth Plan Facility or Place of Birth: Home or health facility for birth, appropriate facility for emergencies Skilled Provider: To attend birth Provider/Facility Contact Information Transportation: Reliable, accessible, especially for odd hours Funds: Personal savings, emergency funds Decision-Making: Who will make decisions, especially in an emergency Prevention and Control of Malaria during Pregnancy 22 Essential Elements of a Birth Plan (cont’d.) Family and Community Support: Care for family in woman’s absence and birth companion during labor Blood Donor: In case of emergency Needed Items: For clean and safe birth and for newborn care Danger Signs/Signs of Advanced Labor Prevention and Control of Malaria during Pregnancy 23 Danger Signs of Pregnancy Vaginal bleeding Difficulty breathing Fever Severe abdominal pain Severe headache/blurred vision Convulsions/loss of consciousness Labor pains before 37 weeks Prevention and Control of Malaria during Pregnancy 24 Health Education: Objectives Inform and educate the woman with health messages and counseling appropriate to: Individual needs, concerns, circumstances Gestational age Most prevalent health issues Support the woman in making decisions and solving actual or anticipated problems Involve partner and family in supporting/adopting healthy practices Prevention and Control of Malaria during Pregnancy 25 Health Education: Topics Addressed Prevention of malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Other methods Other important issues to be discussed include: Nutrition Care for common discomforts Use of potentially harmful substances Hygiene Rest and activity Prevention and Control of Malaria during Pregnancy 26 Health Education: Topics Addressed (cont’d.) Sexual relations and safer sex Early and exclusive breastfeeding Prevention of tetanus and anemia Voluntary counseling and testing for HIV Prevention of other endemic diseases/deficiencies Prevention and Control of Malaria during Pregnancy 27 Interpersonal Skills Speak in a quiet, gentle tone of voice Listen to woman/family and respond appropriately Encourage them to ask questions and express concerns Allow them to demonstrate understanding of information provided Explain all procedures/actions and obtain permission before proceeding Show respect for cultural beliefs and social norms Be empathetic and nonjudgmental Avoid distractions while conducting the visit Prevention and Control of Malaria during Pregnancy 28 Record Keeping First ANC Visit History Physical examination Testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs Date of next ANC visit Subsequent ANC Visits Interim history Targeted physical examination, testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs (and relevant information on how client obtained and used ITN) Date of next ANC visit Record all information on the ANC chart and clinic card: Prevention and Control of Malaria during Pregnancy Chapter II: Malaria Transmission Prevention and Control of Malaria during Pregnancy 30 Malaria Transmission: Chapter Objectives Define malaria and how it is transmitted Describe extent of malaria in Africa Identify groups at highest risk of malaria infection List effects of malaria on pregnant women and their unborn babies Describe effects of malaria on pregnant women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 31 Malaria Transmission Caused by Plasmodium parasites Spread by female Anopheles mosquitoes infected with parasites Anopheles mosquitoes usually active at night Infected mosquito bites a person Malaria parasites reproduce in human blood Mosquito bites infected person, and goes on to bite and infect another person Prevention and Control of Malaria during Pregnancy 32 Populations Most Affected by Malaria Children under 5 years of age Pregnant women Unborn babies Immigrants from low-transmission areas HIV-infected persons Prevention and Control of Malaria during Pregnancy 33 Effects of Malaria on Pregnant Women All pregnant women in malaria-endemic areas are at risk Parasites attack and destroy red blood cells Malaria causes up to 15% of anemia in pregnancy Can cause severe anemia In Africa, anemia due to malaria causes up to 10,000 maternal deaths per year Prevention and Control of Malaria during Pregnancy 34 Effects on Unborn Babies Parasites hide in placenta Interferes with transfer of oxygen and nutrients to the baby, increasing risk of: Spontaneous abortion Preterm birth Low birthweight—single greatest risk factor for death during first month of life Stillbirth
Slide 35 - Prevention and Control of Malaria during Pregnancy A Workshop for Healthcare Providers Prevention and Control of Malaria during Pregnancy 2 Facts about Malaria 300 million cases each year worldwide 9 of 10 cases occur in Africa A person in Africa dies of malaria every 10 seconds Women and young children are most at risk Affects five times as many people as AIDS, leprosy, measles, and tuberculosis combined Prevention and Control of Malaria during Pregnancy 3 Facts about Malaria and Pregnancy 30 million African women are pregnant yearly Malaria is more frequent and complicated during pregnancy In malaria-endemic areas, malaria during pregnancy may account for: Up to 15% of maternal anemia 5–14% of low birthweight 30% of “preventable” low birthweight Prevention and Control of Malaria during Pregnancy 4 Roll Back Malaria Worldwide partnership Governments, private groups, research organizations, civil society, media Aim to reduce malaria by half by 2010 Free advocacy resources and tools: http://www.rbm.who.int Priority: Prevent poor outcomes caused by malaria in pregnancy Abuja declaration: Goal is for 60% of women in Africa to be sleeping under insecticide-treated nets (ITNs) and getting intermittent preventive treatment (IPT) by 2005 Prevention and Control of Malaria during Pregnancy 5 Malaria Prevention and Treatment during Pregnancy Focused antenatal care (ANC) with health education about malaria Use of insecticide-treated nets (ITNs) Intermittent preventive treatment (IPT) Case management of women with symptoms and signs of malaria Prevention and Control of Malaria during Pregnancy Chapter I: Focused Antenatal Care Prevention and Control of Malaria during Pregnancy 7 Focused Antenatal Care: Chapter Objectives Describe four main components of focused antenatal care (ANC) Discuss frequency and timing of ANC visits Describe essential elements of a birth plan that includes complication readiness Describe interpersonal skills for effective ANC Describe components of record keeping for ANC Prevention and Control of Malaria during Pregnancy 8 Focused Antenatal Care An approach to ANC that emphasizes: Evidence-based, goal-directed actions Individualized, woman-centered care Quality vs. quantity of visits Care by skilled providers Prevention and Control of Malaria during Pregnancy 9 Goal of Focused Antenatal Care To promote maternal and newborn health and survival through: Early detection and treatment of problems and complications Prevention of complications and disease Birth preparedness and complication readiness Health promotion Prevention and Control of Malaria during Pregnancy 10 Traditional Antenatal Care Emphasizes: Ritualistic, “routine” care vs. evidence-based, goal-directed actions Frequent visits Does not emphasize individual client needs Prevention and Control of Malaria during Pregnancy 11 No Longer Recommended Numerous, routine visits Burden to women and healthcare system Routine measurements and examinations: Maternal height and weight Ankle edema Fetal position before 36 weeks Care based on risk assessment Prevention and Control of Malaria during Pregnancy 12 Risk Approach Not an effective ANC strategy because: Complications cannot be predicted—all pregnant women are at risk for developing complications Risk factors are usually not direct cause of complications Many “low risk” women develop complications Have false sense of security Do not know how to recognize/respond to problems Most “high risk” women give birth without complications Inefficient use of scarce resources Prevention and Control of Malaria during Pregnancy 13 Focused Antenatal Care Services Evidence-based, goal-directed actions: Address most prevalent health issues affecting women and newborns Adjusted for specific populations/regions Appropriate to gestational age Based on firm rationale Prevention and Control of Malaria during Pregnancy 14 Focused Antenatal Care Services (cont’d.) Individualized, woman-centered care based on each woman’s: Specific needs and concerns Circumstances History, physical examination, testing Available resources Prevention and Control of Malaria during Pregnancy 15 Focused Antenatal Care Services (cont’d.) Quality vs. quantity of ANC visits: WHO multi-center study Number of visits reduced without affecting outcome for mother or baby Recommendations Content and quality vs. number of visits Goal-oriented care Minimum of four visits Prevention and Control of Malaria during Pregnancy 16 First visit: By 16 weeks or when woman first thinks she is pregnant Second visit: At 24–28 weeks or at least once in second trimester Third visit: At 32 weeks Fourth visit: At 36 weeks Other visits: If complication occurs, followup or referral is needed, woman wants to see provider, or provider changes frequency based on findings (history, exam, testing) or local policy Scheduling and Timing of ANC Visits Prevention and Control of Malaria during Pregnancy 17 Focused Antenatal Care Services (cont’d.) Care by a skilled provider who: Has formal training and experience Has knowledge, skills, and qualifications to deliver safe, effective maternal and newborn healthcare Practices in home, hospital, health center May be a midwife, nurse, doctor, clinical officer, etc. Prevention and Control of Malaria during Pregnancy 18 Early Detection and Treatment Malaria—history and physical exam Fever and accompanying signs/symptoms Region Complicated vs. uncomplicated cases Severe anemia—physical exam, testing Pre-eclampsia/eclampsia—measurement of blood pressure HIV—voluntary counseling and testing Sexually transmitted infections, including syphilis— testing Prevention and Control of Malaria during Pregnancy 19 Prevention: Key Preventive Measures Malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Tetanus toxoid, iron/folate supplements Country/region-specific interventions as appropriate Vitamin A supplements Iodine supplements Presumptive treatment for hookworm Prevention and Control of Malaria during Pregnancy 20 Birth Preparedness and Complication Readiness: Objectives Develop birth plan—exact plan for normal birth and possible complications: Arrangements made in advance by woman and family (with help of skilled provider) Usually not a written document Reviewed/revised at every visit Minimize disorganization at time of birth or in an emergency Ensure timely and appropriate care Prevention and Control of Malaria during Pregnancy 21 Essential Elements of a Birth Plan Facility or Place of Birth: Home or health facility for birth, appropriate facility for emergencies Skilled Provider: To attend birth Provider/Facility Contact Information Transportation: Reliable, accessible, especially for odd hours Funds: Personal savings, emergency funds Decision-Making: Who will make decisions, especially in an emergency Prevention and Control of Malaria during Pregnancy 22 Essential Elements of a Birth Plan (cont’d.) Family and Community Support: Care for family in woman’s absence and birth companion during labor Blood Donor: In case of emergency Needed Items: For clean and safe birth and for newborn care Danger Signs/Signs of Advanced Labor Prevention and Control of Malaria during Pregnancy 23 Danger Signs of Pregnancy Vaginal bleeding Difficulty breathing Fever Severe abdominal pain Severe headache/blurred vision Convulsions/loss of consciousness Labor pains before 37 weeks Prevention and Control of Malaria during Pregnancy 24 Health Education: Objectives Inform and educate the woman with health messages and counseling appropriate to: Individual needs, concerns, circumstances Gestational age Most prevalent health issues Support the woman in making decisions and solving actual or anticipated problems Involve partner and family in supporting/adopting healthy practices Prevention and Control of Malaria during Pregnancy 25 Health Education: Topics Addressed Prevention of malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Other methods Other important issues to be discussed include: Nutrition Care for common discomforts Use of potentially harmful substances Hygiene Rest and activity Prevention and Control of Malaria during Pregnancy 26 Health Education: Topics Addressed (cont’d.) Sexual relations and safer sex Early and exclusive breastfeeding Prevention of tetanus and anemia Voluntary counseling and testing for HIV Prevention of other endemic diseases/deficiencies Prevention and Control of Malaria during Pregnancy 27 Interpersonal Skills Speak in a quiet, gentle tone of voice Listen to woman/family and respond appropriately Encourage them to ask questions and express concerns Allow them to demonstrate understanding of information provided Explain all procedures/actions and obtain permission before proceeding Show respect for cultural beliefs and social norms Be empathetic and nonjudgmental Avoid distractions while conducting the visit Prevention and Control of Malaria during Pregnancy 28 Record Keeping First ANC Visit History Physical examination Testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs Date of next ANC visit Subsequent ANC Visits Interim history Targeted physical examination, testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs (and relevant information on how client obtained and used ITN) Date of next ANC visit Record all information on the ANC chart and clinic card: Prevention and Control of Malaria during Pregnancy Chapter II: Malaria Transmission Prevention and Control of Malaria during Pregnancy 30 Malaria Transmission: Chapter Objectives Define malaria and how it is transmitted Describe extent of malaria in Africa Identify groups at highest risk of malaria infection List effects of malaria on pregnant women and their unborn babies Describe effects of malaria on pregnant women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 31 Malaria Transmission Caused by Plasmodium parasites Spread by female Anopheles mosquitoes infected with parasites Anopheles mosquitoes usually active at night Infected mosquito bites a person Malaria parasites reproduce in human blood Mosquito bites infected person, and goes on to bite and infect another person Prevention and Control of Malaria during Pregnancy 32 Populations Most Affected by Malaria Children under 5 years of age Pregnant women Unborn babies Immigrants from low-transmission areas HIV-infected persons Prevention and Control of Malaria during Pregnancy 33 Effects of Malaria on Pregnant Women All pregnant women in malaria-endemic areas are at risk Parasites attack and destroy red blood cells Malaria causes up to 15% of anemia in pregnancy Can cause severe anemia In Africa, anemia due to malaria causes up to 10,000 maternal deaths per year Prevention and Control of Malaria during Pregnancy 34 Effects on Unborn Babies Parasites hide in placenta Interferes with transfer of oxygen and nutrients to the baby, increasing risk of: Spontaneous abortion Preterm birth Low birthweight—single greatest risk factor for death during first month of life Stillbirth Prevention and Control of Malaria during Pregnancy 35 Effects on Communities Causes missed work and wages Results in frequent school absences Uses scarce resources Causes preventable deaths: increases maternal, newborn, and infant mortality rates
Slide 36 - Prevention and Control of Malaria during Pregnancy A Workshop for Healthcare Providers Prevention and Control of Malaria during Pregnancy 2 Facts about Malaria 300 million cases each year worldwide 9 of 10 cases occur in Africa A person in Africa dies of malaria every 10 seconds Women and young children are most at risk Affects five times as many people as AIDS, leprosy, measles, and tuberculosis combined Prevention and Control of Malaria during Pregnancy 3 Facts about Malaria and Pregnancy 30 million African women are pregnant yearly Malaria is more frequent and complicated during pregnancy In malaria-endemic areas, malaria during pregnancy may account for: Up to 15% of maternal anemia 5–14% of low birthweight 30% of “preventable” low birthweight Prevention and Control of Malaria during Pregnancy 4 Roll Back Malaria Worldwide partnership Governments, private groups, research organizations, civil society, media Aim to reduce malaria by half by 2010 Free advocacy resources and tools: http://www.rbm.who.int Priority: Prevent poor outcomes caused by malaria in pregnancy Abuja declaration: Goal is for 60% of women in Africa to be sleeping under insecticide-treated nets (ITNs) and getting intermittent preventive treatment (IPT) by 2005 Prevention and Control of Malaria during Pregnancy 5 Malaria Prevention and Treatment during Pregnancy Focused antenatal care (ANC) with health education about malaria Use of insecticide-treated nets (ITNs) Intermittent preventive treatment (IPT) Case management of women with symptoms and signs of malaria Prevention and Control of Malaria during Pregnancy Chapter I: Focused Antenatal Care Prevention and Control of Malaria during Pregnancy 7 Focused Antenatal Care: Chapter Objectives Describe four main components of focused antenatal care (ANC) Discuss frequency and timing of ANC visits Describe essential elements of a birth plan that includes complication readiness Describe interpersonal skills for effective ANC Describe components of record keeping for ANC Prevention and Control of Malaria during Pregnancy 8 Focused Antenatal Care An approach to ANC that emphasizes: Evidence-based, goal-directed actions Individualized, woman-centered care Quality vs. quantity of visits Care by skilled providers Prevention and Control of Malaria during Pregnancy 9 Goal of Focused Antenatal Care To promote maternal and newborn health and survival through: Early detection and treatment of problems and complications Prevention of complications and disease Birth preparedness and complication readiness Health promotion Prevention and Control of Malaria during Pregnancy 10 Traditional Antenatal Care Emphasizes: Ritualistic, “routine” care vs. evidence-based, goal-directed actions Frequent visits Does not emphasize individual client needs Prevention and Control of Malaria during Pregnancy 11 No Longer Recommended Numerous, routine visits Burden to women and healthcare system Routine measurements and examinations: Maternal height and weight Ankle edema Fetal position before 36 weeks Care based on risk assessment Prevention and Control of Malaria during Pregnancy 12 Risk Approach Not an effective ANC strategy because: Complications cannot be predicted—all pregnant women are at risk for developing complications Risk factors are usually not direct cause of complications Many “low risk” women develop complications Have false sense of security Do not know how to recognize/respond to problems Most “high risk” women give birth without complications Inefficient use of scarce resources Prevention and Control of Malaria during Pregnancy 13 Focused Antenatal Care Services Evidence-based, goal-directed actions: Address most prevalent health issues affecting women and newborns Adjusted for specific populations/regions Appropriate to gestational age Based on firm rationale Prevention and Control of Malaria during Pregnancy 14 Focused Antenatal Care Services (cont’d.) Individualized, woman-centered care based on each woman’s: Specific needs and concerns Circumstances History, physical examination, testing Available resources Prevention and Control of Malaria during Pregnancy 15 Focused Antenatal Care Services (cont’d.) Quality vs. quantity of ANC visits: WHO multi-center study Number of visits reduced without affecting outcome for mother or baby Recommendations Content and quality vs. number of visits Goal-oriented care Minimum of four visits Prevention and Control of Malaria during Pregnancy 16 First visit: By 16 weeks or when woman first thinks she is pregnant Second visit: At 24–28 weeks or at least once in second trimester Third visit: At 32 weeks Fourth visit: At 36 weeks Other visits: If complication occurs, followup or referral is needed, woman wants to see provider, or provider changes frequency based on findings (history, exam, testing) or local policy Scheduling and Timing of ANC Visits Prevention and Control of Malaria during Pregnancy 17 Focused Antenatal Care Services (cont’d.) Care by a skilled provider who: Has formal training and experience Has knowledge, skills, and qualifications to deliver safe, effective maternal and newborn healthcare Practices in home, hospital, health center May be a midwife, nurse, doctor, clinical officer, etc. Prevention and Control of Malaria during Pregnancy 18 Early Detection and Treatment Malaria—history and physical exam Fever and accompanying signs/symptoms Region Complicated vs. uncomplicated cases Severe anemia—physical exam, testing Pre-eclampsia/eclampsia—measurement of blood pressure HIV—voluntary counseling and testing Sexually transmitted infections, including syphilis— testing Prevention and Control of Malaria during Pregnancy 19 Prevention: Key Preventive Measures Malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Tetanus toxoid, iron/folate supplements Country/region-specific interventions as appropriate Vitamin A supplements Iodine supplements Presumptive treatment for hookworm Prevention and Control of Malaria during Pregnancy 20 Birth Preparedness and Complication Readiness: Objectives Develop birth plan—exact plan for normal birth and possible complications: Arrangements made in advance by woman and family (with help of skilled provider) Usually not a written document Reviewed/revised at every visit Minimize disorganization at time of birth or in an emergency Ensure timely and appropriate care Prevention and Control of Malaria during Pregnancy 21 Essential Elements of a Birth Plan Facility or Place of Birth: Home or health facility for birth, appropriate facility for emergencies Skilled Provider: To attend birth Provider/Facility Contact Information Transportation: Reliable, accessible, especially for odd hours Funds: Personal savings, emergency funds Decision-Making: Who will make decisions, especially in an emergency Prevention and Control of Malaria during Pregnancy 22 Essential Elements of a Birth Plan (cont’d.) Family and Community Support: Care for family in woman’s absence and birth companion during labor Blood Donor: In case of emergency Needed Items: For clean and safe birth and for newborn care Danger Signs/Signs of Advanced Labor Prevention and Control of Malaria during Pregnancy 23 Danger Signs of Pregnancy Vaginal bleeding Difficulty breathing Fever Severe abdominal pain Severe headache/blurred vision Convulsions/loss of consciousness Labor pains before 37 weeks Prevention and Control of Malaria during Pregnancy 24 Health Education: Objectives Inform and educate the woman with health messages and counseling appropriate to: Individual needs, concerns, circumstances Gestational age Most prevalent health issues Support the woman in making decisions and solving actual or anticipated problems Involve partner and family in supporting/adopting healthy practices Prevention and Control of Malaria during Pregnancy 25 Health Education: Topics Addressed Prevention of malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Other methods Other important issues to be discussed include: Nutrition Care for common discomforts Use of potentially harmful substances Hygiene Rest and activity Prevention and Control of Malaria during Pregnancy 26 Health Education: Topics Addressed (cont’d.) Sexual relations and safer sex Early and exclusive breastfeeding Prevention of tetanus and anemia Voluntary counseling and testing for HIV Prevention of other endemic diseases/deficiencies Prevention and Control of Malaria during Pregnancy 27 Interpersonal Skills Speak in a quiet, gentle tone of voice Listen to woman/family and respond appropriately Encourage them to ask questions and express concerns Allow them to demonstrate understanding of information provided Explain all procedures/actions and obtain permission before proceeding Show respect for cultural beliefs and social norms Be empathetic and nonjudgmental Avoid distractions while conducting the visit Prevention and Control of Malaria during Pregnancy 28 Record Keeping First ANC Visit History Physical examination Testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs Date of next ANC visit Subsequent ANC Visits Interim history Targeted physical examination, testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs (and relevant information on how client obtained and used ITN) Date of next ANC visit Record all information on the ANC chart and clinic card: Prevention and Control of Malaria during Pregnancy Chapter II: Malaria Transmission Prevention and Control of Malaria during Pregnancy 30 Malaria Transmission: Chapter Objectives Define malaria and how it is transmitted Describe extent of malaria in Africa Identify groups at highest risk of malaria infection List effects of malaria on pregnant women and their unborn babies Describe effects of malaria on pregnant women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 31 Malaria Transmission Caused by Plasmodium parasites Spread by female Anopheles mosquitoes infected with parasites Anopheles mosquitoes usually active at night Infected mosquito bites a person Malaria parasites reproduce in human blood Mosquito bites infected person, and goes on to bite and infect another person Prevention and Control of Malaria during Pregnancy 32 Populations Most Affected by Malaria Children under 5 years of age Pregnant women Unborn babies Immigrants from low-transmission areas HIV-infected persons Prevention and Control of Malaria during Pregnancy 33 Effects of Malaria on Pregnant Women All pregnant women in malaria-endemic areas are at risk Parasites attack and destroy red blood cells Malaria causes up to 15% of anemia in pregnancy Can cause severe anemia In Africa, anemia due to malaria causes up to 10,000 maternal deaths per year Prevention and Control of Malaria during Pregnancy 34 Effects on Unborn Babies Parasites hide in placenta Interferes with transfer of oxygen and nutrients to the baby, increasing risk of: Spontaneous abortion Preterm birth Low birthweight—single greatest risk factor for death during first month of life Stillbirth Prevention and Control of Malaria during Pregnancy 35 Effects on Communities Causes missed work and wages Results in frequent school absences Uses scarce resources Causes preventable deaths: increases maternal, newborn, and infant mortality rates Prevention and Control of Malaria during Pregnancy 36 HIV/AIDS and Malaria during Pregnancy HIV/AIDS reduces a woman’s resistance to malaria Intermittent preventive treatment (IPT) given 3 times during pregnancy is effective for women with HIV/AIDS
Slide 37 - Prevention and Control of Malaria during Pregnancy A Workshop for Healthcare Providers Prevention and Control of Malaria during Pregnancy 2 Facts about Malaria 300 million cases each year worldwide 9 of 10 cases occur in Africa A person in Africa dies of malaria every 10 seconds Women and young children are most at risk Affects five times as many people as AIDS, leprosy, measles, and tuberculosis combined Prevention and Control of Malaria during Pregnancy 3 Facts about Malaria and Pregnancy 30 million African women are pregnant yearly Malaria is more frequent and complicated during pregnancy In malaria-endemic areas, malaria during pregnancy may account for: Up to 15% of maternal anemia 5–14% of low birthweight 30% of “preventable” low birthweight Prevention and Control of Malaria during Pregnancy 4 Roll Back Malaria Worldwide partnership Governments, private groups, research organizations, civil society, media Aim to reduce malaria by half by 2010 Free advocacy resources and tools: http://www.rbm.who.int Priority: Prevent poor outcomes caused by malaria in pregnancy Abuja declaration: Goal is for 60% of women in Africa to be sleeping under insecticide-treated nets (ITNs) and getting intermittent preventive treatment (IPT) by 2005 Prevention and Control of Malaria during Pregnancy 5 Malaria Prevention and Treatment during Pregnancy Focused antenatal care (ANC) with health education about malaria Use of insecticide-treated nets (ITNs) Intermittent preventive treatment (IPT) Case management of women with symptoms and signs of malaria Prevention and Control of Malaria during Pregnancy Chapter I: Focused Antenatal Care Prevention and Control of Malaria during Pregnancy 7 Focused Antenatal Care: Chapter Objectives Describe four main components of focused antenatal care (ANC) Discuss frequency and timing of ANC visits Describe essential elements of a birth plan that includes complication readiness Describe interpersonal skills for effective ANC Describe components of record keeping for ANC Prevention and Control of Malaria during Pregnancy 8 Focused Antenatal Care An approach to ANC that emphasizes: Evidence-based, goal-directed actions Individualized, woman-centered care Quality vs. quantity of visits Care by skilled providers Prevention and Control of Malaria during Pregnancy 9 Goal of Focused Antenatal Care To promote maternal and newborn health and survival through: Early detection and treatment of problems and complications Prevention of complications and disease Birth preparedness and complication readiness Health promotion Prevention and Control of Malaria during Pregnancy 10 Traditional Antenatal Care Emphasizes: Ritualistic, “routine” care vs. evidence-based, goal-directed actions Frequent visits Does not emphasize individual client needs Prevention and Control of Malaria during Pregnancy 11 No Longer Recommended Numerous, routine visits Burden to women and healthcare system Routine measurements and examinations: Maternal height and weight Ankle edema Fetal position before 36 weeks Care based on risk assessment Prevention and Control of Malaria during Pregnancy 12 Risk Approach Not an effective ANC strategy because: Complications cannot be predicted—all pregnant women are at risk for developing complications Risk factors are usually not direct cause of complications Many “low risk” women develop complications Have false sense of security Do not know how to recognize/respond to problems Most “high risk” women give birth without complications Inefficient use of scarce resources Prevention and Control of Malaria during Pregnancy 13 Focused Antenatal Care Services Evidence-based, goal-directed actions: Address most prevalent health issues affecting women and newborns Adjusted for specific populations/regions Appropriate to gestational age Based on firm rationale Prevention and Control of Malaria during Pregnancy 14 Focused Antenatal Care Services (cont’d.) Individualized, woman-centered care based on each woman’s: Specific needs and concerns Circumstances History, physical examination, testing Available resources Prevention and Control of Malaria during Pregnancy 15 Focused Antenatal Care Services (cont’d.) Quality vs. quantity of ANC visits: WHO multi-center study Number of visits reduced without affecting outcome for mother or baby Recommendations Content and quality vs. number of visits Goal-oriented care Minimum of four visits Prevention and Control of Malaria during Pregnancy 16 First visit: By 16 weeks or when woman first thinks she is pregnant Second visit: At 24–28 weeks or at least once in second trimester Third visit: At 32 weeks Fourth visit: At 36 weeks Other visits: If complication occurs, followup or referral is needed, woman wants to see provider, or provider changes frequency based on findings (history, exam, testing) or local policy Scheduling and Timing of ANC Visits Prevention and Control of Malaria during Pregnancy 17 Focused Antenatal Care Services (cont’d.) Care by a skilled provider who: Has formal training and experience Has knowledge, skills, and qualifications to deliver safe, effective maternal and newborn healthcare Practices in home, hospital, health center May be a midwife, nurse, doctor, clinical officer, etc. Prevention and Control of Malaria during Pregnancy 18 Early Detection and Treatment Malaria—history and physical exam Fever and accompanying signs/symptoms Region Complicated vs. uncomplicated cases Severe anemia—physical exam, testing Pre-eclampsia/eclampsia—measurement of blood pressure HIV—voluntary counseling and testing Sexually transmitted infections, including syphilis— testing Prevention and Control of Malaria during Pregnancy 19 Prevention: Key Preventive Measures Malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Tetanus toxoid, iron/folate supplements Country/region-specific interventions as appropriate Vitamin A supplements Iodine supplements Presumptive treatment for hookworm Prevention and Control of Malaria during Pregnancy 20 Birth Preparedness and Complication Readiness: Objectives Develop birth plan—exact plan for normal birth and possible complications: Arrangements made in advance by woman and family (with help of skilled provider) Usually not a written document Reviewed/revised at every visit Minimize disorganization at time of birth or in an emergency Ensure timely and appropriate care Prevention and Control of Malaria during Pregnancy 21 Essential Elements of a Birth Plan Facility or Place of Birth: Home or health facility for birth, appropriate facility for emergencies Skilled Provider: To attend birth Provider/Facility Contact Information Transportation: Reliable, accessible, especially for odd hours Funds: Personal savings, emergency funds Decision-Making: Who will make decisions, especially in an emergency Prevention and Control of Malaria during Pregnancy 22 Essential Elements of a Birth Plan (cont’d.) Family and Community Support: Care for family in woman’s absence and birth companion during labor Blood Donor: In case of emergency Needed Items: For clean and safe birth and for newborn care Danger Signs/Signs of Advanced Labor Prevention and Control of Malaria during Pregnancy 23 Danger Signs of Pregnancy Vaginal bleeding Difficulty breathing Fever Severe abdominal pain Severe headache/blurred vision Convulsions/loss of consciousness Labor pains before 37 weeks Prevention and Control of Malaria during Pregnancy 24 Health Education: Objectives Inform and educate the woman with health messages and counseling appropriate to: Individual needs, concerns, circumstances Gestational age Most prevalent health issues Support the woman in making decisions and solving actual or anticipated problems Involve partner and family in supporting/adopting healthy practices Prevention and Control of Malaria during Pregnancy 25 Health Education: Topics Addressed Prevention of malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Other methods Other important issues to be discussed include: Nutrition Care for common discomforts Use of potentially harmful substances Hygiene Rest and activity Prevention and Control of Malaria during Pregnancy 26 Health Education: Topics Addressed (cont’d.) Sexual relations and safer sex Early and exclusive breastfeeding Prevention of tetanus and anemia Voluntary counseling and testing for HIV Prevention of other endemic diseases/deficiencies Prevention and Control of Malaria during Pregnancy 27 Interpersonal Skills Speak in a quiet, gentle tone of voice Listen to woman/family and respond appropriately Encourage them to ask questions and express concerns Allow them to demonstrate understanding of information provided Explain all procedures/actions and obtain permission before proceeding Show respect for cultural beliefs and social norms Be empathetic and nonjudgmental Avoid distractions while conducting the visit Prevention and Control of Malaria during Pregnancy 28 Record Keeping First ANC Visit History Physical examination Testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs Date of next ANC visit Subsequent ANC Visits Interim history Targeted physical examination, testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs (and relevant information on how client obtained and used ITN) Date of next ANC visit Record all information on the ANC chart and clinic card: Prevention and Control of Malaria during Pregnancy Chapter II: Malaria Transmission Prevention and Control of Malaria during Pregnancy 30 Malaria Transmission: Chapter Objectives Define malaria and how it is transmitted Describe extent of malaria in Africa Identify groups at highest risk of malaria infection List effects of malaria on pregnant women and their unborn babies Describe effects of malaria on pregnant women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 31 Malaria Transmission Caused by Plasmodium parasites Spread by female Anopheles mosquitoes infected with parasites Anopheles mosquitoes usually active at night Infected mosquito bites a person Malaria parasites reproduce in human blood Mosquito bites infected person, and goes on to bite and infect another person Prevention and Control of Malaria during Pregnancy 32 Populations Most Affected by Malaria Children under 5 years of age Pregnant women Unborn babies Immigrants from low-transmission areas HIV-infected persons Prevention and Control of Malaria during Pregnancy 33 Effects of Malaria on Pregnant Women All pregnant women in malaria-endemic areas are at risk Parasites attack and destroy red blood cells Malaria causes up to 15% of anemia in pregnancy Can cause severe anemia In Africa, anemia due to malaria causes up to 10,000 maternal deaths per year Prevention and Control of Malaria during Pregnancy 34 Effects on Unborn Babies Parasites hide in placenta Interferes with transfer of oxygen and nutrients to the baby, increasing risk of: Spontaneous abortion Preterm birth Low birthweight—single greatest risk factor for death during first month of life Stillbirth Prevention and Control of Malaria during Pregnancy 35 Effects on Communities Causes missed work and wages Results in frequent school absences Uses scarce resources Causes preventable deaths: increases maternal, newborn, and infant mortality rates Prevention and Control of Malaria during Pregnancy 36 HIV/AIDS and Malaria during Pregnancy HIV/AIDS reduces a woman’s resistance to malaria Intermittent preventive treatment (IPT) given 3 times during pregnancy is effective for women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 37 Summary of Health Education Points Malaria transmitted through mosquito bites Pregnant women and children are most at risk Pregnant women infected with malaria may have no symptoms Women with HIV/AIDS are at higher risk Malaria can lead to severe anemia, spontaneous abortion, low-birthweight babies Malaria is preventable
Slide 38 - Prevention and Control of Malaria during Pregnancy A Workshop for Healthcare Providers Prevention and Control of Malaria during Pregnancy 2 Facts about Malaria 300 million cases each year worldwide 9 of 10 cases occur in Africa A person in Africa dies of malaria every 10 seconds Women and young children are most at risk Affects five times as many people as AIDS, leprosy, measles, and tuberculosis combined Prevention and Control of Malaria during Pregnancy 3 Facts about Malaria and Pregnancy 30 million African women are pregnant yearly Malaria is more frequent and complicated during pregnancy In malaria-endemic areas, malaria during pregnancy may account for: Up to 15% of maternal anemia 5–14% of low birthweight 30% of “preventable” low birthweight Prevention and Control of Malaria during Pregnancy 4 Roll Back Malaria Worldwide partnership Governments, private groups, research organizations, civil society, media Aim to reduce malaria by half by 2010 Free advocacy resources and tools: http://www.rbm.who.int Priority: Prevent poor outcomes caused by malaria in pregnancy Abuja declaration: Goal is for 60% of women in Africa to be sleeping under insecticide-treated nets (ITNs) and getting intermittent preventive treatment (IPT) by 2005 Prevention and Control of Malaria during Pregnancy 5 Malaria Prevention and Treatment during Pregnancy Focused antenatal care (ANC) with health education about malaria Use of insecticide-treated nets (ITNs) Intermittent preventive treatment (IPT) Case management of women with symptoms and signs of malaria Prevention and Control of Malaria during Pregnancy Chapter I: Focused Antenatal Care Prevention and Control of Malaria during Pregnancy 7 Focused Antenatal Care: Chapter Objectives Describe four main components of focused antenatal care (ANC) Discuss frequency and timing of ANC visits Describe essential elements of a birth plan that includes complication readiness Describe interpersonal skills for effective ANC Describe components of record keeping for ANC Prevention and Control of Malaria during Pregnancy 8 Focused Antenatal Care An approach to ANC that emphasizes: Evidence-based, goal-directed actions Individualized, woman-centered care Quality vs. quantity of visits Care by skilled providers Prevention and Control of Malaria during Pregnancy 9 Goal of Focused Antenatal Care To promote maternal and newborn health and survival through: Early detection and treatment of problems and complications Prevention of complications and disease Birth preparedness and complication readiness Health promotion Prevention and Control of Malaria during Pregnancy 10 Traditional Antenatal Care Emphasizes: Ritualistic, “routine” care vs. evidence-based, goal-directed actions Frequent visits Does not emphasize individual client needs Prevention and Control of Malaria during Pregnancy 11 No Longer Recommended Numerous, routine visits Burden to women and healthcare system Routine measurements and examinations: Maternal height and weight Ankle edema Fetal position before 36 weeks Care based on risk assessment Prevention and Control of Malaria during Pregnancy 12 Risk Approach Not an effective ANC strategy because: Complications cannot be predicted—all pregnant women are at risk for developing complications Risk factors are usually not direct cause of complications Many “low risk” women develop complications Have false sense of security Do not know how to recognize/respond to problems Most “high risk” women give birth without complications Inefficient use of scarce resources Prevention and Control of Malaria during Pregnancy 13 Focused Antenatal Care Services Evidence-based, goal-directed actions: Address most prevalent health issues affecting women and newborns Adjusted for specific populations/regions Appropriate to gestational age Based on firm rationale Prevention and Control of Malaria during Pregnancy 14 Focused Antenatal Care Services (cont’d.) Individualized, woman-centered care based on each woman’s: Specific needs and concerns Circumstances History, physical examination, testing Available resources Prevention and Control of Malaria during Pregnancy 15 Focused Antenatal Care Services (cont’d.) Quality vs. quantity of ANC visits: WHO multi-center study Number of visits reduced without affecting outcome for mother or baby Recommendations Content and quality vs. number of visits Goal-oriented care Minimum of four visits Prevention and Control of Malaria during Pregnancy 16 First visit: By 16 weeks or when woman first thinks she is pregnant Second visit: At 24–28 weeks or at least once in second trimester Third visit: At 32 weeks Fourth visit: At 36 weeks Other visits: If complication occurs, followup or referral is needed, woman wants to see provider, or provider changes frequency based on findings (history, exam, testing) or local policy Scheduling and Timing of ANC Visits Prevention and Control of Malaria during Pregnancy 17 Focused Antenatal Care Services (cont’d.) Care by a skilled provider who: Has formal training and experience Has knowledge, skills, and qualifications to deliver safe, effective maternal and newborn healthcare Practices in home, hospital, health center May be a midwife, nurse, doctor, clinical officer, etc. Prevention and Control of Malaria during Pregnancy 18 Early Detection and Treatment Malaria—history and physical exam Fever and accompanying signs/symptoms Region Complicated vs. uncomplicated cases Severe anemia—physical exam, testing Pre-eclampsia/eclampsia—measurement of blood pressure HIV—voluntary counseling and testing Sexually transmitted infections, including syphilis— testing Prevention and Control of Malaria during Pregnancy 19 Prevention: Key Preventive Measures Malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Tetanus toxoid, iron/folate supplements Country/region-specific interventions as appropriate Vitamin A supplements Iodine supplements Presumptive treatment for hookworm Prevention and Control of Malaria during Pregnancy 20 Birth Preparedness and Complication Readiness: Objectives Develop birth plan—exact plan for normal birth and possible complications: Arrangements made in advance by woman and family (with help of skilled provider) Usually not a written document Reviewed/revised at every visit Minimize disorganization at time of birth or in an emergency Ensure timely and appropriate care Prevention and Control of Malaria during Pregnancy 21 Essential Elements of a Birth Plan Facility or Place of Birth: Home or health facility for birth, appropriate facility for emergencies Skilled Provider: To attend birth Provider/Facility Contact Information Transportation: Reliable, accessible, especially for odd hours Funds: Personal savings, emergency funds Decision-Making: Who will make decisions, especially in an emergency Prevention and Control of Malaria during Pregnancy 22 Essential Elements of a Birth Plan (cont’d.) Family and Community Support: Care for family in woman’s absence and birth companion during labor Blood Donor: In case of emergency Needed Items: For clean and safe birth and for newborn care Danger Signs/Signs of Advanced Labor Prevention and Control of Malaria during Pregnancy 23 Danger Signs of Pregnancy Vaginal bleeding Difficulty breathing Fever Severe abdominal pain Severe headache/blurred vision Convulsions/loss of consciousness Labor pains before 37 weeks Prevention and Control of Malaria during Pregnancy 24 Health Education: Objectives Inform and educate the woman with health messages and counseling appropriate to: Individual needs, concerns, circumstances Gestational age Most prevalent health issues Support the woman in making decisions and solving actual or anticipated problems Involve partner and family in supporting/adopting healthy practices Prevention and Control of Malaria during Pregnancy 25 Health Education: Topics Addressed Prevention of malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Other methods Other important issues to be discussed include: Nutrition Care for common discomforts Use of potentially harmful substances Hygiene Rest and activity Prevention and Control of Malaria during Pregnancy 26 Health Education: Topics Addressed (cont’d.) Sexual relations and safer sex Early and exclusive breastfeeding Prevention of tetanus and anemia Voluntary counseling and testing for HIV Prevention of other endemic diseases/deficiencies Prevention and Control of Malaria during Pregnancy 27 Interpersonal Skills Speak in a quiet, gentle tone of voice Listen to woman/family and respond appropriately Encourage them to ask questions and express concerns Allow them to demonstrate understanding of information provided Explain all procedures/actions and obtain permission before proceeding Show respect for cultural beliefs and social norms Be empathetic and nonjudgmental Avoid distractions while conducting the visit Prevention and Control of Malaria during Pregnancy 28 Record Keeping First ANC Visit History Physical examination Testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs Date of next ANC visit Subsequent ANC Visits Interim history Targeted physical examination, testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs (and relevant information on how client obtained and used ITN) Date of next ANC visit Record all information on the ANC chart and clinic card: Prevention and Control of Malaria during Pregnancy Chapter II: Malaria Transmission Prevention and Control of Malaria during Pregnancy 30 Malaria Transmission: Chapter Objectives Define malaria and how it is transmitted Describe extent of malaria in Africa Identify groups at highest risk of malaria infection List effects of malaria on pregnant women and their unborn babies Describe effects of malaria on pregnant women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 31 Malaria Transmission Caused by Plasmodium parasites Spread by female Anopheles mosquitoes infected with parasites Anopheles mosquitoes usually active at night Infected mosquito bites a person Malaria parasites reproduce in human blood Mosquito bites infected person, and goes on to bite and infect another person Prevention and Control of Malaria during Pregnancy 32 Populations Most Affected by Malaria Children under 5 years of age Pregnant women Unborn babies Immigrants from low-transmission areas HIV-infected persons Prevention and Control of Malaria during Pregnancy 33 Effects of Malaria on Pregnant Women All pregnant women in malaria-endemic areas are at risk Parasites attack and destroy red blood cells Malaria causes up to 15% of anemia in pregnancy Can cause severe anemia In Africa, anemia due to malaria causes up to 10,000 maternal deaths per year Prevention and Control of Malaria during Pregnancy 34 Effects on Unborn Babies Parasites hide in placenta Interferes with transfer of oxygen and nutrients to the baby, increasing risk of: Spontaneous abortion Preterm birth Low birthweight—single greatest risk factor for death during first month of life Stillbirth Prevention and Control of Malaria during Pregnancy 35 Effects on Communities Causes missed work and wages Results in frequent school absences Uses scarce resources Causes preventable deaths: increases maternal, newborn, and infant mortality rates Prevention and Control of Malaria during Pregnancy 36 HIV/AIDS and Malaria during Pregnancy HIV/AIDS reduces a woman’s resistance to malaria Intermittent preventive treatment (IPT) given 3 times during pregnancy is effective for women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 37 Summary of Health Education Points Malaria transmitted through mosquito bites Pregnant women and children are most at risk Pregnant women infected with malaria may have no symptoms Women with HIV/AIDS are at higher risk Malaria can lead to severe anemia, spontaneous abortion, low-birthweight babies Malaria is preventable Prevention and Control of Malaria during Pregnancy Chapter III: Preventing Malaria
Slide 39 - Prevention and Control of Malaria during Pregnancy A Workshop for Healthcare Providers Prevention and Control of Malaria during Pregnancy 2 Facts about Malaria 300 million cases each year worldwide 9 of 10 cases occur in Africa A person in Africa dies of malaria every 10 seconds Women and young children are most at risk Affects five times as many people as AIDS, leprosy, measles, and tuberculosis combined Prevention and Control of Malaria during Pregnancy 3 Facts about Malaria and Pregnancy 30 million African women are pregnant yearly Malaria is more frequent and complicated during pregnancy In malaria-endemic areas, malaria during pregnancy may account for: Up to 15% of maternal anemia 5–14% of low birthweight 30% of “preventable” low birthweight Prevention and Control of Malaria during Pregnancy 4 Roll Back Malaria Worldwide partnership Governments, private groups, research organizations, civil society, media Aim to reduce malaria by half by 2010 Free advocacy resources and tools: http://www.rbm.who.int Priority: Prevent poor outcomes caused by malaria in pregnancy Abuja declaration: Goal is for 60% of women in Africa to be sleeping under insecticide-treated nets (ITNs) and getting intermittent preventive treatment (IPT) by 2005 Prevention and Control of Malaria during Pregnancy 5 Malaria Prevention and Treatment during Pregnancy Focused antenatal care (ANC) with health education about malaria Use of insecticide-treated nets (ITNs) Intermittent preventive treatment (IPT) Case management of women with symptoms and signs of malaria Prevention and Control of Malaria during Pregnancy Chapter I: Focused Antenatal Care Prevention and Control of Malaria during Pregnancy 7 Focused Antenatal Care: Chapter Objectives Describe four main components of focused antenatal care (ANC) Discuss frequency and timing of ANC visits Describe essential elements of a birth plan that includes complication readiness Describe interpersonal skills for effective ANC Describe components of record keeping for ANC Prevention and Control of Malaria during Pregnancy 8 Focused Antenatal Care An approach to ANC that emphasizes: Evidence-based, goal-directed actions Individualized, woman-centered care Quality vs. quantity of visits Care by skilled providers Prevention and Control of Malaria during Pregnancy 9 Goal of Focused Antenatal Care To promote maternal and newborn health and survival through: Early detection and treatment of problems and complications Prevention of complications and disease Birth preparedness and complication readiness Health promotion Prevention and Control of Malaria during Pregnancy 10 Traditional Antenatal Care Emphasizes: Ritualistic, “routine” care vs. evidence-based, goal-directed actions Frequent visits Does not emphasize individual client needs Prevention and Control of Malaria during Pregnancy 11 No Longer Recommended Numerous, routine visits Burden to women and healthcare system Routine measurements and examinations: Maternal height and weight Ankle edema Fetal position before 36 weeks Care based on risk assessment Prevention and Control of Malaria during Pregnancy 12 Risk Approach Not an effective ANC strategy because: Complications cannot be predicted—all pregnant women are at risk for developing complications Risk factors are usually not direct cause of complications Many “low risk” women develop complications Have false sense of security Do not know how to recognize/respond to problems Most “high risk” women give birth without complications Inefficient use of scarce resources Prevention and Control of Malaria during Pregnancy 13 Focused Antenatal Care Services Evidence-based, goal-directed actions: Address most prevalent health issues affecting women and newborns Adjusted for specific populations/regions Appropriate to gestational age Based on firm rationale Prevention and Control of Malaria during Pregnancy 14 Focused Antenatal Care Services (cont’d.) Individualized, woman-centered care based on each woman’s: Specific needs and concerns Circumstances History, physical examination, testing Available resources Prevention and Control of Malaria during Pregnancy 15 Focused Antenatal Care Services (cont’d.) Quality vs. quantity of ANC visits: WHO multi-center study Number of visits reduced without affecting outcome for mother or baby Recommendations Content and quality vs. number of visits Goal-oriented care Minimum of four visits Prevention and Control of Malaria during Pregnancy 16 First visit: By 16 weeks or when woman first thinks she is pregnant Second visit: At 24–28 weeks or at least once in second trimester Third visit: At 32 weeks Fourth visit: At 36 weeks Other visits: If complication occurs, followup or referral is needed, woman wants to see provider, or provider changes frequency based on findings (history, exam, testing) or local policy Scheduling and Timing of ANC Visits Prevention and Control of Malaria during Pregnancy 17 Focused Antenatal Care Services (cont’d.) Care by a skilled provider who: Has formal training and experience Has knowledge, skills, and qualifications to deliver safe, effective maternal and newborn healthcare Practices in home, hospital, health center May be a midwife, nurse, doctor, clinical officer, etc. Prevention and Control of Malaria during Pregnancy 18 Early Detection and Treatment Malaria—history and physical exam Fever and accompanying signs/symptoms Region Complicated vs. uncomplicated cases Severe anemia—physical exam, testing Pre-eclampsia/eclampsia—measurement of blood pressure HIV—voluntary counseling and testing Sexually transmitted infections, including syphilis— testing Prevention and Control of Malaria during Pregnancy 19 Prevention: Key Preventive Measures Malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Tetanus toxoid, iron/folate supplements Country/region-specific interventions as appropriate Vitamin A supplements Iodine supplements Presumptive treatment for hookworm Prevention and Control of Malaria during Pregnancy 20 Birth Preparedness and Complication Readiness: Objectives Develop birth plan—exact plan for normal birth and possible complications: Arrangements made in advance by woman and family (with help of skilled provider) Usually not a written document Reviewed/revised at every visit Minimize disorganization at time of birth or in an emergency Ensure timely and appropriate care Prevention and Control of Malaria during Pregnancy 21 Essential Elements of a Birth Plan Facility or Place of Birth: Home or health facility for birth, appropriate facility for emergencies Skilled Provider: To attend birth Provider/Facility Contact Information Transportation: Reliable, accessible, especially for odd hours Funds: Personal savings, emergency funds Decision-Making: Who will make decisions, especially in an emergency Prevention and Control of Malaria during Pregnancy 22 Essential Elements of a Birth Plan (cont’d.) Family and Community Support: Care for family in woman’s absence and birth companion during labor Blood Donor: In case of emergency Needed Items: For clean and safe birth and for newborn care Danger Signs/Signs of Advanced Labor Prevention and Control of Malaria during Pregnancy 23 Danger Signs of Pregnancy Vaginal bleeding Difficulty breathing Fever Severe abdominal pain Severe headache/blurred vision Convulsions/loss of consciousness Labor pains before 37 weeks Prevention and Control of Malaria during Pregnancy 24 Health Education: Objectives Inform and educate the woman with health messages and counseling appropriate to: Individual needs, concerns, circumstances Gestational age Most prevalent health issues Support the woman in making decisions and solving actual or anticipated problems Involve partner and family in supporting/adopting healthy practices Prevention and Control of Malaria during Pregnancy 25 Health Education: Topics Addressed Prevention of malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Other methods Other important issues to be discussed include: Nutrition Care for common discomforts Use of potentially harmful substances Hygiene Rest and activity Prevention and Control of Malaria during Pregnancy 26 Health Education: Topics Addressed (cont’d.) Sexual relations and safer sex Early and exclusive breastfeeding Prevention of tetanus and anemia Voluntary counseling and testing for HIV Prevention of other endemic diseases/deficiencies Prevention and Control of Malaria during Pregnancy 27 Interpersonal Skills Speak in a quiet, gentle tone of voice Listen to woman/family and respond appropriately Encourage them to ask questions and express concerns Allow them to demonstrate understanding of information provided Explain all procedures/actions and obtain permission before proceeding Show respect for cultural beliefs and social norms Be empathetic and nonjudgmental Avoid distractions while conducting the visit Prevention and Control of Malaria during Pregnancy 28 Record Keeping First ANC Visit History Physical examination Testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs Date of next ANC visit Subsequent ANC Visits Interim history Targeted physical examination, testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs (and relevant information on how client obtained and used ITN) Date of next ANC visit Record all information on the ANC chart and clinic card: Prevention and Control of Malaria during Pregnancy Chapter II: Malaria Transmission Prevention and Control of Malaria during Pregnancy 30 Malaria Transmission: Chapter Objectives Define malaria and how it is transmitted Describe extent of malaria in Africa Identify groups at highest risk of malaria infection List effects of malaria on pregnant women and their unborn babies Describe effects of malaria on pregnant women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 31 Malaria Transmission Caused by Plasmodium parasites Spread by female Anopheles mosquitoes infected with parasites Anopheles mosquitoes usually active at night Infected mosquito bites a person Malaria parasites reproduce in human blood Mosquito bites infected person, and goes on to bite and infect another person Prevention and Control of Malaria during Pregnancy 32 Populations Most Affected by Malaria Children under 5 years of age Pregnant women Unborn babies Immigrants from low-transmission areas HIV-infected persons Prevention and Control of Malaria during Pregnancy 33 Effects of Malaria on Pregnant Women All pregnant women in malaria-endemic areas are at risk Parasites attack and destroy red blood cells Malaria causes up to 15% of anemia in pregnancy Can cause severe anemia In Africa, anemia due to malaria causes up to 10,000 maternal deaths per year Prevention and Control of Malaria during Pregnancy 34 Effects on Unborn Babies Parasites hide in placenta Interferes with transfer of oxygen and nutrients to the baby, increasing risk of: Spontaneous abortion Preterm birth Low birthweight—single greatest risk factor for death during first month of life Stillbirth Prevention and Control of Malaria during Pregnancy 35 Effects on Communities Causes missed work and wages Results in frequent school absences Uses scarce resources Causes preventable deaths: increases maternal, newborn, and infant mortality rates Prevention and Control of Malaria during Pregnancy 36 HIV/AIDS and Malaria during Pregnancy HIV/AIDS reduces a woman’s resistance to malaria Intermittent preventive treatment (IPT) given 3 times during pregnancy is effective for women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 37 Summary of Health Education Points Malaria transmitted through mosquito bites Pregnant women and children are most at risk Pregnant women infected with malaria may have no symptoms Women with HIV/AIDS are at higher risk Malaria can lead to severe anemia, spontaneous abortion, low-birthweight babies Malaria is preventable Prevention and Control of Malaria during Pregnancy Chapter III: Preventing Malaria Prevention and Control of Malaria during Pregnancy 39 Preventing Malaria: Chapter Objectives List the elements of counseling women about the use of insecticide-treated nets (ITNs) and intermittent preventive treatment (IPT) during pregnancy Describe the use of sulfadoxine-pyrimethamine (SP) for IPT during pregnancy
Slide 40 - Prevention and Control of Malaria during Pregnancy A Workshop for Healthcare Providers Prevention and Control of Malaria during Pregnancy 2 Facts about Malaria 300 million cases each year worldwide 9 of 10 cases occur in Africa A person in Africa dies of malaria every 10 seconds Women and young children are most at risk Affects five times as many people as AIDS, leprosy, measles, and tuberculosis combined Prevention and Control of Malaria during Pregnancy 3 Facts about Malaria and Pregnancy 30 million African women are pregnant yearly Malaria is more frequent and complicated during pregnancy In malaria-endemic areas, malaria during pregnancy may account for: Up to 15% of maternal anemia 5–14% of low birthweight 30% of “preventable” low birthweight Prevention and Control of Malaria during Pregnancy 4 Roll Back Malaria Worldwide partnership Governments, private groups, research organizations, civil society, media Aim to reduce malaria by half by 2010 Free advocacy resources and tools: http://www.rbm.who.int Priority: Prevent poor outcomes caused by malaria in pregnancy Abuja declaration: Goal is for 60% of women in Africa to be sleeping under insecticide-treated nets (ITNs) and getting intermittent preventive treatment (IPT) by 2005 Prevention and Control of Malaria during Pregnancy 5 Malaria Prevention and Treatment during Pregnancy Focused antenatal care (ANC) with health education about malaria Use of insecticide-treated nets (ITNs) Intermittent preventive treatment (IPT) Case management of women with symptoms and signs of malaria Prevention and Control of Malaria during Pregnancy Chapter I: Focused Antenatal Care Prevention and Control of Malaria during Pregnancy 7 Focused Antenatal Care: Chapter Objectives Describe four main components of focused antenatal care (ANC) Discuss frequency and timing of ANC visits Describe essential elements of a birth plan that includes complication readiness Describe interpersonal skills for effective ANC Describe components of record keeping for ANC Prevention and Control of Malaria during Pregnancy 8 Focused Antenatal Care An approach to ANC that emphasizes: Evidence-based, goal-directed actions Individualized, woman-centered care Quality vs. quantity of visits Care by skilled providers Prevention and Control of Malaria during Pregnancy 9 Goal of Focused Antenatal Care To promote maternal and newborn health and survival through: Early detection and treatment of problems and complications Prevention of complications and disease Birth preparedness and complication readiness Health promotion Prevention and Control of Malaria during Pregnancy 10 Traditional Antenatal Care Emphasizes: Ritualistic, “routine” care vs. evidence-based, goal-directed actions Frequent visits Does not emphasize individual client needs Prevention and Control of Malaria during Pregnancy 11 No Longer Recommended Numerous, routine visits Burden to women and healthcare system Routine measurements and examinations: Maternal height and weight Ankle edema Fetal position before 36 weeks Care based on risk assessment Prevention and Control of Malaria during Pregnancy 12 Risk Approach Not an effective ANC strategy because: Complications cannot be predicted—all pregnant women are at risk for developing complications Risk factors are usually not direct cause of complications Many “low risk” women develop complications Have false sense of security Do not know how to recognize/respond to problems Most “high risk” women give birth without complications Inefficient use of scarce resources Prevention and Control of Malaria during Pregnancy 13 Focused Antenatal Care Services Evidence-based, goal-directed actions: Address most prevalent health issues affecting women and newborns Adjusted for specific populations/regions Appropriate to gestational age Based on firm rationale Prevention and Control of Malaria during Pregnancy 14 Focused Antenatal Care Services (cont’d.) Individualized, woman-centered care based on each woman’s: Specific needs and concerns Circumstances History, physical examination, testing Available resources Prevention and Control of Malaria during Pregnancy 15 Focused Antenatal Care Services (cont’d.) Quality vs. quantity of ANC visits: WHO multi-center study Number of visits reduced without affecting outcome for mother or baby Recommendations Content and quality vs. number of visits Goal-oriented care Minimum of four visits Prevention and Control of Malaria during Pregnancy 16 First visit: By 16 weeks or when woman first thinks she is pregnant Second visit: At 24–28 weeks or at least once in second trimester Third visit: At 32 weeks Fourth visit: At 36 weeks Other visits: If complication occurs, followup or referral is needed, woman wants to see provider, or provider changes frequency based on findings (history, exam, testing) or local policy Scheduling and Timing of ANC Visits Prevention and Control of Malaria during Pregnancy 17 Focused Antenatal Care Services (cont’d.) Care by a skilled provider who: Has formal training and experience Has knowledge, skills, and qualifications to deliver safe, effective maternal and newborn healthcare Practices in home, hospital, health center May be a midwife, nurse, doctor, clinical officer, etc. Prevention and Control of Malaria during Pregnancy 18 Early Detection and Treatment Malaria—history and physical exam Fever and accompanying signs/symptoms Region Complicated vs. uncomplicated cases Severe anemia—physical exam, testing Pre-eclampsia/eclampsia—measurement of blood pressure HIV—voluntary counseling and testing Sexually transmitted infections, including syphilis— testing Prevention and Control of Malaria during Pregnancy 19 Prevention: Key Preventive Measures Malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Tetanus toxoid, iron/folate supplements Country/region-specific interventions as appropriate Vitamin A supplements Iodine supplements Presumptive treatment for hookworm Prevention and Control of Malaria during Pregnancy 20 Birth Preparedness and Complication Readiness: Objectives Develop birth plan—exact plan for normal birth and possible complications: Arrangements made in advance by woman and family (with help of skilled provider) Usually not a written document Reviewed/revised at every visit Minimize disorganization at time of birth or in an emergency Ensure timely and appropriate care Prevention and Control of Malaria during Pregnancy 21 Essential Elements of a Birth Plan Facility or Place of Birth: Home or health facility for birth, appropriate facility for emergencies Skilled Provider: To attend birth Provider/Facility Contact Information Transportation: Reliable, accessible, especially for odd hours Funds: Personal savings, emergency funds Decision-Making: Who will make decisions, especially in an emergency Prevention and Control of Malaria during Pregnancy 22 Essential Elements of a Birth Plan (cont’d.) Family and Community Support: Care for family in woman’s absence and birth companion during labor Blood Donor: In case of emergency Needed Items: For clean and safe birth and for newborn care Danger Signs/Signs of Advanced Labor Prevention and Control of Malaria during Pregnancy 23 Danger Signs of Pregnancy Vaginal bleeding Difficulty breathing Fever Severe abdominal pain Severe headache/blurred vision Convulsions/loss of consciousness Labor pains before 37 weeks Prevention and Control of Malaria during Pregnancy 24 Health Education: Objectives Inform and educate the woman with health messages and counseling appropriate to: Individual needs, concerns, circumstances Gestational age Most prevalent health issues Support the woman in making decisions and solving actual or anticipated problems Involve partner and family in supporting/adopting healthy practices Prevention and Control of Malaria during Pregnancy 25 Health Education: Topics Addressed Prevention of malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Other methods Other important issues to be discussed include: Nutrition Care for common discomforts Use of potentially harmful substances Hygiene Rest and activity Prevention and Control of Malaria during Pregnancy 26 Health Education: Topics Addressed (cont’d.) Sexual relations and safer sex Early and exclusive breastfeeding Prevention of tetanus and anemia Voluntary counseling and testing for HIV Prevention of other endemic diseases/deficiencies Prevention and Control of Malaria during Pregnancy 27 Interpersonal Skills Speak in a quiet, gentle tone of voice Listen to woman/family and respond appropriately Encourage them to ask questions and express concerns Allow them to demonstrate understanding of information provided Explain all procedures/actions and obtain permission before proceeding Show respect for cultural beliefs and social norms Be empathetic and nonjudgmental Avoid distractions while conducting the visit Prevention and Control of Malaria during Pregnancy 28 Record Keeping First ANC Visit History Physical examination Testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs Date of next ANC visit Subsequent ANC Visits Interim history Targeted physical examination, testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs (and relevant information on how client obtained and used ITN) Date of next ANC visit Record all information on the ANC chart and clinic card: Prevention and Control of Malaria during Pregnancy Chapter II: Malaria Transmission Prevention and Control of Malaria during Pregnancy 30 Malaria Transmission: Chapter Objectives Define malaria and how it is transmitted Describe extent of malaria in Africa Identify groups at highest risk of malaria infection List effects of malaria on pregnant women and their unborn babies Describe effects of malaria on pregnant women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 31 Malaria Transmission Caused by Plasmodium parasites Spread by female Anopheles mosquitoes infected with parasites Anopheles mosquitoes usually active at night Infected mosquito bites a person Malaria parasites reproduce in human blood Mosquito bites infected person, and goes on to bite and infect another person Prevention and Control of Malaria during Pregnancy 32 Populations Most Affected by Malaria Children under 5 years of age Pregnant women Unborn babies Immigrants from low-transmission areas HIV-infected persons Prevention and Control of Malaria during Pregnancy 33 Effects of Malaria on Pregnant Women All pregnant women in malaria-endemic areas are at risk Parasites attack and destroy red blood cells Malaria causes up to 15% of anemia in pregnancy Can cause severe anemia In Africa, anemia due to malaria causes up to 10,000 maternal deaths per year Prevention and Control of Malaria during Pregnancy 34 Effects on Unborn Babies Parasites hide in placenta Interferes with transfer of oxygen and nutrients to the baby, increasing risk of: Spontaneous abortion Preterm birth Low birthweight—single greatest risk factor for death during first month of life Stillbirth Prevention and Control of Malaria during Pregnancy 35 Effects on Communities Causes missed work and wages Results in frequent school absences Uses scarce resources Causes preventable deaths: increases maternal, newborn, and infant mortality rates Prevention and Control of Malaria during Pregnancy 36 HIV/AIDS and Malaria during Pregnancy HIV/AIDS reduces a woman’s resistance to malaria Intermittent preventive treatment (IPT) given 3 times during pregnancy is effective for women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 37 Summary of Health Education Points Malaria transmitted through mosquito bites Pregnant women and children are most at risk Pregnant women infected with malaria may have no symptoms Women with HIV/AIDS are at higher risk Malaria can lead to severe anemia, spontaneous abortion, low-birthweight babies Malaria is preventable Prevention and Control of Malaria during Pregnancy Chapter III: Preventing Malaria Prevention and Control of Malaria during Pregnancy 39 Preventing Malaria: Chapter Objectives List the elements of counseling women about the use of insecticide-treated nets (ITNs) and intermittent preventive treatment (IPT) during pregnancy Describe the use of sulfadoxine-pyrimethamine (SP) for IPT during pregnancy Prevention and Control of Malaria during Pregnancy 40 Insecticide-Treated Nets Kill or repel mosquitoes Prevent physical contact with mosquitoes Kill or repel other insects: Lice Ticks Bedbugs Cockroaches
Slide 41 - Prevention and Control of Malaria during Pregnancy A Workshop for Healthcare Providers Prevention and Control of Malaria during Pregnancy 2 Facts about Malaria 300 million cases each year worldwide 9 of 10 cases occur in Africa A person in Africa dies of malaria every 10 seconds Women and young children are most at risk Affects five times as many people as AIDS, leprosy, measles, and tuberculosis combined Prevention and Control of Malaria during Pregnancy 3 Facts about Malaria and Pregnancy 30 million African women are pregnant yearly Malaria is more frequent and complicated during pregnancy In malaria-endemic areas, malaria during pregnancy may account for: Up to 15% of maternal anemia 5–14% of low birthweight 30% of “preventable” low birthweight Prevention and Control of Malaria during Pregnancy 4 Roll Back Malaria Worldwide partnership Governments, private groups, research organizations, civil society, media Aim to reduce malaria by half by 2010 Free advocacy resources and tools: http://www.rbm.who.int Priority: Prevent poor outcomes caused by malaria in pregnancy Abuja declaration: Goal is for 60% of women in Africa to be sleeping under insecticide-treated nets (ITNs) and getting intermittent preventive treatment (IPT) by 2005 Prevention and Control of Malaria during Pregnancy 5 Malaria Prevention and Treatment during Pregnancy Focused antenatal care (ANC) with health education about malaria Use of insecticide-treated nets (ITNs) Intermittent preventive treatment (IPT) Case management of women with symptoms and signs of malaria Prevention and Control of Malaria during Pregnancy Chapter I: Focused Antenatal Care Prevention and Control of Malaria during Pregnancy 7 Focused Antenatal Care: Chapter Objectives Describe four main components of focused antenatal care (ANC) Discuss frequency and timing of ANC visits Describe essential elements of a birth plan that includes complication readiness Describe interpersonal skills for effective ANC Describe components of record keeping for ANC Prevention and Control of Malaria during Pregnancy 8 Focused Antenatal Care An approach to ANC that emphasizes: Evidence-based, goal-directed actions Individualized, woman-centered care Quality vs. quantity of visits Care by skilled providers Prevention and Control of Malaria during Pregnancy 9 Goal of Focused Antenatal Care To promote maternal and newborn health and survival through: Early detection and treatment of problems and complications Prevention of complications and disease Birth preparedness and complication readiness Health promotion Prevention and Control of Malaria during Pregnancy 10 Traditional Antenatal Care Emphasizes: Ritualistic, “routine” care vs. evidence-based, goal-directed actions Frequent visits Does not emphasize individual client needs Prevention and Control of Malaria during Pregnancy 11 No Longer Recommended Numerous, routine visits Burden to women and healthcare system Routine measurements and examinations: Maternal height and weight Ankle edema Fetal position before 36 weeks Care based on risk assessment Prevention and Control of Malaria during Pregnancy 12 Risk Approach Not an effective ANC strategy because: Complications cannot be predicted—all pregnant women are at risk for developing complications Risk factors are usually not direct cause of complications Many “low risk” women develop complications Have false sense of security Do not know how to recognize/respond to problems Most “high risk” women give birth without complications Inefficient use of scarce resources Prevention and Control of Malaria during Pregnancy 13 Focused Antenatal Care Services Evidence-based, goal-directed actions: Address most prevalent health issues affecting women and newborns Adjusted for specific populations/regions Appropriate to gestational age Based on firm rationale Prevention and Control of Malaria during Pregnancy 14 Focused Antenatal Care Services (cont’d.) Individualized, woman-centered care based on each woman’s: Specific needs and concerns Circumstances History, physical examination, testing Available resources Prevention and Control of Malaria during Pregnancy 15 Focused Antenatal Care Services (cont’d.) Quality vs. quantity of ANC visits: WHO multi-center study Number of visits reduced without affecting outcome for mother or baby Recommendations Content and quality vs. number of visits Goal-oriented care Minimum of four visits Prevention and Control of Malaria during Pregnancy 16 First visit: By 16 weeks or when woman first thinks she is pregnant Second visit: At 24–28 weeks or at least once in second trimester Third visit: At 32 weeks Fourth visit: At 36 weeks Other visits: If complication occurs, followup or referral is needed, woman wants to see provider, or provider changes frequency based on findings (history, exam, testing) or local policy Scheduling and Timing of ANC Visits Prevention and Control of Malaria during Pregnancy 17 Focused Antenatal Care Services (cont’d.) Care by a skilled provider who: Has formal training and experience Has knowledge, skills, and qualifications to deliver safe, effective maternal and newborn healthcare Practices in home, hospital, health center May be a midwife, nurse, doctor, clinical officer, etc. Prevention and Control of Malaria during Pregnancy 18 Early Detection and Treatment Malaria—history and physical exam Fever and accompanying signs/symptoms Region Complicated vs. uncomplicated cases Severe anemia—physical exam, testing Pre-eclampsia/eclampsia—measurement of blood pressure HIV—voluntary counseling and testing Sexually transmitted infections, including syphilis— testing Prevention and Control of Malaria during Pregnancy 19 Prevention: Key Preventive Measures Malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Tetanus toxoid, iron/folate supplements Country/region-specific interventions as appropriate Vitamin A supplements Iodine supplements Presumptive treatment for hookworm Prevention and Control of Malaria during Pregnancy 20 Birth Preparedness and Complication Readiness: Objectives Develop birth plan—exact plan for normal birth and possible complications: Arrangements made in advance by woman and family (with help of skilled provider) Usually not a written document Reviewed/revised at every visit Minimize disorganization at time of birth or in an emergency Ensure timely and appropriate care Prevention and Control of Malaria during Pregnancy 21 Essential Elements of a Birth Plan Facility or Place of Birth: Home or health facility for birth, appropriate facility for emergencies Skilled Provider: To attend birth Provider/Facility Contact Information Transportation: Reliable, accessible, especially for odd hours Funds: Personal savings, emergency funds Decision-Making: Who will make decisions, especially in an emergency Prevention and Control of Malaria during Pregnancy 22 Essential Elements of a Birth Plan (cont’d.) Family and Community Support: Care for family in woman’s absence and birth companion during labor Blood Donor: In case of emergency Needed Items: For clean and safe birth and for newborn care Danger Signs/Signs of Advanced Labor Prevention and Control of Malaria during Pregnancy 23 Danger Signs of Pregnancy Vaginal bleeding Difficulty breathing Fever Severe abdominal pain Severe headache/blurred vision Convulsions/loss of consciousness Labor pains before 37 weeks Prevention and Control of Malaria during Pregnancy 24 Health Education: Objectives Inform and educate the woman with health messages and counseling appropriate to: Individual needs, concerns, circumstances Gestational age Most prevalent health issues Support the woman in making decisions and solving actual or anticipated problems Involve partner and family in supporting/adopting healthy practices Prevention and Control of Malaria during Pregnancy 25 Health Education: Topics Addressed Prevention of malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Other methods Other important issues to be discussed include: Nutrition Care for common discomforts Use of potentially harmful substances Hygiene Rest and activity Prevention and Control of Malaria during Pregnancy 26 Health Education: Topics Addressed (cont’d.) Sexual relations and safer sex Early and exclusive breastfeeding Prevention of tetanus and anemia Voluntary counseling and testing for HIV Prevention of other endemic diseases/deficiencies Prevention and Control of Malaria during Pregnancy 27 Interpersonal Skills Speak in a quiet, gentle tone of voice Listen to woman/family and respond appropriately Encourage them to ask questions and express concerns Allow them to demonstrate understanding of information provided Explain all procedures/actions and obtain permission before proceeding Show respect for cultural beliefs and social norms Be empathetic and nonjudgmental Avoid distractions while conducting the visit Prevention and Control of Malaria during Pregnancy 28 Record Keeping First ANC Visit History Physical examination Testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs Date of next ANC visit Subsequent ANC Visits Interim history Targeted physical examination, testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs (and relevant information on how client obtained and used ITN) Date of next ANC visit Record all information on the ANC chart and clinic card: Prevention and Control of Malaria during Pregnancy Chapter II: Malaria Transmission Prevention and Control of Malaria during Pregnancy 30 Malaria Transmission: Chapter Objectives Define malaria and how it is transmitted Describe extent of malaria in Africa Identify groups at highest risk of malaria infection List effects of malaria on pregnant women and their unborn babies Describe effects of malaria on pregnant women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 31 Malaria Transmission Caused by Plasmodium parasites Spread by female Anopheles mosquitoes infected with parasites Anopheles mosquitoes usually active at night Infected mosquito bites a person Malaria parasites reproduce in human blood Mosquito bites infected person, and goes on to bite and infect another person Prevention and Control of Malaria during Pregnancy 32 Populations Most Affected by Malaria Children under 5 years of age Pregnant women Unborn babies Immigrants from low-transmission areas HIV-infected persons Prevention and Control of Malaria during Pregnancy 33 Effects of Malaria on Pregnant Women All pregnant women in malaria-endemic areas are at risk Parasites attack and destroy red blood cells Malaria causes up to 15% of anemia in pregnancy Can cause severe anemia In Africa, anemia due to malaria causes up to 10,000 maternal deaths per year Prevention and Control of Malaria during Pregnancy 34 Effects on Unborn Babies Parasites hide in placenta Interferes with transfer of oxygen and nutrients to the baby, increasing risk of: Spontaneous abortion Preterm birth Low birthweight—single greatest risk factor for death during first month of life Stillbirth Prevention and Control of Malaria during Pregnancy 35 Effects on Communities Causes missed work and wages Results in frequent school absences Uses scarce resources Causes preventable deaths: increases maternal, newborn, and infant mortality rates Prevention and Control of Malaria during Pregnancy 36 HIV/AIDS and Malaria during Pregnancy HIV/AIDS reduces a woman’s resistance to malaria Intermittent preventive treatment (IPT) given 3 times during pregnancy is effective for women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 37 Summary of Health Education Points Malaria transmitted through mosquito bites Pregnant women and children are most at risk Pregnant women infected with malaria may have no symptoms Women with HIV/AIDS are at higher risk Malaria can lead to severe anemia, spontaneous abortion, low-birthweight babies Malaria is preventable Prevention and Control of Malaria during Pregnancy Chapter III: Preventing Malaria Prevention and Control of Malaria during Pregnancy 39 Preventing Malaria: Chapter Objectives List the elements of counseling women about the use of insecticide-treated nets (ITNs) and intermittent preventive treatment (IPT) during pregnancy Describe the use of sulfadoxine-pyrimethamine (SP) for IPT during pregnancy Prevention and Control of Malaria during Pregnancy 40 Insecticide-Treated Nets Kill or repel mosquitoes Prevent physical contact with mosquitoes Kill or repel other insects: Lice Ticks Bedbugs Cockroaches Prevention and Control of Malaria during Pregnancy 41 Insecticide-Treated Nets (cont’d.) Untreated Nets Provide some protection against malaria Do not kill or repel mosquitoes that touch net Do not reduce number of mosquitoes Do not kill other insects like lice, roaches, and bedbugs Are safe for pregnant women, young children, and infants Insecticide-Treated Nets Provide a high level of protection against malaria Kills or repels mosquitoes that touch the net Reduce number of mosquitoes in/outside net Kills other insects such as lice, roaches, and bedbugs Are safe for pregnant women, young children, and infants
Slide 42 - Prevention and Control of Malaria during Pregnancy A Workshop for Healthcare Providers Prevention and Control of Malaria during Pregnancy 2 Facts about Malaria 300 million cases each year worldwide 9 of 10 cases occur in Africa A person in Africa dies of malaria every 10 seconds Women and young children are most at risk Affects five times as many people as AIDS, leprosy, measles, and tuberculosis combined Prevention and Control of Malaria during Pregnancy 3 Facts about Malaria and Pregnancy 30 million African women are pregnant yearly Malaria is more frequent and complicated during pregnancy In malaria-endemic areas, malaria during pregnancy may account for: Up to 15% of maternal anemia 5–14% of low birthweight 30% of “preventable” low birthweight Prevention and Control of Malaria during Pregnancy 4 Roll Back Malaria Worldwide partnership Governments, private groups, research organizations, civil society, media Aim to reduce malaria by half by 2010 Free advocacy resources and tools: http://www.rbm.who.int Priority: Prevent poor outcomes caused by malaria in pregnancy Abuja declaration: Goal is for 60% of women in Africa to be sleeping under insecticide-treated nets (ITNs) and getting intermittent preventive treatment (IPT) by 2005 Prevention and Control of Malaria during Pregnancy 5 Malaria Prevention and Treatment during Pregnancy Focused antenatal care (ANC) with health education about malaria Use of insecticide-treated nets (ITNs) Intermittent preventive treatment (IPT) Case management of women with symptoms and signs of malaria Prevention and Control of Malaria during Pregnancy Chapter I: Focused Antenatal Care Prevention and Control of Malaria during Pregnancy 7 Focused Antenatal Care: Chapter Objectives Describe four main components of focused antenatal care (ANC) Discuss frequency and timing of ANC visits Describe essential elements of a birth plan that includes complication readiness Describe interpersonal skills for effective ANC Describe components of record keeping for ANC Prevention and Control of Malaria during Pregnancy 8 Focused Antenatal Care An approach to ANC that emphasizes: Evidence-based, goal-directed actions Individualized, woman-centered care Quality vs. quantity of visits Care by skilled providers Prevention and Control of Malaria during Pregnancy 9 Goal of Focused Antenatal Care To promote maternal and newborn health and survival through: Early detection and treatment of problems and complications Prevention of complications and disease Birth preparedness and complication readiness Health promotion Prevention and Control of Malaria during Pregnancy 10 Traditional Antenatal Care Emphasizes: Ritualistic, “routine” care vs. evidence-based, goal-directed actions Frequent visits Does not emphasize individual client needs Prevention and Control of Malaria during Pregnancy 11 No Longer Recommended Numerous, routine visits Burden to women and healthcare system Routine measurements and examinations: Maternal height and weight Ankle edema Fetal position before 36 weeks Care based on risk assessment Prevention and Control of Malaria during Pregnancy 12 Risk Approach Not an effective ANC strategy because: Complications cannot be predicted—all pregnant women are at risk for developing complications Risk factors are usually not direct cause of complications Many “low risk” women develop complications Have false sense of security Do not know how to recognize/respond to problems Most “high risk” women give birth without complications Inefficient use of scarce resources Prevention and Control of Malaria during Pregnancy 13 Focused Antenatal Care Services Evidence-based, goal-directed actions: Address most prevalent health issues affecting women and newborns Adjusted for specific populations/regions Appropriate to gestational age Based on firm rationale Prevention and Control of Malaria during Pregnancy 14 Focused Antenatal Care Services (cont’d.) Individualized, woman-centered care based on each woman’s: Specific needs and concerns Circumstances History, physical examination, testing Available resources Prevention and Control of Malaria during Pregnancy 15 Focused Antenatal Care Services (cont’d.) Quality vs. quantity of ANC visits: WHO multi-center study Number of visits reduced without affecting outcome for mother or baby Recommendations Content and quality vs. number of visits Goal-oriented care Minimum of four visits Prevention and Control of Malaria during Pregnancy 16 First visit: By 16 weeks or when woman first thinks she is pregnant Second visit: At 24–28 weeks or at least once in second trimester Third visit: At 32 weeks Fourth visit: At 36 weeks Other visits: If complication occurs, followup or referral is needed, woman wants to see provider, or provider changes frequency based on findings (history, exam, testing) or local policy Scheduling and Timing of ANC Visits Prevention and Control of Malaria during Pregnancy 17 Focused Antenatal Care Services (cont’d.) Care by a skilled provider who: Has formal training and experience Has knowledge, skills, and qualifications to deliver safe, effective maternal and newborn healthcare Practices in home, hospital, health center May be a midwife, nurse, doctor, clinical officer, etc. Prevention and Control of Malaria during Pregnancy 18 Early Detection and Treatment Malaria—history and physical exam Fever and accompanying signs/symptoms Region Complicated vs. uncomplicated cases Severe anemia—physical exam, testing Pre-eclampsia/eclampsia—measurement of blood pressure HIV—voluntary counseling and testing Sexually transmitted infections, including syphilis— testing Prevention and Control of Malaria during Pregnancy 19 Prevention: Key Preventive Measures Malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Tetanus toxoid, iron/folate supplements Country/region-specific interventions as appropriate Vitamin A supplements Iodine supplements Presumptive treatment for hookworm Prevention and Control of Malaria during Pregnancy 20 Birth Preparedness and Complication Readiness: Objectives Develop birth plan—exact plan for normal birth and possible complications: Arrangements made in advance by woman and family (with help of skilled provider) Usually not a written document Reviewed/revised at every visit Minimize disorganization at time of birth or in an emergency Ensure timely and appropriate care Prevention and Control of Malaria during Pregnancy 21 Essential Elements of a Birth Plan Facility or Place of Birth: Home or health facility for birth, appropriate facility for emergencies Skilled Provider: To attend birth Provider/Facility Contact Information Transportation: Reliable, accessible, especially for odd hours Funds: Personal savings, emergency funds Decision-Making: Who will make decisions, especially in an emergency Prevention and Control of Malaria during Pregnancy 22 Essential Elements of a Birth Plan (cont’d.) Family and Community Support: Care for family in woman’s absence and birth companion during labor Blood Donor: In case of emergency Needed Items: For clean and safe birth and for newborn care Danger Signs/Signs of Advanced Labor Prevention and Control of Malaria during Pregnancy 23 Danger Signs of Pregnancy Vaginal bleeding Difficulty breathing Fever Severe abdominal pain Severe headache/blurred vision Convulsions/loss of consciousness Labor pains before 37 weeks Prevention and Control of Malaria during Pregnancy 24 Health Education: Objectives Inform and educate the woman with health messages and counseling appropriate to: Individual needs, concerns, circumstances Gestational age Most prevalent health issues Support the woman in making decisions and solving actual or anticipated problems Involve partner and family in supporting/adopting healthy practices Prevention and Control of Malaria during Pregnancy 25 Health Education: Topics Addressed Prevention of malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Other methods Other important issues to be discussed include: Nutrition Care for common discomforts Use of potentially harmful substances Hygiene Rest and activity Prevention and Control of Malaria during Pregnancy 26 Health Education: Topics Addressed (cont’d.) Sexual relations and safer sex Early and exclusive breastfeeding Prevention of tetanus and anemia Voluntary counseling and testing for HIV Prevention of other endemic diseases/deficiencies Prevention and Control of Malaria during Pregnancy 27 Interpersonal Skills Speak in a quiet, gentle tone of voice Listen to woman/family and respond appropriately Encourage them to ask questions and express concerns Allow them to demonstrate understanding of information provided Explain all procedures/actions and obtain permission before proceeding Show respect for cultural beliefs and social norms Be empathetic and nonjudgmental Avoid distractions while conducting the visit Prevention and Control of Malaria during Pregnancy 28 Record Keeping First ANC Visit History Physical examination Testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs Date of next ANC visit Subsequent ANC Visits Interim history Targeted physical examination, testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs (and relevant information on how client obtained and used ITN) Date of next ANC visit Record all information on the ANC chart and clinic card: Prevention and Control of Malaria during Pregnancy Chapter II: Malaria Transmission Prevention and Control of Malaria during Pregnancy 30 Malaria Transmission: Chapter Objectives Define malaria and how it is transmitted Describe extent of malaria in Africa Identify groups at highest risk of malaria infection List effects of malaria on pregnant women and their unborn babies Describe effects of malaria on pregnant women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 31 Malaria Transmission Caused by Plasmodium parasites Spread by female Anopheles mosquitoes infected with parasites Anopheles mosquitoes usually active at night Infected mosquito bites a person Malaria parasites reproduce in human blood Mosquito bites infected person, and goes on to bite and infect another person Prevention and Control of Malaria during Pregnancy 32 Populations Most Affected by Malaria Children under 5 years of age Pregnant women Unborn babies Immigrants from low-transmission areas HIV-infected persons Prevention and Control of Malaria during Pregnancy 33 Effects of Malaria on Pregnant Women All pregnant women in malaria-endemic areas are at risk Parasites attack and destroy red blood cells Malaria causes up to 15% of anemia in pregnancy Can cause severe anemia In Africa, anemia due to malaria causes up to 10,000 maternal deaths per year Prevention and Control of Malaria during Pregnancy 34 Effects on Unborn Babies Parasites hide in placenta Interferes with transfer of oxygen and nutrients to the baby, increasing risk of: Spontaneous abortion Preterm birth Low birthweight—single greatest risk factor for death during first month of life Stillbirth Prevention and Control of Malaria during Pregnancy 35 Effects on Communities Causes missed work and wages Results in frequent school absences Uses scarce resources Causes preventable deaths: increases maternal, newborn, and infant mortality rates Prevention and Control of Malaria during Pregnancy 36 HIV/AIDS and Malaria during Pregnancy HIV/AIDS reduces a woman’s resistance to malaria Intermittent preventive treatment (IPT) given 3 times during pregnancy is effective for women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 37 Summary of Health Education Points Malaria transmitted through mosquito bites Pregnant women and children are most at risk Pregnant women infected with malaria may have no symptoms Women with HIV/AIDS are at higher risk Malaria can lead to severe anemia, spontaneous abortion, low-birthweight babies Malaria is preventable Prevention and Control of Malaria during Pregnancy Chapter III: Preventing Malaria Prevention and Control of Malaria during Pregnancy 39 Preventing Malaria: Chapter Objectives List the elements of counseling women about the use of insecticide-treated nets (ITNs) and intermittent preventive treatment (IPT) during pregnancy Describe the use of sulfadoxine-pyrimethamine (SP) for IPT during pregnancy Prevention and Control of Malaria during Pregnancy 40 Insecticide-Treated Nets Kill or repel mosquitoes Prevent physical contact with mosquitoes Kill or repel other insects: Lice Ticks Bedbugs Cockroaches Prevention and Control of Malaria during Pregnancy 41 Insecticide-Treated Nets (cont’d.) Untreated Nets Provide some protection against malaria Do not kill or repel mosquitoes that touch net Do not reduce number of mosquitoes Do not kill other insects like lice, roaches, and bedbugs Are safe for pregnant women, young children, and infants Insecticide-Treated Nets Provide a high level of protection against malaria Kills or repels mosquitoes that touch the net Reduce number of mosquitoes in/outside net Kills other insects such as lice, roaches, and bedbugs Are safe for pregnant women, young children, and infants Prevention and Control of Malaria during Pregnancy 42 Benefits of Insecticide-Treated Nets Prevent mosquito bites Protect against malaria, resulting in less: Anemia Prematurity and low birthweight Risk of maternal and newborn death Help people sleep better Promote growth and development of fetus and newborn
Slide 43 - Prevention and Control of Malaria during Pregnancy A Workshop for Healthcare Providers Prevention and Control of Malaria during Pregnancy 2 Facts about Malaria 300 million cases each year worldwide 9 of 10 cases occur in Africa A person in Africa dies of malaria every 10 seconds Women and young children are most at risk Affects five times as many people as AIDS, leprosy, measles, and tuberculosis combined Prevention and Control of Malaria during Pregnancy 3 Facts about Malaria and Pregnancy 30 million African women are pregnant yearly Malaria is more frequent and complicated during pregnancy In malaria-endemic areas, malaria during pregnancy may account for: Up to 15% of maternal anemia 5–14% of low birthweight 30% of “preventable” low birthweight Prevention and Control of Malaria during Pregnancy 4 Roll Back Malaria Worldwide partnership Governments, private groups, research organizations, civil society, media Aim to reduce malaria by half by 2010 Free advocacy resources and tools: http://www.rbm.who.int Priority: Prevent poor outcomes caused by malaria in pregnancy Abuja declaration: Goal is for 60% of women in Africa to be sleeping under insecticide-treated nets (ITNs) and getting intermittent preventive treatment (IPT) by 2005 Prevention and Control of Malaria during Pregnancy 5 Malaria Prevention and Treatment during Pregnancy Focused antenatal care (ANC) with health education about malaria Use of insecticide-treated nets (ITNs) Intermittent preventive treatment (IPT) Case management of women with symptoms and signs of malaria Prevention and Control of Malaria during Pregnancy Chapter I: Focused Antenatal Care Prevention and Control of Malaria during Pregnancy 7 Focused Antenatal Care: Chapter Objectives Describe four main components of focused antenatal care (ANC) Discuss frequency and timing of ANC visits Describe essential elements of a birth plan that includes complication readiness Describe interpersonal skills for effective ANC Describe components of record keeping for ANC Prevention and Control of Malaria during Pregnancy 8 Focused Antenatal Care An approach to ANC that emphasizes: Evidence-based, goal-directed actions Individualized, woman-centered care Quality vs. quantity of visits Care by skilled providers Prevention and Control of Malaria during Pregnancy 9 Goal of Focused Antenatal Care To promote maternal and newborn health and survival through: Early detection and treatment of problems and complications Prevention of complications and disease Birth preparedness and complication readiness Health promotion Prevention and Control of Malaria during Pregnancy 10 Traditional Antenatal Care Emphasizes: Ritualistic, “routine” care vs. evidence-based, goal-directed actions Frequent visits Does not emphasize individual client needs Prevention and Control of Malaria during Pregnancy 11 No Longer Recommended Numerous, routine visits Burden to women and healthcare system Routine measurements and examinations: Maternal height and weight Ankle edema Fetal position before 36 weeks Care based on risk assessment Prevention and Control of Malaria during Pregnancy 12 Risk Approach Not an effective ANC strategy because: Complications cannot be predicted—all pregnant women are at risk for developing complications Risk factors are usually not direct cause of complications Many “low risk” women develop complications Have false sense of security Do not know how to recognize/respond to problems Most “high risk” women give birth without complications Inefficient use of scarce resources Prevention and Control of Malaria during Pregnancy 13 Focused Antenatal Care Services Evidence-based, goal-directed actions: Address most prevalent health issues affecting women and newborns Adjusted for specific populations/regions Appropriate to gestational age Based on firm rationale Prevention and Control of Malaria during Pregnancy 14 Focused Antenatal Care Services (cont’d.) Individualized, woman-centered care based on each woman’s: Specific needs and concerns Circumstances History, physical examination, testing Available resources Prevention and Control of Malaria during Pregnancy 15 Focused Antenatal Care Services (cont’d.) Quality vs. quantity of ANC visits: WHO multi-center study Number of visits reduced without affecting outcome for mother or baby Recommendations Content and quality vs. number of visits Goal-oriented care Minimum of four visits Prevention and Control of Malaria during Pregnancy 16 First visit: By 16 weeks or when woman first thinks she is pregnant Second visit: At 24–28 weeks or at least once in second trimester Third visit: At 32 weeks Fourth visit: At 36 weeks Other visits: If complication occurs, followup or referral is needed, woman wants to see provider, or provider changes frequency based on findings (history, exam, testing) or local policy Scheduling and Timing of ANC Visits Prevention and Control of Malaria during Pregnancy 17 Focused Antenatal Care Services (cont’d.) Care by a skilled provider who: Has formal training and experience Has knowledge, skills, and qualifications to deliver safe, effective maternal and newborn healthcare Practices in home, hospital, health center May be a midwife, nurse, doctor, clinical officer, etc. Prevention and Control of Malaria during Pregnancy 18 Early Detection and Treatment Malaria—history and physical exam Fever and accompanying signs/symptoms Region Complicated vs. uncomplicated cases Severe anemia—physical exam, testing Pre-eclampsia/eclampsia—measurement of blood pressure HIV—voluntary counseling and testing Sexually transmitted infections, including syphilis— testing Prevention and Control of Malaria during Pregnancy 19 Prevention: Key Preventive Measures Malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Tetanus toxoid, iron/folate supplements Country/region-specific interventions as appropriate Vitamin A supplements Iodine supplements Presumptive treatment for hookworm Prevention and Control of Malaria during Pregnancy 20 Birth Preparedness and Complication Readiness: Objectives Develop birth plan—exact plan for normal birth and possible complications: Arrangements made in advance by woman and family (with help of skilled provider) Usually not a written document Reviewed/revised at every visit Minimize disorganization at time of birth or in an emergency Ensure timely and appropriate care Prevention and Control of Malaria during Pregnancy 21 Essential Elements of a Birth Plan Facility or Place of Birth: Home or health facility for birth, appropriate facility for emergencies Skilled Provider: To attend birth Provider/Facility Contact Information Transportation: Reliable, accessible, especially for odd hours Funds: Personal savings, emergency funds Decision-Making: Who will make decisions, especially in an emergency Prevention and Control of Malaria during Pregnancy 22 Essential Elements of a Birth Plan (cont’d.) Family and Community Support: Care for family in woman’s absence and birth companion during labor Blood Donor: In case of emergency Needed Items: For clean and safe birth and for newborn care Danger Signs/Signs of Advanced Labor Prevention and Control of Malaria during Pregnancy 23 Danger Signs of Pregnancy Vaginal bleeding Difficulty breathing Fever Severe abdominal pain Severe headache/blurred vision Convulsions/loss of consciousness Labor pains before 37 weeks Prevention and Control of Malaria during Pregnancy 24 Health Education: Objectives Inform and educate the woman with health messages and counseling appropriate to: Individual needs, concerns, circumstances Gestational age Most prevalent health issues Support the woman in making decisions and solving actual or anticipated problems Involve partner and family in supporting/adopting healthy practices Prevention and Control of Malaria during Pregnancy 25 Health Education: Topics Addressed Prevention of malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Other methods Other important issues to be discussed include: Nutrition Care for common discomforts Use of potentially harmful substances Hygiene Rest and activity Prevention and Control of Malaria during Pregnancy 26 Health Education: Topics Addressed (cont’d.) Sexual relations and safer sex Early and exclusive breastfeeding Prevention of tetanus and anemia Voluntary counseling and testing for HIV Prevention of other endemic diseases/deficiencies Prevention and Control of Malaria during Pregnancy 27 Interpersonal Skills Speak in a quiet, gentle tone of voice Listen to woman/family and respond appropriately Encourage them to ask questions and express concerns Allow them to demonstrate understanding of information provided Explain all procedures/actions and obtain permission before proceeding Show respect for cultural beliefs and social norms Be empathetic and nonjudgmental Avoid distractions while conducting the visit Prevention and Control of Malaria during Pregnancy 28 Record Keeping First ANC Visit History Physical examination Testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs Date of next ANC visit Subsequent ANC Visits Interim history Targeted physical examination, testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs (and relevant information on how client obtained and used ITN) Date of next ANC visit Record all information on the ANC chart and clinic card: Prevention and Control of Malaria during Pregnancy Chapter II: Malaria Transmission Prevention and Control of Malaria during Pregnancy 30 Malaria Transmission: Chapter Objectives Define malaria and how it is transmitted Describe extent of malaria in Africa Identify groups at highest risk of malaria infection List effects of malaria on pregnant women and their unborn babies Describe effects of malaria on pregnant women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 31 Malaria Transmission Caused by Plasmodium parasites Spread by female Anopheles mosquitoes infected with parasites Anopheles mosquitoes usually active at night Infected mosquito bites a person Malaria parasites reproduce in human blood Mosquito bites infected person, and goes on to bite and infect another person Prevention and Control of Malaria during Pregnancy 32 Populations Most Affected by Malaria Children under 5 years of age Pregnant women Unborn babies Immigrants from low-transmission areas HIV-infected persons Prevention and Control of Malaria during Pregnancy 33 Effects of Malaria on Pregnant Women All pregnant women in malaria-endemic areas are at risk Parasites attack and destroy red blood cells Malaria causes up to 15% of anemia in pregnancy Can cause severe anemia In Africa, anemia due to malaria causes up to 10,000 maternal deaths per year Prevention and Control of Malaria during Pregnancy 34 Effects on Unborn Babies Parasites hide in placenta Interferes with transfer of oxygen and nutrients to the baby, increasing risk of: Spontaneous abortion Preterm birth Low birthweight—single greatest risk factor for death during first month of life Stillbirth Prevention and Control of Malaria during Pregnancy 35 Effects on Communities Causes missed work and wages Results in frequent school absences Uses scarce resources Causes preventable deaths: increases maternal, newborn, and infant mortality rates Prevention and Control of Malaria during Pregnancy 36 HIV/AIDS and Malaria during Pregnancy HIV/AIDS reduces a woman’s resistance to malaria Intermittent preventive treatment (IPT) given 3 times during pregnancy is effective for women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 37 Summary of Health Education Points Malaria transmitted through mosquito bites Pregnant women and children are most at risk Pregnant women infected with malaria may have no symptoms Women with HIV/AIDS are at higher risk Malaria can lead to severe anemia, spontaneous abortion, low-birthweight babies Malaria is preventable Prevention and Control of Malaria during Pregnancy Chapter III: Preventing Malaria Prevention and Control of Malaria during Pregnancy 39 Preventing Malaria: Chapter Objectives List the elements of counseling women about the use of insecticide-treated nets (ITNs) and intermittent preventive treatment (IPT) during pregnancy Describe the use of sulfadoxine-pyrimethamine (SP) for IPT during pregnancy Prevention and Control of Malaria during Pregnancy 40 Insecticide-Treated Nets Kill or repel mosquitoes Prevent physical contact with mosquitoes Kill or repel other insects: Lice Ticks Bedbugs Cockroaches Prevention and Control of Malaria during Pregnancy 41 Insecticide-Treated Nets (cont’d.) Untreated Nets Provide some protection against malaria Do not kill or repel mosquitoes that touch net Do not reduce number of mosquitoes Do not kill other insects like lice, roaches, and bedbugs Are safe for pregnant women, young children, and infants Insecticide-Treated Nets Provide a high level of protection against malaria Kills or repels mosquitoes that touch the net Reduce number of mosquitoes in/outside net Kills other insects such as lice, roaches, and bedbugs Are safe for pregnant women, young children, and infants Prevention and Control of Malaria during Pregnancy 42 Benefits of Insecticide-Treated Nets Prevent mosquito bites Protect against malaria, resulting in less: Anemia Prematurity and low birthweight Risk of maternal and newborn death Help people sleep better Promote growth and development of fetus and newborn Prevention and Control of Malaria during Pregnancy 43 Benefits of Insecticide-Treated Nets: Community Cost less than treating malaria Reduce number of sick children and adults (helping children grow to be healthy and helping working adults remain productive) Reduce number of deaths
Slide 44 - Prevention and Control of Malaria during Pregnancy A Workshop for Healthcare Providers Prevention and Control of Malaria during Pregnancy 2 Facts about Malaria 300 million cases each year worldwide 9 of 10 cases occur in Africa A person in Africa dies of malaria every 10 seconds Women and young children are most at risk Affects five times as many people as AIDS, leprosy, measles, and tuberculosis combined Prevention and Control of Malaria during Pregnancy 3 Facts about Malaria and Pregnancy 30 million African women are pregnant yearly Malaria is more frequent and complicated during pregnancy In malaria-endemic areas, malaria during pregnancy may account for: Up to 15% of maternal anemia 5–14% of low birthweight 30% of “preventable” low birthweight Prevention and Control of Malaria during Pregnancy 4 Roll Back Malaria Worldwide partnership Governments, private groups, research organizations, civil society, media Aim to reduce malaria by half by 2010 Free advocacy resources and tools: http://www.rbm.who.int Priority: Prevent poor outcomes caused by malaria in pregnancy Abuja declaration: Goal is for 60% of women in Africa to be sleeping under insecticide-treated nets (ITNs) and getting intermittent preventive treatment (IPT) by 2005 Prevention and Control of Malaria during Pregnancy 5 Malaria Prevention and Treatment during Pregnancy Focused antenatal care (ANC) with health education about malaria Use of insecticide-treated nets (ITNs) Intermittent preventive treatment (IPT) Case management of women with symptoms and signs of malaria Prevention and Control of Malaria during Pregnancy Chapter I: Focused Antenatal Care Prevention and Control of Malaria during Pregnancy 7 Focused Antenatal Care: Chapter Objectives Describe four main components of focused antenatal care (ANC) Discuss frequency and timing of ANC visits Describe essential elements of a birth plan that includes complication readiness Describe interpersonal skills for effective ANC Describe components of record keeping for ANC Prevention and Control of Malaria during Pregnancy 8 Focused Antenatal Care An approach to ANC that emphasizes: Evidence-based, goal-directed actions Individualized, woman-centered care Quality vs. quantity of visits Care by skilled providers Prevention and Control of Malaria during Pregnancy 9 Goal of Focused Antenatal Care To promote maternal and newborn health and survival through: Early detection and treatment of problems and complications Prevention of complications and disease Birth preparedness and complication readiness Health promotion Prevention and Control of Malaria during Pregnancy 10 Traditional Antenatal Care Emphasizes: Ritualistic, “routine” care vs. evidence-based, goal-directed actions Frequent visits Does not emphasize individual client needs Prevention and Control of Malaria during Pregnancy 11 No Longer Recommended Numerous, routine visits Burden to women and healthcare system Routine measurements and examinations: Maternal height and weight Ankle edema Fetal position before 36 weeks Care based on risk assessment Prevention and Control of Malaria during Pregnancy 12 Risk Approach Not an effective ANC strategy because: Complications cannot be predicted—all pregnant women are at risk for developing complications Risk factors are usually not direct cause of complications Many “low risk” women develop complications Have false sense of security Do not know how to recognize/respond to problems Most “high risk” women give birth without complications Inefficient use of scarce resources Prevention and Control of Malaria during Pregnancy 13 Focused Antenatal Care Services Evidence-based, goal-directed actions: Address most prevalent health issues affecting women and newborns Adjusted for specific populations/regions Appropriate to gestational age Based on firm rationale Prevention and Control of Malaria during Pregnancy 14 Focused Antenatal Care Services (cont’d.) Individualized, woman-centered care based on each woman’s: Specific needs and concerns Circumstances History, physical examination, testing Available resources Prevention and Control of Malaria during Pregnancy 15 Focused Antenatal Care Services (cont’d.) Quality vs. quantity of ANC visits: WHO multi-center study Number of visits reduced without affecting outcome for mother or baby Recommendations Content and quality vs. number of visits Goal-oriented care Minimum of four visits Prevention and Control of Malaria during Pregnancy 16 First visit: By 16 weeks or when woman first thinks she is pregnant Second visit: At 24–28 weeks or at least once in second trimester Third visit: At 32 weeks Fourth visit: At 36 weeks Other visits: If complication occurs, followup or referral is needed, woman wants to see provider, or provider changes frequency based on findings (history, exam, testing) or local policy Scheduling and Timing of ANC Visits Prevention and Control of Malaria during Pregnancy 17 Focused Antenatal Care Services (cont’d.) Care by a skilled provider who: Has formal training and experience Has knowledge, skills, and qualifications to deliver safe, effective maternal and newborn healthcare Practices in home, hospital, health center May be a midwife, nurse, doctor, clinical officer, etc. Prevention and Control of Malaria during Pregnancy 18 Early Detection and Treatment Malaria—history and physical exam Fever and accompanying signs/symptoms Region Complicated vs. uncomplicated cases Severe anemia—physical exam, testing Pre-eclampsia/eclampsia—measurement of blood pressure HIV—voluntary counseling and testing Sexually transmitted infections, including syphilis— testing Prevention and Control of Malaria during Pregnancy 19 Prevention: Key Preventive Measures Malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Tetanus toxoid, iron/folate supplements Country/region-specific interventions as appropriate Vitamin A supplements Iodine supplements Presumptive treatment for hookworm Prevention and Control of Malaria during Pregnancy 20 Birth Preparedness and Complication Readiness: Objectives Develop birth plan—exact plan for normal birth and possible complications: Arrangements made in advance by woman and family (with help of skilled provider) Usually not a written document Reviewed/revised at every visit Minimize disorganization at time of birth or in an emergency Ensure timely and appropriate care Prevention and Control of Malaria during Pregnancy 21 Essential Elements of a Birth Plan Facility or Place of Birth: Home or health facility for birth, appropriate facility for emergencies Skilled Provider: To attend birth Provider/Facility Contact Information Transportation: Reliable, accessible, especially for odd hours Funds: Personal savings, emergency funds Decision-Making: Who will make decisions, especially in an emergency Prevention and Control of Malaria during Pregnancy 22 Essential Elements of a Birth Plan (cont’d.) Family and Community Support: Care for family in woman’s absence and birth companion during labor Blood Donor: In case of emergency Needed Items: For clean and safe birth and for newborn care Danger Signs/Signs of Advanced Labor Prevention and Control of Malaria during Pregnancy 23 Danger Signs of Pregnancy Vaginal bleeding Difficulty breathing Fever Severe abdominal pain Severe headache/blurred vision Convulsions/loss of consciousness Labor pains before 37 weeks Prevention and Control of Malaria during Pregnancy 24 Health Education: Objectives Inform and educate the woman with health messages and counseling appropriate to: Individual needs, concerns, circumstances Gestational age Most prevalent health issues Support the woman in making decisions and solving actual or anticipated problems Involve partner and family in supporting/adopting healthy practices Prevention and Control of Malaria during Pregnancy 25 Health Education: Topics Addressed Prevention of malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Other methods Other important issues to be discussed include: Nutrition Care for common discomforts Use of potentially harmful substances Hygiene Rest and activity Prevention and Control of Malaria during Pregnancy 26 Health Education: Topics Addressed (cont’d.) Sexual relations and safer sex Early and exclusive breastfeeding Prevention of tetanus and anemia Voluntary counseling and testing for HIV Prevention of other endemic diseases/deficiencies Prevention and Control of Malaria during Pregnancy 27 Interpersonal Skills Speak in a quiet, gentle tone of voice Listen to woman/family and respond appropriately Encourage them to ask questions and express concerns Allow them to demonstrate understanding of information provided Explain all procedures/actions and obtain permission before proceeding Show respect for cultural beliefs and social norms Be empathetic and nonjudgmental Avoid distractions while conducting the visit Prevention and Control of Malaria during Pregnancy 28 Record Keeping First ANC Visit History Physical examination Testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs Date of next ANC visit Subsequent ANC Visits Interim history Targeted physical examination, testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs (and relevant information on how client obtained and used ITN) Date of next ANC visit Record all information on the ANC chart and clinic card: Prevention and Control of Malaria during Pregnancy Chapter II: Malaria Transmission Prevention and Control of Malaria during Pregnancy 30 Malaria Transmission: Chapter Objectives Define malaria and how it is transmitted Describe extent of malaria in Africa Identify groups at highest risk of malaria infection List effects of malaria on pregnant women and their unborn babies Describe effects of malaria on pregnant women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 31 Malaria Transmission Caused by Plasmodium parasites Spread by female Anopheles mosquitoes infected with parasites Anopheles mosquitoes usually active at night Infected mosquito bites a person Malaria parasites reproduce in human blood Mosquito bites infected person, and goes on to bite and infect another person Prevention and Control of Malaria during Pregnancy 32 Populations Most Affected by Malaria Children under 5 years of age Pregnant women Unborn babies Immigrants from low-transmission areas HIV-infected persons Prevention and Control of Malaria during Pregnancy 33 Effects of Malaria on Pregnant Women All pregnant women in malaria-endemic areas are at risk Parasites attack and destroy red blood cells Malaria causes up to 15% of anemia in pregnancy Can cause severe anemia In Africa, anemia due to malaria causes up to 10,000 maternal deaths per year Prevention and Control of Malaria during Pregnancy 34 Effects on Unborn Babies Parasites hide in placenta Interferes with transfer of oxygen and nutrients to the baby, increasing risk of: Spontaneous abortion Preterm birth Low birthweight—single greatest risk factor for death during first month of life Stillbirth Prevention and Control of Malaria during Pregnancy 35 Effects on Communities Causes missed work and wages Results in frequent school absences Uses scarce resources Causes preventable deaths: increases maternal, newborn, and infant mortality rates Prevention and Control of Malaria during Pregnancy 36 HIV/AIDS and Malaria during Pregnancy HIV/AIDS reduces a woman’s resistance to malaria Intermittent preventive treatment (IPT) given 3 times during pregnancy is effective for women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 37 Summary of Health Education Points Malaria transmitted through mosquito bites Pregnant women and children are most at risk Pregnant women infected with malaria may have no symptoms Women with HIV/AIDS are at higher risk Malaria can lead to severe anemia, spontaneous abortion, low-birthweight babies Malaria is preventable Prevention and Control of Malaria during Pregnancy Chapter III: Preventing Malaria Prevention and Control of Malaria during Pregnancy 39 Preventing Malaria: Chapter Objectives List the elements of counseling women about the use of insecticide-treated nets (ITNs) and intermittent preventive treatment (IPT) during pregnancy Describe the use of sulfadoxine-pyrimethamine (SP) for IPT during pregnancy Prevention and Control of Malaria during Pregnancy 40 Insecticide-Treated Nets Kill or repel mosquitoes Prevent physical contact with mosquitoes Kill or repel other insects: Lice Ticks Bedbugs Cockroaches Prevention and Control of Malaria during Pregnancy 41 Insecticide-Treated Nets (cont’d.) Untreated Nets Provide some protection against malaria Do not kill or repel mosquitoes that touch net Do not reduce number of mosquitoes Do not kill other insects like lice, roaches, and bedbugs Are safe for pregnant women, young children, and infants Insecticide-Treated Nets Provide a high level of protection against malaria Kills or repels mosquitoes that touch the net Reduce number of mosquitoes in/outside net Kills other insects such as lice, roaches, and bedbugs Are safe for pregnant women, young children, and infants Prevention and Control of Malaria during Pregnancy 42 Benefits of Insecticide-Treated Nets Prevent mosquito bites Protect against malaria, resulting in less: Anemia Prematurity and low birthweight Risk of maternal and newborn death Help people sleep better Promote growth and development of fetus and newborn Prevention and Control of Malaria during Pregnancy 43 Benefits of Insecticide-Treated Nets: Community Cost less than treating malaria Reduce number of sick children and adults (helping children grow to be healthy and helping working adults remain productive) Reduce number of deaths Prevention and Control of Malaria during Pregnancy 44 Where to Find Insecticide-Treated Nets General merchandise shops Drug shops/pharmacies Markets Public and private health facilities Community health workers NGOs, community-based organizations
Slide 45 - Prevention and Control of Malaria during Pregnancy A Workshop for Healthcare Providers Prevention and Control of Malaria during Pregnancy 2 Facts about Malaria 300 million cases each year worldwide 9 of 10 cases occur in Africa A person in Africa dies of malaria every 10 seconds Women and young children are most at risk Affects five times as many people as AIDS, leprosy, measles, and tuberculosis combined Prevention and Control of Malaria during Pregnancy 3 Facts about Malaria and Pregnancy 30 million African women are pregnant yearly Malaria is more frequent and complicated during pregnancy In malaria-endemic areas, malaria during pregnancy may account for: Up to 15% of maternal anemia 5–14% of low birthweight 30% of “preventable” low birthweight Prevention and Control of Malaria during Pregnancy 4 Roll Back Malaria Worldwide partnership Governments, private groups, research organizations, civil society, media Aim to reduce malaria by half by 2010 Free advocacy resources and tools: http://www.rbm.who.int Priority: Prevent poor outcomes caused by malaria in pregnancy Abuja declaration: Goal is for 60% of women in Africa to be sleeping under insecticide-treated nets (ITNs) and getting intermittent preventive treatment (IPT) by 2005 Prevention and Control of Malaria during Pregnancy 5 Malaria Prevention and Treatment during Pregnancy Focused antenatal care (ANC) with health education about malaria Use of insecticide-treated nets (ITNs) Intermittent preventive treatment (IPT) Case management of women with symptoms and signs of malaria Prevention and Control of Malaria during Pregnancy Chapter I: Focused Antenatal Care Prevention and Control of Malaria during Pregnancy 7 Focused Antenatal Care: Chapter Objectives Describe four main components of focused antenatal care (ANC) Discuss frequency and timing of ANC visits Describe essential elements of a birth plan that includes complication readiness Describe interpersonal skills for effective ANC Describe components of record keeping for ANC Prevention and Control of Malaria during Pregnancy 8 Focused Antenatal Care An approach to ANC that emphasizes: Evidence-based, goal-directed actions Individualized, woman-centered care Quality vs. quantity of visits Care by skilled providers Prevention and Control of Malaria during Pregnancy 9 Goal of Focused Antenatal Care To promote maternal and newborn health and survival through: Early detection and treatment of problems and complications Prevention of complications and disease Birth preparedness and complication readiness Health promotion Prevention and Control of Malaria during Pregnancy 10 Traditional Antenatal Care Emphasizes: Ritualistic, “routine” care vs. evidence-based, goal-directed actions Frequent visits Does not emphasize individual client needs Prevention and Control of Malaria during Pregnancy 11 No Longer Recommended Numerous, routine visits Burden to women and healthcare system Routine measurements and examinations: Maternal height and weight Ankle edema Fetal position before 36 weeks Care based on risk assessment Prevention and Control of Malaria during Pregnancy 12 Risk Approach Not an effective ANC strategy because: Complications cannot be predicted—all pregnant women are at risk for developing complications Risk factors are usually not direct cause of complications Many “low risk” women develop complications Have false sense of security Do not know how to recognize/respond to problems Most “high risk” women give birth without complications Inefficient use of scarce resources Prevention and Control of Malaria during Pregnancy 13 Focused Antenatal Care Services Evidence-based, goal-directed actions: Address most prevalent health issues affecting women and newborns Adjusted for specific populations/regions Appropriate to gestational age Based on firm rationale Prevention and Control of Malaria during Pregnancy 14 Focused Antenatal Care Services (cont’d.) Individualized, woman-centered care based on each woman’s: Specific needs and concerns Circumstances History, physical examination, testing Available resources Prevention and Control of Malaria during Pregnancy 15 Focused Antenatal Care Services (cont’d.) Quality vs. quantity of ANC visits: WHO multi-center study Number of visits reduced without affecting outcome for mother or baby Recommendations Content and quality vs. number of visits Goal-oriented care Minimum of four visits Prevention and Control of Malaria during Pregnancy 16 First visit: By 16 weeks or when woman first thinks she is pregnant Second visit: At 24–28 weeks or at least once in second trimester Third visit: At 32 weeks Fourth visit: At 36 weeks Other visits: If complication occurs, followup or referral is needed, woman wants to see provider, or provider changes frequency based on findings (history, exam, testing) or local policy Scheduling and Timing of ANC Visits Prevention and Control of Malaria during Pregnancy 17 Focused Antenatal Care Services (cont’d.) Care by a skilled provider who: Has formal training and experience Has knowledge, skills, and qualifications to deliver safe, effective maternal and newborn healthcare Practices in home, hospital, health center May be a midwife, nurse, doctor, clinical officer, etc. Prevention and Control of Malaria during Pregnancy 18 Early Detection and Treatment Malaria—history and physical exam Fever and accompanying signs/symptoms Region Complicated vs. uncomplicated cases Severe anemia—physical exam, testing Pre-eclampsia/eclampsia—measurement of blood pressure HIV—voluntary counseling and testing Sexually transmitted infections, including syphilis— testing Prevention and Control of Malaria during Pregnancy 19 Prevention: Key Preventive Measures Malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Tetanus toxoid, iron/folate supplements Country/region-specific interventions as appropriate Vitamin A supplements Iodine supplements Presumptive treatment for hookworm Prevention and Control of Malaria during Pregnancy 20 Birth Preparedness and Complication Readiness: Objectives Develop birth plan—exact plan for normal birth and possible complications: Arrangements made in advance by woman and family (with help of skilled provider) Usually not a written document Reviewed/revised at every visit Minimize disorganization at time of birth or in an emergency Ensure timely and appropriate care Prevention and Control of Malaria during Pregnancy 21 Essential Elements of a Birth Plan Facility or Place of Birth: Home or health facility for birth, appropriate facility for emergencies Skilled Provider: To attend birth Provider/Facility Contact Information Transportation: Reliable, accessible, especially for odd hours Funds: Personal savings, emergency funds Decision-Making: Who will make decisions, especially in an emergency Prevention and Control of Malaria during Pregnancy 22 Essential Elements of a Birth Plan (cont’d.) Family and Community Support: Care for family in woman’s absence and birth companion during labor Blood Donor: In case of emergency Needed Items: For clean and safe birth and for newborn care Danger Signs/Signs of Advanced Labor Prevention and Control of Malaria during Pregnancy 23 Danger Signs of Pregnancy Vaginal bleeding Difficulty breathing Fever Severe abdominal pain Severe headache/blurred vision Convulsions/loss of consciousness Labor pains before 37 weeks Prevention and Control of Malaria during Pregnancy 24 Health Education: Objectives Inform and educate the woman with health messages and counseling appropriate to: Individual needs, concerns, circumstances Gestational age Most prevalent health issues Support the woman in making decisions and solving actual or anticipated problems Involve partner and family in supporting/adopting healthy practices Prevention and Control of Malaria during Pregnancy 25 Health Education: Topics Addressed Prevention of malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Other methods Other important issues to be discussed include: Nutrition Care for common discomforts Use of potentially harmful substances Hygiene Rest and activity Prevention and Control of Malaria during Pregnancy 26 Health Education: Topics Addressed (cont’d.) Sexual relations and safer sex Early and exclusive breastfeeding Prevention of tetanus and anemia Voluntary counseling and testing for HIV Prevention of other endemic diseases/deficiencies Prevention and Control of Malaria during Pregnancy 27 Interpersonal Skills Speak in a quiet, gentle tone of voice Listen to woman/family and respond appropriately Encourage them to ask questions and express concerns Allow them to demonstrate understanding of information provided Explain all procedures/actions and obtain permission before proceeding Show respect for cultural beliefs and social norms Be empathetic and nonjudgmental Avoid distractions while conducting the visit Prevention and Control of Malaria during Pregnancy 28 Record Keeping First ANC Visit History Physical examination Testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs Date of next ANC visit Subsequent ANC Visits Interim history Targeted physical examination, testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs (and relevant information on how client obtained and used ITN) Date of next ANC visit Record all information on the ANC chart and clinic card: Prevention and Control of Malaria during Pregnancy Chapter II: Malaria Transmission Prevention and Control of Malaria during Pregnancy 30 Malaria Transmission: Chapter Objectives Define malaria and how it is transmitted Describe extent of malaria in Africa Identify groups at highest risk of malaria infection List effects of malaria on pregnant women and their unborn babies Describe effects of malaria on pregnant women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 31 Malaria Transmission Caused by Plasmodium parasites Spread by female Anopheles mosquitoes infected with parasites Anopheles mosquitoes usually active at night Infected mosquito bites a person Malaria parasites reproduce in human blood Mosquito bites infected person, and goes on to bite and infect another person Prevention and Control of Malaria during Pregnancy 32 Populations Most Affected by Malaria Children under 5 years of age Pregnant women Unborn babies Immigrants from low-transmission areas HIV-infected persons Prevention and Control of Malaria during Pregnancy 33 Effects of Malaria on Pregnant Women All pregnant women in malaria-endemic areas are at risk Parasites attack and destroy red blood cells Malaria causes up to 15% of anemia in pregnancy Can cause severe anemia In Africa, anemia due to malaria causes up to 10,000 maternal deaths per year Prevention and Control of Malaria during Pregnancy 34 Effects on Unborn Babies Parasites hide in placenta Interferes with transfer of oxygen and nutrients to the baby, increasing risk of: Spontaneous abortion Preterm birth Low birthweight—single greatest risk factor for death during first month of life Stillbirth Prevention and Control of Malaria during Pregnancy 35 Effects on Communities Causes missed work and wages Results in frequent school absences Uses scarce resources Causes preventable deaths: increases maternal, newborn, and infant mortality rates Prevention and Control of Malaria during Pregnancy 36 HIV/AIDS and Malaria during Pregnancy HIV/AIDS reduces a woman’s resistance to malaria Intermittent preventive treatment (IPT) given 3 times during pregnancy is effective for women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 37 Summary of Health Education Points Malaria transmitted through mosquito bites Pregnant women and children are most at risk Pregnant women infected with malaria may have no symptoms Women with HIV/AIDS are at higher risk Malaria can lead to severe anemia, spontaneous abortion, low-birthweight babies Malaria is preventable Prevention and Control of Malaria during Pregnancy Chapter III: Preventing Malaria Prevention and Control of Malaria during Pregnancy 39 Preventing Malaria: Chapter Objectives List the elements of counseling women about the use of insecticide-treated nets (ITNs) and intermittent preventive treatment (IPT) during pregnancy Describe the use of sulfadoxine-pyrimethamine (SP) for IPT during pregnancy Prevention and Control of Malaria during Pregnancy 40 Insecticide-Treated Nets Kill or repel mosquitoes Prevent physical contact with mosquitoes Kill or repel other insects: Lice Ticks Bedbugs Cockroaches Prevention and Control of Malaria during Pregnancy 41 Insecticide-Treated Nets (cont’d.) Untreated Nets Provide some protection against malaria Do not kill or repel mosquitoes that touch net Do not reduce number of mosquitoes Do not kill other insects like lice, roaches, and bedbugs Are safe for pregnant women, young children, and infants Insecticide-Treated Nets Provide a high level of protection against malaria Kills or repels mosquitoes that touch the net Reduce number of mosquitoes in/outside net Kills other insects such as lice, roaches, and bedbugs Are safe for pregnant women, young children, and infants Prevention and Control of Malaria during Pregnancy 42 Benefits of Insecticide-Treated Nets Prevent mosquito bites Protect against malaria, resulting in less: Anemia Prematurity and low birthweight Risk of maternal and newborn death Help people sleep better Promote growth and development of fetus and newborn Prevention and Control of Malaria during Pregnancy 43 Benefits of Insecticide-Treated Nets: Community Cost less than treating malaria Reduce number of sick children and adults (helping children grow to be healthy and helping working adults remain productive) Reduce number of deaths Prevention and Control of Malaria during Pregnancy 44 Where to Find Insecticide-Treated Nets General merchandise shops Drug shops/pharmacies Markets Public and private health facilities Community health workers NGOs, community-based organizations Prevention and Control of Malaria during Pregnancy 45 How to Use Insecticide-Treated Nets Hang above bed or sleeping mat Tuck under mattress or mat Use every night, all year long Use for everyone, if possible, but give priority to pregnant women, infants, and children
Slide 46 - Prevention and Control of Malaria during Pregnancy A Workshop for Healthcare Providers Prevention and Control of Malaria during Pregnancy 2 Facts about Malaria 300 million cases each year worldwide 9 of 10 cases occur in Africa A person in Africa dies of malaria every 10 seconds Women and young children are most at risk Affects five times as many people as AIDS, leprosy, measles, and tuberculosis combined Prevention and Control of Malaria during Pregnancy 3 Facts about Malaria and Pregnancy 30 million African women are pregnant yearly Malaria is more frequent and complicated during pregnancy In malaria-endemic areas, malaria during pregnancy may account for: Up to 15% of maternal anemia 5–14% of low birthweight 30% of “preventable” low birthweight Prevention and Control of Malaria during Pregnancy 4 Roll Back Malaria Worldwide partnership Governments, private groups, research organizations, civil society, media Aim to reduce malaria by half by 2010 Free advocacy resources and tools: http://www.rbm.who.int Priority: Prevent poor outcomes caused by malaria in pregnancy Abuja declaration: Goal is for 60% of women in Africa to be sleeping under insecticide-treated nets (ITNs) and getting intermittent preventive treatment (IPT) by 2005 Prevention and Control of Malaria during Pregnancy 5 Malaria Prevention and Treatment during Pregnancy Focused antenatal care (ANC) with health education about malaria Use of insecticide-treated nets (ITNs) Intermittent preventive treatment (IPT) Case management of women with symptoms and signs of malaria Prevention and Control of Malaria during Pregnancy Chapter I: Focused Antenatal Care Prevention and Control of Malaria during Pregnancy 7 Focused Antenatal Care: Chapter Objectives Describe four main components of focused antenatal care (ANC) Discuss frequency and timing of ANC visits Describe essential elements of a birth plan that includes complication readiness Describe interpersonal skills for effective ANC Describe components of record keeping for ANC Prevention and Control of Malaria during Pregnancy 8 Focused Antenatal Care An approach to ANC that emphasizes: Evidence-based, goal-directed actions Individualized, woman-centered care Quality vs. quantity of visits Care by skilled providers Prevention and Control of Malaria during Pregnancy 9 Goal of Focused Antenatal Care To promote maternal and newborn health and survival through: Early detection and treatment of problems and complications Prevention of complications and disease Birth preparedness and complication readiness Health promotion Prevention and Control of Malaria during Pregnancy 10 Traditional Antenatal Care Emphasizes: Ritualistic, “routine” care vs. evidence-based, goal-directed actions Frequent visits Does not emphasize individual client needs Prevention and Control of Malaria during Pregnancy 11 No Longer Recommended Numerous, routine visits Burden to women and healthcare system Routine measurements and examinations: Maternal height and weight Ankle edema Fetal position before 36 weeks Care based on risk assessment Prevention and Control of Malaria during Pregnancy 12 Risk Approach Not an effective ANC strategy because: Complications cannot be predicted—all pregnant women are at risk for developing complications Risk factors are usually not direct cause of complications Many “low risk” women develop complications Have false sense of security Do not know how to recognize/respond to problems Most “high risk” women give birth without complications Inefficient use of scarce resources Prevention and Control of Malaria during Pregnancy 13 Focused Antenatal Care Services Evidence-based, goal-directed actions: Address most prevalent health issues affecting women and newborns Adjusted for specific populations/regions Appropriate to gestational age Based on firm rationale Prevention and Control of Malaria during Pregnancy 14 Focused Antenatal Care Services (cont’d.) Individualized, woman-centered care based on each woman’s: Specific needs and concerns Circumstances History, physical examination, testing Available resources Prevention and Control of Malaria during Pregnancy 15 Focused Antenatal Care Services (cont’d.) Quality vs. quantity of ANC visits: WHO multi-center study Number of visits reduced without affecting outcome for mother or baby Recommendations Content and quality vs. number of visits Goal-oriented care Minimum of four visits Prevention and Control of Malaria during Pregnancy 16 First visit: By 16 weeks or when woman first thinks she is pregnant Second visit: At 24–28 weeks or at least once in second trimester Third visit: At 32 weeks Fourth visit: At 36 weeks Other visits: If complication occurs, followup or referral is needed, woman wants to see provider, or provider changes frequency based on findings (history, exam, testing) or local policy Scheduling and Timing of ANC Visits Prevention and Control of Malaria during Pregnancy 17 Focused Antenatal Care Services (cont’d.) Care by a skilled provider who: Has formal training and experience Has knowledge, skills, and qualifications to deliver safe, effective maternal and newborn healthcare Practices in home, hospital, health center May be a midwife, nurse, doctor, clinical officer, etc. Prevention and Control of Malaria during Pregnancy 18 Early Detection and Treatment Malaria—history and physical exam Fever and accompanying signs/symptoms Region Complicated vs. uncomplicated cases Severe anemia—physical exam, testing Pre-eclampsia/eclampsia—measurement of blood pressure HIV—voluntary counseling and testing Sexually transmitted infections, including syphilis— testing Prevention and Control of Malaria during Pregnancy 19 Prevention: Key Preventive Measures Malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Tetanus toxoid, iron/folate supplements Country/region-specific interventions as appropriate Vitamin A supplements Iodine supplements Presumptive treatment for hookworm Prevention and Control of Malaria during Pregnancy 20 Birth Preparedness and Complication Readiness: Objectives Develop birth plan—exact plan for normal birth and possible complications: Arrangements made in advance by woman and family (with help of skilled provider) Usually not a written document Reviewed/revised at every visit Minimize disorganization at time of birth or in an emergency Ensure timely and appropriate care Prevention and Control of Malaria during Pregnancy 21 Essential Elements of a Birth Plan Facility or Place of Birth: Home or health facility for birth, appropriate facility for emergencies Skilled Provider: To attend birth Provider/Facility Contact Information Transportation: Reliable, accessible, especially for odd hours Funds: Personal savings, emergency funds Decision-Making: Who will make decisions, especially in an emergency Prevention and Control of Malaria during Pregnancy 22 Essential Elements of a Birth Plan (cont’d.) Family and Community Support: Care for family in woman’s absence and birth companion during labor Blood Donor: In case of emergency Needed Items: For clean and safe birth and for newborn care Danger Signs/Signs of Advanced Labor Prevention and Control of Malaria during Pregnancy 23 Danger Signs of Pregnancy Vaginal bleeding Difficulty breathing Fever Severe abdominal pain Severe headache/blurred vision Convulsions/loss of consciousness Labor pains before 37 weeks Prevention and Control of Malaria during Pregnancy 24 Health Education: Objectives Inform and educate the woman with health messages and counseling appropriate to: Individual needs, concerns, circumstances Gestational age Most prevalent health issues Support the woman in making decisions and solving actual or anticipated problems Involve partner and family in supporting/adopting healthy practices Prevention and Control of Malaria during Pregnancy 25 Health Education: Topics Addressed Prevention of malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Other methods Other important issues to be discussed include: Nutrition Care for common discomforts Use of potentially harmful substances Hygiene Rest and activity Prevention and Control of Malaria during Pregnancy 26 Health Education: Topics Addressed (cont’d.) Sexual relations and safer sex Early and exclusive breastfeeding Prevention of tetanus and anemia Voluntary counseling and testing for HIV Prevention of other endemic diseases/deficiencies Prevention and Control of Malaria during Pregnancy 27 Interpersonal Skills Speak in a quiet, gentle tone of voice Listen to woman/family and respond appropriately Encourage them to ask questions and express concerns Allow them to demonstrate understanding of information provided Explain all procedures/actions and obtain permission before proceeding Show respect for cultural beliefs and social norms Be empathetic and nonjudgmental Avoid distractions while conducting the visit Prevention and Control of Malaria during Pregnancy 28 Record Keeping First ANC Visit History Physical examination Testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs Date of next ANC visit Subsequent ANC Visits Interim history Targeted physical examination, testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs (and relevant information on how client obtained and used ITN) Date of next ANC visit Record all information on the ANC chart and clinic card: Prevention and Control of Malaria during Pregnancy Chapter II: Malaria Transmission Prevention and Control of Malaria during Pregnancy 30 Malaria Transmission: Chapter Objectives Define malaria and how it is transmitted Describe extent of malaria in Africa Identify groups at highest risk of malaria infection List effects of malaria on pregnant women and their unborn babies Describe effects of malaria on pregnant women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 31 Malaria Transmission Caused by Plasmodium parasites Spread by female Anopheles mosquitoes infected with parasites Anopheles mosquitoes usually active at night Infected mosquito bites a person Malaria parasites reproduce in human blood Mosquito bites infected person, and goes on to bite and infect another person Prevention and Control of Malaria during Pregnancy 32 Populations Most Affected by Malaria Children under 5 years of age Pregnant women Unborn babies Immigrants from low-transmission areas HIV-infected persons Prevention and Control of Malaria during Pregnancy 33 Effects of Malaria on Pregnant Women All pregnant women in malaria-endemic areas are at risk Parasites attack and destroy red blood cells Malaria causes up to 15% of anemia in pregnancy Can cause severe anemia In Africa, anemia due to malaria causes up to 10,000 maternal deaths per year Prevention and Control of Malaria during Pregnancy 34 Effects on Unborn Babies Parasites hide in placenta Interferes with transfer of oxygen and nutrients to the baby, increasing risk of: Spontaneous abortion Preterm birth Low birthweight—single greatest risk factor for death during first month of life Stillbirth Prevention and Control of Malaria during Pregnancy 35 Effects on Communities Causes missed work and wages Results in frequent school absences Uses scarce resources Causes preventable deaths: increases maternal, newborn, and infant mortality rates Prevention and Control of Malaria during Pregnancy 36 HIV/AIDS and Malaria during Pregnancy HIV/AIDS reduces a woman’s resistance to malaria Intermittent preventive treatment (IPT) given 3 times during pregnancy is effective for women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 37 Summary of Health Education Points Malaria transmitted through mosquito bites Pregnant women and children are most at risk Pregnant women infected with malaria may have no symptoms Women with HIV/AIDS are at higher risk Malaria can lead to severe anemia, spontaneous abortion, low-birthweight babies Malaria is preventable Prevention and Control of Malaria during Pregnancy Chapter III: Preventing Malaria Prevention and Control of Malaria during Pregnancy 39 Preventing Malaria: Chapter Objectives List the elements of counseling women about the use of insecticide-treated nets (ITNs) and intermittent preventive treatment (IPT) during pregnancy Describe the use of sulfadoxine-pyrimethamine (SP) for IPT during pregnancy Prevention and Control of Malaria during Pregnancy 40 Insecticide-Treated Nets Kill or repel mosquitoes Prevent physical contact with mosquitoes Kill or repel other insects: Lice Ticks Bedbugs Cockroaches Prevention and Control of Malaria during Pregnancy 41 Insecticide-Treated Nets (cont’d.) Untreated Nets Provide some protection against malaria Do not kill or repel mosquitoes that touch net Do not reduce number of mosquitoes Do not kill other insects like lice, roaches, and bedbugs Are safe for pregnant women, young children, and infants Insecticide-Treated Nets Provide a high level of protection against malaria Kills or repels mosquitoes that touch the net Reduce number of mosquitoes in/outside net Kills other insects such as lice, roaches, and bedbugs Are safe for pregnant women, young children, and infants Prevention and Control of Malaria during Pregnancy 42 Benefits of Insecticide-Treated Nets Prevent mosquito bites Protect against malaria, resulting in less: Anemia Prematurity and low birthweight Risk of maternal and newborn death Help people sleep better Promote growth and development of fetus and newborn Prevention and Control of Malaria during Pregnancy 43 Benefits of Insecticide-Treated Nets: Community Cost less than treating malaria Reduce number of sick children and adults (helping children grow to be healthy and helping working adults remain productive) Reduce number of deaths Prevention and Control of Malaria during Pregnancy 44 Where to Find Insecticide-Treated Nets General merchandise shops Drug shops/pharmacies Markets Public and private health facilities Community health workers NGOs, community-based organizations Prevention and Control of Malaria during Pregnancy 45 How to Use Insecticide-Treated Nets Hang above bed or sleeping mat Tuck under mattress or mat Use every night, all year long Use for everyone, if possible, but give priority to pregnant women, infants, and children Prevention and Control of Malaria during Pregnancy 46 Caring for Insecticide-Treated Nets Handle gently to avoid tears Tie net up during day to avoid damage Regularly inspect for holes, repair if found Nets need to be re-treated regularly to stay effective Keep away from smoke, fire, direct sunlight
Slide 47 - Prevention and Control of Malaria during Pregnancy A Workshop for Healthcare Providers Prevention and Control of Malaria during Pregnancy 2 Facts about Malaria 300 million cases each year worldwide 9 of 10 cases occur in Africa A person in Africa dies of malaria every 10 seconds Women and young children are most at risk Affects five times as many people as AIDS, leprosy, measles, and tuberculosis combined Prevention and Control of Malaria during Pregnancy 3 Facts about Malaria and Pregnancy 30 million African women are pregnant yearly Malaria is more frequent and complicated during pregnancy In malaria-endemic areas, malaria during pregnancy may account for: Up to 15% of maternal anemia 5–14% of low birthweight 30% of “preventable” low birthweight Prevention and Control of Malaria during Pregnancy 4 Roll Back Malaria Worldwide partnership Governments, private groups, research organizations, civil society, media Aim to reduce malaria by half by 2010 Free advocacy resources and tools: http://www.rbm.who.int Priority: Prevent poor outcomes caused by malaria in pregnancy Abuja declaration: Goal is for 60% of women in Africa to be sleeping under insecticide-treated nets (ITNs) and getting intermittent preventive treatment (IPT) by 2005 Prevention and Control of Malaria during Pregnancy 5 Malaria Prevention and Treatment during Pregnancy Focused antenatal care (ANC) with health education about malaria Use of insecticide-treated nets (ITNs) Intermittent preventive treatment (IPT) Case management of women with symptoms and signs of malaria Prevention and Control of Malaria during Pregnancy Chapter I: Focused Antenatal Care Prevention and Control of Malaria during Pregnancy 7 Focused Antenatal Care: Chapter Objectives Describe four main components of focused antenatal care (ANC) Discuss frequency and timing of ANC visits Describe essential elements of a birth plan that includes complication readiness Describe interpersonal skills for effective ANC Describe components of record keeping for ANC Prevention and Control of Malaria during Pregnancy 8 Focused Antenatal Care An approach to ANC that emphasizes: Evidence-based, goal-directed actions Individualized, woman-centered care Quality vs. quantity of visits Care by skilled providers Prevention and Control of Malaria during Pregnancy 9 Goal of Focused Antenatal Care To promote maternal and newborn health and survival through: Early detection and treatment of problems and complications Prevention of complications and disease Birth preparedness and complication readiness Health promotion Prevention and Control of Malaria during Pregnancy 10 Traditional Antenatal Care Emphasizes: Ritualistic, “routine” care vs. evidence-based, goal-directed actions Frequent visits Does not emphasize individual client needs Prevention and Control of Malaria during Pregnancy 11 No Longer Recommended Numerous, routine visits Burden to women and healthcare system Routine measurements and examinations: Maternal height and weight Ankle edema Fetal position before 36 weeks Care based on risk assessment Prevention and Control of Malaria during Pregnancy 12 Risk Approach Not an effective ANC strategy because: Complications cannot be predicted—all pregnant women are at risk for developing complications Risk factors are usually not direct cause of complications Many “low risk” women develop complications Have false sense of security Do not know how to recognize/respond to problems Most “high risk” women give birth without complications Inefficient use of scarce resources Prevention and Control of Malaria during Pregnancy 13 Focused Antenatal Care Services Evidence-based, goal-directed actions: Address most prevalent health issues affecting women and newborns Adjusted for specific populations/regions Appropriate to gestational age Based on firm rationale Prevention and Control of Malaria during Pregnancy 14 Focused Antenatal Care Services (cont’d.) Individualized, woman-centered care based on each woman’s: Specific needs and concerns Circumstances History, physical examination, testing Available resources Prevention and Control of Malaria during Pregnancy 15 Focused Antenatal Care Services (cont’d.) Quality vs. quantity of ANC visits: WHO multi-center study Number of visits reduced without affecting outcome for mother or baby Recommendations Content and quality vs. number of visits Goal-oriented care Minimum of four visits Prevention and Control of Malaria during Pregnancy 16 First visit: By 16 weeks or when woman first thinks she is pregnant Second visit: At 24–28 weeks or at least once in second trimester Third visit: At 32 weeks Fourth visit: At 36 weeks Other visits: If complication occurs, followup or referral is needed, woman wants to see provider, or provider changes frequency based on findings (history, exam, testing) or local policy Scheduling and Timing of ANC Visits Prevention and Control of Malaria during Pregnancy 17 Focused Antenatal Care Services (cont’d.) Care by a skilled provider who: Has formal training and experience Has knowledge, skills, and qualifications to deliver safe, effective maternal and newborn healthcare Practices in home, hospital, health center May be a midwife, nurse, doctor, clinical officer, etc. Prevention and Control of Malaria during Pregnancy 18 Early Detection and Treatment Malaria—history and physical exam Fever and accompanying signs/symptoms Region Complicated vs. uncomplicated cases Severe anemia—physical exam, testing Pre-eclampsia/eclampsia—measurement of blood pressure HIV—voluntary counseling and testing Sexually transmitted infections, including syphilis— testing Prevention and Control of Malaria during Pregnancy 19 Prevention: Key Preventive Measures Malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Tetanus toxoid, iron/folate supplements Country/region-specific interventions as appropriate Vitamin A supplements Iodine supplements Presumptive treatment for hookworm Prevention and Control of Malaria during Pregnancy 20 Birth Preparedness and Complication Readiness: Objectives Develop birth plan—exact plan for normal birth and possible complications: Arrangements made in advance by woman and family (with help of skilled provider) Usually not a written document Reviewed/revised at every visit Minimize disorganization at time of birth or in an emergency Ensure timely and appropriate care Prevention and Control of Malaria during Pregnancy 21 Essential Elements of a Birth Plan Facility or Place of Birth: Home or health facility for birth, appropriate facility for emergencies Skilled Provider: To attend birth Provider/Facility Contact Information Transportation: Reliable, accessible, especially for odd hours Funds: Personal savings, emergency funds Decision-Making: Who will make decisions, especially in an emergency Prevention and Control of Malaria during Pregnancy 22 Essential Elements of a Birth Plan (cont’d.) Family and Community Support: Care for family in woman’s absence and birth companion during labor Blood Donor: In case of emergency Needed Items: For clean and safe birth and for newborn care Danger Signs/Signs of Advanced Labor Prevention and Control of Malaria during Pregnancy 23 Danger Signs of Pregnancy Vaginal bleeding Difficulty breathing Fever Severe abdominal pain Severe headache/blurred vision Convulsions/loss of consciousness Labor pains before 37 weeks Prevention and Control of Malaria during Pregnancy 24 Health Education: Objectives Inform and educate the woman with health messages and counseling appropriate to: Individual needs, concerns, circumstances Gestational age Most prevalent health issues Support the woman in making decisions and solving actual or anticipated problems Involve partner and family in supporting/adopting healthy practices Prevention and Control of Malaria during Pregnancy 25 Health Education: Topics Addressed Prevention of malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Other methods Other important issues to be discussed include: Nutrition Care for common discomforts Use of potentially harmful substances Hygiene Rest and activity Prevention and Control of Malaria during Pregnancy 26 Health Education: Topics Addressed (cont’d.) Sexual relations and safer sex Early and exclusive breastfeeding Prevention of tetanus and anemia Voluntary counseling and testing for HIV Prevention of other endemic diseases/deficiencies Prevention and Control of Malaria during Pregnancy 27 Interpersonal Skills Speak in a quiet, gentle tone of voice Listen to woman/family and respond appropriately Encourage them to ask questions and express concerns Allow them to demonstrate understanding of information provided Explain all procedures/actions and obtain permission before proceeding Show respect for cultural beliefs and social norms Be empathetic and nonjudgmental Avoid distractions while conducting the visit Prevention and Control of Malaria during Pregnancy 28 Record Keeping First ANC Visit History Physical examination Testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs Date of next ANC visit Subsequent ANC Visits Interim history Targeted physical examination, testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs (and relevant information on how client obtained and used ITN) Date of next ANC visit Record all information on the ANC chart and clinic card: Prevention and Control of Malaria during Pregnancy Chapter II: Malaria Transmission Prevention and Control of Malaria during Pregnancy 30 Malaria Transmission: Chapter Objectives Define malaria and how it is transmitted Describe extent of malaria in Africa Identify groups at highest risk of malaria infection List effects of malaria on pregnant women and their unborn babies Describe effects of malaria on pregnant women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 31 Malaria Transmission Caused by Plasmodium parasites Spread by female Anopheles mosquitoes infected with parasites Anopheles mosquitoes usually active at night Infected mosquito bites a person Malaria parasites reproduce in human blood Mosquito bites infected person, and goes on to bite and infect another person Prevention and Control of Malaria during Pregnancy 32 Populations Most Affected by Malaria Children under 5 years of age Pregnant women Unborn babies Immigrants from low-transmission areas HIV-infected persons Prevention and Control of Malaria during Pregnancy 33 Effects of Malaria on Pregnant Women All pregnant women in malaria-endemic areas are at risk Parasites attack and destroy red blood cells Malaria causes up to 15% of anemia in pregnancy Can cause severe anemia In Africa, anemia due to malaria causes up to 10,000 maternal deaths per year Prevention and Control of Malaria during Pregnancy 34 Effects on Unborn Babies Parasites hide in placenta Interferes with transfer of oxygen and nutrients to the baby, increasing risk of: Spontaneous abortion Preterm birth Low birthweight—single greatest risk factor for death during first month of life Stillbirth Prevention and Control of Malaria during Pregnancy 35 Effects on Communities Causes missed work and wages Results in frequent school absences Uses scarce resources Causes preventable deaths: increases maternal, newborn, and infant mortality rates Prevention and Control of Malaria during Pregnancy 36 HIV/AIDS and Malaria during Pregnancy HIV/AIDS reduces a woman’s resistance to malaria Intermittent preventive treatment (IPT) given 3 times during pregnancy is effective for women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 37 Summary of Health Education Points Malaria transmitted through mosquito bites Pregnant women and children are most at risk Pregnant women infected with malaria may have no symptoms Women with HIV/AIDS are at higher risk Malaria can lead to severe anemia, spontaneous abortion, low-birthweight babies Malaria is preventable Prevention and Control of Malaria during Pregnancy Chapter III: Preventing Malaria Prevention and Control of Malaria during Pregnancy 39 Preventing Malaria: Chapter Objectives List the elements of counseling women about the use of insecticide-treated nets (ITNs) and intermittent preventive treatment (IPT) during pregnancy Describe the use of sulfadoxine-pyrimethamine (SP) for IPT during pregnancy Prevention and Control of Malaria during Pregnancy 40 Insecticide-Treated Nets Kill or repel mosquitoes Prevent physical contact with mosquitoes Kill or repel other insects: Lice Ticks Bedbugs Cockroaches Prevention and Control of Malaria during Pregnancy 41 Insecticide-Treated Nets (cont’d.) Untreated Nets Provide some protection against malaria Do not kill or repel mosquitoes that touch net Do not reduce number of mosquitoes Do not kill other insects like lice, roaches, and bedbugs Are safe for pregnant women, young children, and infants Insecticide-Treated Nets Provide a high level of protection against malaria Kills or repels mosquitoes that touch the net Reduce number of mosquitoes in/outside net Kills other insects such as lice, roaches, and bedbugs Are safe for pregnant women, young children, and infants Prevention and Control of Malaria during Pregnancy 42 Benefits of Insecticide-Treated Nets Prevent mosquito bites Protect against malaria, resulting in less: Anemia Prematurity and low birthweight Risk of maternal and newborn death Help people sleep better Promote growth and development of fetus and newborn Prevention and Control of Malaria during Pregnancy 43 Benefits of Insecticide-Treated Nets: Community Cost less than treating malaria Reduce number of sick children and adults (helping children grow to be healthy and helping working adults remain productive) Reduce number of deaths Prevention and Control of Malaria during Pregnancy 44 Where to Find Insecticide-Treated Nets General merchandise shops Drug shops/pharmacies Markets Public and private health facilities Community health workers NGOs, community-based organizations Prevention and Control of Malaria during Pregnancy 45 How to Use Insecticide-Treated Nets Hang above bed or sleeping mat Tuck under mattress or mat Use every night, all year long Use for everyone, if possible, but give priority to pregnant women, infants, and children Prevention and Control of Malaria during Pregnancy 46 Caring for Insecticide-Treated Nets Handle gently to avoid tears Tie net up during day to avoid damage Regularly inspect for holes, repair if found Nets need to be re-treated regularly to stay effective Keep away from smoke, fire, direct sunlight Prevention and Control of Malaria during Pregnancy 47 Intermittent Preventive Treatment Based on the assumption that every pregnant woman living in an area of high malaria transmission has malaria parasites in her blood or placenta, whether or not she has symptoms of malaria
Slide 48 - Prevention and Control of Malaria during Pregnancy A Workshop for Healthcare Providers Prevention and Control of Malaria during Pregnancy 2 Facts about Malaria 300 million cases each year worldwide 9 of 10 cases occur in Africa A person in Africa dies of malaria every 10 seconds Women and young children are most at risk Affects five times as many people as AIDS, leprosy, measles, and tuberculosis combined Prevention and Control of Malaria during Pregnancy 3 Facts about Malaria and Pregnancy 30 million African women are pregnant yearly Malaria is more frequent and complicated during pregnancy In malaria-endemic areas, malaria during pregnancy may account for: Up to 15% of maternal anemia 5–14% of low birthweight 30% of “preventable” low birthweight Prevention and Control of Malaria during Pregnancy 4 Roll Back Malaria Worldwide partnership Governments, private groups, research organizations, civil society, media Aim to reduce malaria by half by 2010 Free advocacy resources and tools: http://www.rbm.who.int Priority: Prevent poor outcomes caused by malaria in pregnancy Abuja declaration: Goal is for 60% of women in Africa to be sleeping under insecticide-treated nets (ITNs) and getting intermittent preventive treatment (IPT) by 2005 Prevention and Control of Malaria during Pregnancy 5 Malaria Prevention and Treatment during Pregnancy Focused antenatal care (ANC) with health education about malaria Use of insecticide-treated nets (ITNs) Intermittent preventive treatment (IPT) Case management of women with symptoms and signs of malaria Prevention and Control of Malaria during Pregnancy Chapter I: Focused Antenatal Care Prevention and Control of Malaria during Pregnancy 7 Focused Antenatal Care: Chapter Objectives Describe four main components of focused antenatal care (ANC) Discuss frequency and timing of ANC visits Describe essential elements of a birth plan that includes complication readiness Describe interpersonal skills for effective ANC Describe components of record keeping for ANC Prevention and Control of Malaria during Pregnancy 8 Focused Antenatal Care An approach to ANC that emphasizes: Evidence-based, goal-directed actions Individualized, woman-centered care Quality vs. quantity of visits Care by skilled providers Prevention and Control of Malaria during Pregnancy 9 Goal of Focused Antenatal Care To promote maternal and newborn health and survival through: Early detection and treatment of problems and complications Prevention of complications and disease Birth preparedness and complication readiness Health promotion Prevention and Control of Malaria during Pregnancy 10 Traditional Antenatal Care Emphasizes: Ritualistic, “routine” care vs. evidence-based, goal-directed actions Frequent visits Does not emphasize individual client needs Prevention and Control of Malaria during Pregnancy 11 No Longer Recommended Numerous, routine visits Burden to women and healthcare system Routine measurements and examinations: Maternal height and weight Ankle edema Fetal position before 36 weeks Care based on risk assessment Prevention and Control of Malaria during Pregnancy 12 Risk Approach Not an effective ANC strategy because: Complications cannot be predicted—all pregnant women are at risk for developing complications Risk factors are usually not direct cause of complications Many “low risk” women develop complications Have false sense of security Do not know how to recognize/respond to problems Most “high risk” women give birth without complications Inefficient use of scarce resources Prevention and Control of Malaria during Pregnancy 13 Focused Antenatal Care Services Evidence-based, goal-directed actions: Address most prevalent health issues affecting women and newborns Adjusted for specific populations/regions Appropriate to gestational age Based on firm rationale Prevention and Control of Malaria during Pregnancy 14 Focused Antenatal Care Services (cont’d.) Individualized, woman-centered care based on each woman’s: Specific needs and concerns Circumstances History, physical examination, testing Available resources Prevention and Control of Malaria during Pregnancy 15 Focused Antenatal Care Services (cont’d.) Quality vs. quantity of ANC visits: WHO multi-center study Number of visits reduced without affecting outcome for mother or baby Recommendations Content and quality vs. number of visits Goal-oriented care Minimum of four visits Prevention and Control of Malaria during Pregnancy 16 First visit: By 16 weeks or when woman first thinks she is pregnant Second visit: At 24–28 weeks or at least once in second trimester Third visit: At 32 weeks Fourth visit: At 36 weeks Other visits: If complication occurs, followup or referral is needed, woman wants to see provider, or provider changes frequency based on findings (history, exam, testing) or local policy Scheduling and Timing of ANC Visits Prevention and Control of Malaria during Pregnancy 17 Focused Antenatal Care Services (cont’d.) Care by a skilled provider who: Has formal training and experience Has knowledge, skills, and qualifications to deliver safe, effective maternal and newborn healthcare Practices in home, hospital, health center May be a midwife, nurse, doctor, clinical officer, etc. Prevention and Control of Malaria during Pregnancy 18 Early Detection and Treatment Malaria—history and physical exam Fever and accompanying signs/symptoms Region Complicated vs. uncomplicated cases Severe anemia—physical exam, testing Pre-eclampsia/eclampsia—measurement of blood pressure HIV—voluntary counseling and testing Sexually transmitted infections, including syphilis— testing Prevention and Control of Malaria during Pregnancy 19 Prevention: Key Preventive Measures Malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Tetanus toxoid, iron/folate supplements Country/region-specific interventions as appropriate Vitamin A supplements Iodine supplements Presumptive treatment for hookworm Prevention and Control of Malaria during Pregnancy 20 Birth Preparedness and Complication Readiness: Objectives Develop birth plan—exact plan for normal birth and possible complications: Arrangements made in advance by woman and family (with help of skilled provider) Usually not a written document Reviewed/revised at every visit Minimize disorganization at time of birth or in an emergency Ensure timely and appropriate care Prevention and Control of Malaria during Pregnancy 21 Essential Elements of a Birth Plan Facility or Place of Birth: Home or health facility for birth, appropriate facility for emergencies Skilled Provider: To attend birth Provider/Facility Contact Information Transportation: Reliable, accessible, especially for odd hours Funds: Personal savings, emergency funds Decision-Making: Who will make decisions, especially in an emergency Prevention and Control of Malaria during Pregnancy 22 Essential Elements of a Birth Plan (cont’d.) Family and Community Support: Care for family in woman’s absence and birth companion during labor Blood Donor: In case of emergency Needed Items: For clean and safe birth and for newborn care Danger Signs/Signs of Advanced Labor Prevention and Control of Malaria during Pregnancy 23 Danger Signs of Pregnancy Vaginal bleeding Difficulty breathing Fever Severe abdominal pain Severe headache/blurred vision Convulsions/loss of consciousness Labor pains before 37 weeks Prevention and Control of Malaria during Pregnancy 24 Health Education: Objectives Inform and educate the woman with health messages and counseling appropriate to: Individual needs, concerns, circumstances Gestational age Most prevalent health issues Support the woman in making decisions and solving actual or anticipated problems Involve partner and family in supporting/adopting healthy practices Prevention and Control of Malaria during Pregnancy 25 Health Education: Topics Addressed Prevention of malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Other methods Other important issues to be discussed include: Nutrition Care for common discomforts Use of potentially harmful substances Hygiene Rest and activity Prevention and Control of Malaria during Pregnancy 26 Health Education: Topics Addressed (cont’d.) Sexual relations and safer sex Early and exclusive breastfeeding Prevention of tetanus and anemia Voluntary counseling and testing for HIV Prevention of other endemic diseases/deficiencies Prevention and Control of Malaria during Pregnancy 27 Interpersonal Skills Speak in a quiet, gentle tone of voice Listen to woman/family and respond appropriately Encourage them to ask questions and express concerns Allow them to demonstrate understanding of information provided Explain all procedures/actions and obtain permission before proceeding Show respect for cultural beliefs and social norms Be empathetic and nonjudgmental Avoid distractions while conducting the visit Prevention and Control of Malaria during Pregnancy 28 Record Keeping First ANC Visit History Physical examination Testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs Date of next ANC visit Subsequent ANC Visits Interim history Targeted physical examination, testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs (and relevant information on how client obtained and used ITN) Date of next ANC visit Record all information on the ANC chart and clinic card: Prevention and Control of Malaria during Pregnancy Chapter II: Malaria Transmission Prevention and Control of Malaria during Pregnancy 30 Malaria Transmission: Chapter Objectives Define malaria and how it is transmitted Describe extent of malaria in Africa Identify groups at highest risk of malaria infection List effects of malaria on pregnant women and their unborn babies Describe effects of malaria on pregnant women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 31 Malaria Transmission Caused by Plasmodium parasites Spread by female Anopheles mosquitoes infected with parasites Anopheles mosquitoes usually active at night Infected mosquito bites a person Malaria parasites reproduce in human blood Mosquito bites infected person, and goes on to bite and infect another person Prevention and Control of Malaria during Pregnancy 32 Populations Most Affected by Malaria Children under 5 years of age Pregnant women Unborn babies Immigrants from low-transmission areas HIV-infected persons Prevention and Control of Malaria during Pregnancy 33 Effects of Malaria on Pregnant Women All pregnant women in malaria-endemic areas are at risk Parasites attack and destroy red blood cells Malaria causes up to 15% of anemia in pregnancy Can cause severe anemia In Africa, anemia due to malaria causes up to 10,000 maternal deaths per year Prevention and Control of Malaria during Pregnancy 34 Effects on Unborn Babies Parasites hide in placenta Interferes with transfer of oxygen and nutrients to the baby, increasing risk of: Spontaneous abortion Preterm birth Low birthweight—single greatest risk factor for death during first month of life Stillbirth Prevention and Control of Malaria during Pregnancy 35 Effects on Communities Causes missed work and wages Results in frequent school absences Uses scarce resources Causes preventable deaths: increases maternal, newborn, and infant mortality rates Prevention and Control of Malaria during Pregnancy 36 HIV/AIDS and Malaria during Pregnancy HIV/AIDS reduces a woman’s resistance to malaria Intermittent preventive treatment (IPT) given 3 times during pregnancy is effective for women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 37 Summary of Health Education Points Malaria transmitted through mosquito bites Pregnant women and children are most at risk Pregnant women infected with malaria may have no symptoms Women with HIV/AIDS are at higher risk Malaria can lead to severe anemia, spontaneous abortion, low-birthweight babies Malaria is preventable Prevention and Control of Malaria during Pregnancy Chapter III: Preventing Malaria Prevention and Control of Malaria during Pregnancy 39 Preventing Malaria: Chapter Objectives List the elements of counseling women about the use of insecticide-treated nets (ITNs) and intermittent preventive treatment (IPT) during pregnancy Describe the use of sulfadoxine-pyrimethamine (SP) for IPT during pregnancy Prevention and Control of Malaria during Pregnancy 40 Insecticide-Treated Nets Kill or repel mosquitoes Prevent physical contact with mosquitoes Kill or repel other insects: Lice Ticks Bedbugs Cockroaches Prevention and Control of Malaria during Pregnancy 41 Insecticide-Treated Nets (cont’d.) Untreated Nets Provide some protection against malaria Do not kill or repel mosquitoes that touch net Do not reduce number of mosquitoes Do not kill other insects like lice, roaches, and bedbugs Are safe for pregnant women, young children, and infants Insecticide-Treated Nets Provide a high level of protection against malaria Kills or repels mosquitoes that touch the net Reduce number of mosquitoes in/outside net Kills other insects such as lice, roaches, and bedbugs Are safe for pregnant women, young children, and infants Prevention and Control of Malaria during Pregnancy 42 Benefits of Insecticide-Treated Nets Prevent mosquito bites Protect against malaria, resulting in less: Anemia Prematurity and low birthweight Risk of maternal and newborn death Help people sleep better Promote growth and development of fetus and newborn Prevention and Control of Malaria during Pregnancy 43 Benefits of Insecticide-Treated Nets: Community Cost less than treating malaria Reduce number of sick children and adults (helping children grow to be healthy and helping working adults remain productive) Reduce number of deaths Prevention and Control of Malaria during Pregnancy 44 Where to Find Insecticide-Treated Nets General merchandise shops Drug shops/pharmacies Markets Public and private health facilities Community health workers NGOs, community-based organizations Prevention and Control of Malaria during Pregnancy 45 How to Use Insecticide-Treated Nets Hang above bed or sleeping mat Tuck under mattress or mat Use every night, all year long Use for everyone, if possible, but give priority to pregnant women, infants, and children Prevention and Control of Malaria during Pregnancy 46 Caring for Insecticide-Treated Nets Handle gently to avoid tears Tie net up during day to avoid damage Regularly inspect for holes, repair if found Nets need to be re-treated regularly to stay effective Keep away from smoke, fire, direct sunlight Prevention and Control of Malaria during Pregnancy 47 Intermittent Preventive Treatment Based on the assumption that every pregnant woman living in an area of high malaria transmission has malaria parasites in her blood or placenta, whether or not she has symptoms of malaria Prevention and Control of Malaria during Pregnancy 48 Intermittent Preventive Treatment Although a pregnant woman with malaria may have no symptoms, malaria can still affect her and her unborn child
Slide 49 - Prevention and Control of Malaria during Pregnancy A Workshop for Healthcare Providers Prevention and Control of Malaria during Pregnancy 2 Facts about Malaria 300 million cases each year worldwide 9 of 10 cases occur in Africa A person in Africa dies of malaria every 10 seconds Women and young children are most at risk Affects five times as many people as AIDS, leprosy, measles, and tuberculosis combined Prevention and Control of Malaria during Pregnancy 3 Facts about Malaria and Pregnancy 30 million African women are pregnant yearly Malaria is more frequent and complicated during pregnancy In malaria-endemic areas, malaria during pregnancy may account for: Up to 15% of maternal anemia 5–14% of low birthweight 30% of “preventable” low birthweight Prevention and Control of Malaria during Pregnancy 4 Roll Back Malaria Worldwide partnership Governments, private groups, research organizations, civil society, media Aim to reduce malaria by half by 2010 Free advocacy resources and tools: http://www.rbm.who.int Priority: Prevent poor outcomes caused by malaria in pregnancy Abuja declaration: Goal is for 60% of women in Africa to be sleeping under insecticide-treated nets (ITNs) and getting intermittent preventive treatment (IPT) by 2005 Prevention and Control of Malaria during Pregnancy 5 Malaria Prevention and Treatment during Pregnancy Focused antenatal care (ANC) with health education about malaria Use of insecticide-treated nets (ITNs) Intermittent preventive treatment (IPT) Case management of women with symptoms and signs of malaria Prevention and Control of Malaria during Pregnancy Chapter I: Focused Antenatal Care Prevention and Control of Malaria during Pregnancy 7 Focused Antenatal Care: Chapter Objectives Describe four main components of focused antenatal care (ANC) Discuss frequency and timing of ANC visits Describe essential elements of a birth plan that includes complication readiness Describe interpersonal skills for effective ANC Describe components of record keeping for ANC Prevention and Control of Malaria during Pregnancy 8 Focused Antenatal Care An approach to ANC that emphasizes: Evidence-based, goal-directed actions Individualized, woman-centered care Quality vs. quantity of visits Care by skilled providers Prevention and Control of Malaria during Pregnancy 9 Goal of Focused Antenatal Care To promote maternal and newborn health and survival through: Early detection and treatment of problems and complications Prevention of complications and disease Birth preparedness and complication readiness Health promotion Prevention and Control of Malaria during Pregnancy 10 Traditional Antenatal Care Emphasizes: Ritualistic, “routine” care vs. evidence-based, goal-directed actions Frequent visits Does not emphasize individual client needs Prevention and Control of Malaria during Pregnancy 11 No Longer Recommended Numerous, routine visits Burden to women and healthcare system Routine measurements and examinations: Maternal height and weight Ankle edema Fetal position before 36 weeks Care based on risk assessment Prevention and Control of Malaria during Pregnancy 12 Risk Approach Not an effective ANC strategy because: Complications cannot be predicted—all pregnant women are at risk for developing complications Risk factors are usually not direct cause of complications Many “low risk” women develop complications Have false sense of security Do not know how to recognize/respond to problems Most “high risk” women give birth without complications Inefficient use of scarce resources Prevention and Control of Malaria during Pregnancy 13 Focused Antenatal Care Services Evidence-based, goal-directed actions: Address most prevalent health issues affecting women and newborns Adjusted for specific populations/regions Appropriate to gestational age Based on firm rationale Prevention and Control of Malaria during Pregnancy 14 Focused Antenatal Care Services (cont’d.) Individualized, woman-centered care based on each woman’s: Specific needs and concerns Circumstances History, physical examination, testing Available resources Prevention and Control of Malaria during Pregnancy 15 Focused Antenatal Care Services (cont’d.) Quality vs. quantity of ANC visits: WHO multi-center study Number of visits reduced without affecting outcome for mother or baby Recommendations Content and quality vs. number of visits Goal-oriented care Minimum of four visits Prevention and Control of Malaria during Pregnancy 16 First visit: By 16 weeks or when woman first thinks she is pregnant Second visit: At 24–28 weeks or at least once in second trimester Third visit: At 32 weeks Fourth visit: At 36 weeks Other visits: If complication occurs, followup or referral is needed, woman wants to see provider, or provider changes frequency based on findings (history, exam, testing) or local policy Scheduling and Timing of ANC Visits Prevention and Control of Malaria during Pregnancy 17 Focused Antenatal Care Services (cont’d.) Care by a skilled provider who: Has formal training and experience Has knowledge, skills, and qualifications to deliver safe, effective maternal and newborn healthcare Practices in home, hospital, health center May be a midwife, nurse, doctor, clinical officer, etc. Prevention and Control of Malaria during Pregnancy 18 Early Detection and Treatment Malaria—history and physical exam Fever and accompanying signs/symptoms Region Complicated vs. uncomplicated cases Severe anemia—physical exam, testing Pre-eclampsia/eclampsia—measurement of blood pressure HIV—voluntary counseling and testing Sexually transmitted infections, including syphilis— testing Prevention and Control of Malaria during Pregnancy 19 Prevention: Key Preventive Measures Malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Tetanus toxoid, iron/folate supplements Country/region-specific interventions as appropriate Vitamin A supplements Iodine supplements Presumptive treatment for hookworm Prevention and Control of Malaria during Pregnancy 20 Birth Preparedness and Complication Readiness: Objectives Develop birth plan—exact plan for normal birth and possible complications: Arrangements made in advance by woman and family (with help of skilled provider) Usually not a written document Reviewed/revised at every visit Minimize disorganization at time of birth or in an emergency Ensure timely and appropriate care Prevention and Control of Malaria during Pregnancy 21 Essential Elements of a Birth Plan Facility or Place of Birth: Home or health facility for birth, appropriate facility for emergencies Skilled Provider: To attend birth Provider/Facility Contact Information Transportation: Reliable, accessible, especially for odd hours Funds: Personal savings, emergency funds Decision-Making: Who will make decisions, especially in an emergency Prevention and Control of Malaria during Pregnancy 22 Essential Elements of a Birth Plan (cont’d.) Family and Community Support: Care for family in woman’s absence and birth companion during labor Blood Donor: In case of emergency Needed Items: For clean and safe birth and for newborn care Danger Signs/Signs of Advanced Labor Prevention and Control of Malaria during Pregnancy 23 Danger Signs of Pregnancy Vaginal bleeding Difficulty breathing Fever Severe abdominal pain Severe headache/blurred vision Convulsions/loss of consciousness Labor pains before 37 weeks Prevention and Control of Malaria during Pregnancy 24 Health Education: Objectives Inform and educate the woman with health messages and counseling appropriate to: Individual needs, concerns, circumstances Gestational age Most prevalent health issues Support the woman in making decisions and solving actual or anticipated problems Involve partner and family in supporting/adopting healthy practices Prevention and Control of Malaria during Pregnancy 25 Health Education: Topics Addressed Prevention of malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Other methods Other important issues to be discussed include: Nutrition Care for common discomforts Use of potentially harmful substances Hygiene Rest and activity Prevention and Control of Malaria during Pregnancy 26 Health Education: Topics Addressed (cont’d.) Sexual relations and safer sex Early and exclusive breastfeeding Prevention of tetanus and anemia Voluntary counseling and testing for HIV Prevention of other endemic diseases/deficiencies Prevention and Control of Malaria during Pregnancy 27 Interpersonal Skills Speak in a quiet, gentle tone of voice Listen to woman/family and respond appropriately Encourage them to ask questions and express concerns Allow them to demonstrate understanding of information provided Explain all procedures/actions and obtain permission before proceeding Show respect for cultural beliefs and social norms Be empathetic and nonjudgmental Avoid distractions while conducting the visit Prevention and Control of Malaria during Pregnancy 28 Record Keeping First ANC Visit History Physical examination Testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs Date of next ANC visit Subsequent ANC Visits Interim history Targeted physical examination, testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs (and relevant information on how client obtained and used ITN) Date of next ANC visit Record all information on the ANC chart and clinic card: Prevention and Control of Malaria during Pregnancy Chapter II: Malaria Transmission Prevention and Control of Malaria during Pregnancy 30 Malaria Transmission: Chapter Objectives Define malaria and how it is transmitted Describe extent of malaria in Africa Identify groups at highest risk of malaria infection List effects of malaria on pregnant women and their unborn babies Describe effects of malaria on pregnant women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 31 Malaria Transmission Caused by Plasmodium parasites Spread by female Anopheles mosquitoes infected with parasites Anopheles mosquitoes usually active at night Infected mosquito bites a person Malaria parasites reproduce in human blood Mosquito bites infected person, and goes on to bite and infect another person Prevention and Control of Malaria during Pregnancy 32 Populations Most Affected by Malaria Children under 5 years of age Pregnant women Unborn babies Immigrants from low-transmission areas HIV-infected persons Prevention and Control of Malaria during Pregnancy 33 Effects of Malaria on Pregnant Women All pregnant women in malaria-endemic areas are at risk Parasites attack and destroy red blood cells Malaria causes up to 15% of anemia in pregnancy Can cause severe anemia In Africa, anemia due to malaria causes up to 10,000 maternal deaths per year Prevention and Control of Malaria during Pregnancy 34 Effects on Unborn Babies Parasites hide in placenta Interferes with transfer of oxygen and nutrients to the baby, increasing risk of: Spontaneous abortion Preterm birth Low birthweight—single greatest risk factor for death during first month of life Stillbirth Prevention and Control of Malaria during Pregnancy 35 Effects on Communities Causes missed work and wages Results in frequent school absences Uses scarce resources Causes preventable deaths: increases maternal, newborn, and infant mortality rates Prevention and Control of Malaria during Pregnancy 36 HIV/AIDS and Malaria during Pregnancy HIV/AIDS reduces a woman’s resistance to malaria Intermittent preventive treatment (IPT) given 3 times during pregnancy is effective for women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 37 Summary of Health Education Points Malaria transmitted through mosquito bites Pregnant women and children are most at risk Pregnant women infected with malaria may have no symptoms Women with HIV/AIDS are at higher risk Malaria can lead to severe anemia, spontaneous abortion, low-birthweight babies Malaria is preventable Prevention and Control of Malaria during Pregnancy Chapter III: Preventing Malaria Prevention and Control of Malaria during Pregnancy 39 Preventing Malaria: Chapter Objectives List the elements of counseling women about the use of insecticide-treated nets (ITNs) and intermittent preventive treatment (IPT) during pregnancy Describe the use of sulfadoxine-pyrimethamine (SP) for IPT during pregnancy Prevention and Control of Malaria during Pregnancy 40 Insecticide-Treated Nets Kill or repel mosquitoes Prevent physical contact with mosquitoes Kill or repel other insects: Lice Ticks Bedbugs Cockroaches Prevention and Control of Malaria during Pregnancy 41 Insecticide-Treated Nets (cont’d.) Untreated Nets Provide some protection against malaria Do not kill or repel mosquitoes that touch net Do not reduce number of mosquitoes Do not kill other insects like lice, roaches, and bedbugs Are safe for pregnant women, young children, and infants Insecticide-Treated Nets Provide a high level of protection against malaria Kills or repels mosquitoes that touch the net Reduce number of mosquitoes in/outside net Kills other insects such as lice, roaches, and bedbugs Are safe for pregnant women, young children, and infants Prevention and Control of Malaria during Pregnancy 42 Benefits of Insecticide-Treated Nets Prevent mosquito bites Protect against malaria, resulting in less: Anemia Prematurity and low birthweight Risk of maternal and newborn death Help people sleep better Promote growth and development of fetus and newborn Prevention and Control of Malaria during Pregnancy 43 Benefits of Insecticide-Treated Nets: Community Cost less than treating malaria Reduce number of sick children and adults (helping children grow to be healthy and helping working adults remain productive) Reduce number of deaths Prevention and Control of Malaria during Pregnancy 44 Where to Find Insecticide-Treated Nets General merchandise shops Drug shops/pharmacies Markets Public and private health facilities Community health workers NGOs, community-based organizations Prevention and Control of Malaria during Pregnancy 45 How to Use Insecticide-Treated Nets Hang above bed or sleeping mat Tuck under mattress or mat Use every night, all year long Use for everyone, if possible, but give priority to pregnant women, infants, and children Prevention and Control of Malaria during Pregnancy 46 Caring for Insecticide-Treated Nets Handle gently to avoid tears Tie net up during day to avoid damage Regularly inspect for holes, repair if found Nets need to be re-treated regularly to stay effective Keep away from smoke, fire, direct sunlight Prevention and Control of Malaria during Pregnancy 47 Intermittent Preventive Treatment Based on the assumption that every pregnant woman living in an area of high malaria transmission has malaria parasites in her blood or placenta, whether or not she has symptoms of malaria Prevention and Control of Malaria during Pregnancy 48 Intermittent Preventive Treatment Although a pregnant woman with malaria may have no symptoms, malaria can still affect her and her unborn child Prevention and Control of Malaria during Pregnancy 49 Intermittent Preventive Treatment: WHO Recommendation All pregnant women should receive at least two doses of IPT after quickening, during routinely scheduled ANC visits (WHO recommends a schedule of four visits, three after quickening) Presently, the most effective drug for IPT is sulfadoxine-pyrimethamine (SP) Women should receive at least two doses of IPT with SP at ANC visits after quickening, but no more frequently than monthly
Slide 50 - Prevention and Control of Malaria during Pregnancy A Workshop for Healthcare Providers Prevention and Control of Malaria during Pregnancy 2 Facts about Malaria 300 million cases each year worldwide 9 of 10 cases occur in Africa A person in Africa dies of malaria every 10 seconds Women and young children are most at risk Affects five times as many people as AIDS, leprosy, measles, and tuberculosis combined Prevention and Control of Malaria during Pregnancy 3 Facts about Malaria and Pregnancy 30 million African women are pregnant yearly Malaria is more frequent and complicated during pregnancy In malaria-endemic areas, malaria during pregnancy may account for: Up to 15% of maternal anemia 5–14% of low birthweight 30% of “preventable” low birthweight Prevention and Control of Malaria during Pregnancy 4 Roll Back Malaria Worldwide partnership Governments, private groups, research organizations, civil society, media Aim to reduce malaria by half by 2010 Free advocacy resources and tools: http://www.rbm.who.int Priority: Prevent poor outcomes caused by malaria in pregnancy Abuja declaration: Goal is for 60% of women in Africa to be sleeping under insecticide-treated nets (ITNs) and getting intermittent preventive treatment (IPT) by 2005 Prevention and Control of Malaria during Pregnancy 5 Malaria Prevention and Treatment during Pregnancy Focused antenatal care (ANC) with health education about malaria Use of insecticide-treated nets (ITNs) Intermittent preventive treatment (IPT) Case management of women with symptoms and signs of malaria Prevention and Control of Malaria during Pregnancy Chapter I: Focused Antenatal Care Prevention and Control of Malaria during Pregnancy 7 Focused Antenatal Care: Chapter Objectives Describe four main components of focused antenatal care (ANC) Discuss frequency and timing of ANC visits Describe essential elements of a birth plan that includes complication readiness Describe interpersonal skills for effective ANC Describe components of record keeping for ANC Prevention and Control of Malaria during Pregnancy 8 Focused Antenatal Care An approach to ANC that emphasizes: Evidence-based, goal-directed actions Individualized, woman-centered care Quality vs. quantity of visits Care by skilled providers Prevention and Control of Malaria during Pregnancy 9 Goal of Focused Antenatal Care To promote maternal and newborn health and survival through: Early detection and treatment of problems and complications Prevention of complications and disease Birth preparedness and complication readiness Health promotion Prevention and Control of Malaria during Pregnancy 10 Traditional Antenatal Care Emphasizes: Ritualistic, “routine” care vs. evidence-based, goal-directed actions Frequent visits Does not emphasize individual client needs Prevention and Control of Malaria during Pregnancy 11 No Longer Recommended Numerous, routine visits Burden to women and healthcare system Routine measurements and examinations: Maternal height and weight Ankle edema Fetal position before 36 weeks Care based on risk assessment Prevention and Control of Malaria during Pregnancy 12 Risk Approach Not an effective ANC strategy because: Complications cannot be predicted—all pregnant women are at risk for developing complications Risk factors are usually not direct cause of complications Many “low risk” women develop complications Have false sense of security Do not know how to recognize/respond to problems Most “high risk” women give birth without complications Inefficient use of scarce resources Prevention and Control of Malaria during Pregnancy 13 Focused Antenatal Care Services Evidence-based, goal-directed actions: Address most prevalent health issues affecting women and newborns Adjusted for specific populations/regions Appropriate to gestational age Based on firm rationale Prevention and Control of Malaria during Pregnancy 14 Focused Antenatal Care Services (cont’d.) Individualized, woman-centered care based on each woman’s: Specific needs and concerns Circumstances History, physical examination, testing Available resources Prevention and Control of Malaria during Pregnancy 15 Focused Antenatal Care Services (cont’d.) Quality vs. quantity of ANC visits: WHO multi-center study Number of visits reduced without affecting outcome for mother or baby Recommendations Content and quality vs. number of visits Goal-oriented care Minimum of four visits Prevention and Control of Malaria during Pregnancy 16 First visit: By 16 weeks or when woman first thinks she is pregnant Second visit: At 24–28 weeks or at least once in second trimester Third visit: At 32 weeks Fourth visit: At 36 weeks Other visits: If complication occurs, followup or referral is needed, woman wants to see provider, or provider changes frequency based on findings (history, exam, testing) or local policy Scheduling and Timing of ANC Visits Prevention and Control of Malaria during Pregnancy 17 Focused Antenatal Care Services (cont’d.) Care by a skilled provider who: Has formal training and experience Has knowledge, skills, and qualifications to deliver safe, effective maternal and newborn healthcare Practices in home, hospital, health center May be a midwife, nurse, doctor, clinical officer, etc. Prevention and Control of Malaria during Pregnancy 18 Early Detection and Treatment Malaria—history and physical exam Fever and accompanying signs/symptoms Region Complicated vs. uncomplicated cases Severe anemia—physical exam, testing Pre-eclampsia/eclampsia—measurement of blood pressure HIV—voluntary counseling and testing Sexually transmitted infections, including syphilis— testing Prevention and Control of Malaria during Pregnancy 19 Prevention: Key Preventive Measures Malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Tetanus toxoid, iron/folate supplements Country/region-specific interventions as appropriate Vitamin A supplements Iodine supplements Presumptive treatment for hookworm Prevention and Control of Malaria during Pregnancy 20 Birth Preparedness and Complication Readiness: Objectives Develop birth plan—exact plan for normal birth and possible complications: Arrangements made in advance by woman and family (with help of skilled provider) Usually not a written document Reviewed/revised at every visit Minimize disorganization at time of birth or in an emergency Ensure timely and appropriate care Prevention and Control of Malaria during Pregnancy 21 Essential Elements of a Birth Plan Facility or Place of Birth: Home or health facility for birth, appropriate facility for emergencies Skilled Provider: To attend birth Provider/Facility Contact Information Transportation: Reliable, accessible, especially for odd hours Funds: Personal savings, emergency funds Decision-Making: Who will make decisions, especially in an emergency Prevention and Control of Malaria during Pregnancy 22 Essential Elements of a Birth Plan (cont’d.) Family and Community Support: Care for family in woman’s absence and birth companion during labor Blood Donor: In case of emergency Needed Items: For clean and safe birth and for newborn care Danger Signs/Signs of Advanced Labor Prevention and Control of Malaria during Pregnancy 23 Danger Signs of Pregnancy Vaginal bleeding Difficulty breathing Fever Severe abdominal pain Severe headache/blurred vision Convulsions/loss of consciousness Labor pains before 37 weeks Prevention and Control of Malaria during Pregnancy 24 Health Education: Objectives Inform and educate the woman with health messages and counseling appropriate to: Individual needs, concerns, circumstances Gestational age Most prevalent health issues Support the woman in making decisions and solving actual or anticipated problems Involve partner and family in supporting/adopting healthy practices Prevention and Control of Malaria during Pregnancy 25 Health Education: Topics Addressed Prevention of malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Other methods Other important issues to be discussed include: Nutrition Care for common discomforts Use of potentially harmful substances Hygiene Rest and activity Prevention and Control of Malaria during Pregnancy 26 Health Education: Topics Addressed (cont’d.) Sexual relations and safer sex Early and exclusive breastfeeding Prevention of tetanus and anemia Voluntary counseling and testing for HIV Prevention of other endemic diseases/deficiencies Prevention and Control of Malaria during Pregnancy 27 Interpersonal Skills Speak in a quiet, gentle tone of voice Listen to woman/family and respond appropriately Encourage them to ask questions and express concerns Allow them to demonstrate understanding of information provided Explain all procedures/actions and obtain permission before proceeding Show respect for cultural beliefs and social norms Be empathetic and nonjudgmental Avoid distractions while conducting the visit Prevention and Control of Malaria during Pregnancy 28 Record Keeping First ANC Visit History Physical examination Testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs Date of next ANC visit Subsequent ANC Visits Interim history Targeted physical examination, testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs (and relevant information on how client obtained and used ITN) Date of next ANC visit Record all information on the ANC chart and clinic card: Prevention and Control of Malaria during Pregnancy Chapter II: Malaria Transmission Prevention and Control of Malaria during Pregnancy 30 Malaria Transmission: Chapter Objectives Define malaria and how it is transmitted Describe extent of malaria in Africa Identify groups at highest risk of malaria infection List effects of malaria on pregnant women and their unborn babies Describe effects of malaria on pregnant women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 31 Malaria Transmission Caused by Plasmodium parasites Spread by female Anopheles mosquitoes infected with parasites Anopheles mosquitoes usually active at night Infected mosquito bites a person Malaria parasites reproduce in human blood Mosquito bites infected person, and goes on to bite and infect another person Prevention and Control of Malaria during Pregnancy 32 Populations Most Affected by Malaria Children under 5 years of age Pregnant women Unborn babies Immigrants from low-transmission areas HIV-infected persons Prevention and Control of Malaria during Pregnancy 33 Effects of Malaria on Pregnant Women All pregnant women in malaria-endemic areas are at risk Parasites attack and destroy red blood cells Malaria causes up to 15% of anemia in pregnancy Can cause severe anemia In Africa, anemia due to malaria causes up to 10,000 maternal deaths per year Prevention and Control of Malaria during Pregnancy 34 Effects on Unborn Babies Parasites hide in placenta Interferes with transfer of oxygen and nutrients to the baby, increasing risk of: Spontaneous abortion Preterm birth Low birthweight—single greatest risk factor for death during first month of life Stillbirth Prevention and Control of Malaria during Pregnancy 35 Effects on Communities Causes missed work and wages Results in frequent school absences Uses scarce resources Causes preventable deaths: increases maternal, newborn, and infant mortality rates Prevention and Control of Malaria during Pregnancy 36 HIV/AIDS and Malaria during Pregnancy HIV/AIDS reduces a woman’s resistance to malaria Intermittent preventive treatment (IPT) given 3 times during pregnancy is effective for women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 37 Summary of Health Education Points Malaria transmitted through mosquito bites Pregnant women and children are most at risk Pregnant women infected with malaria may have no symptoms Women with HIV/AIDS are at higher risk Malaria can lead to severe anemia, spontaneous abortion, low-birthweight babies Malaria is preventable Prevention and Control of Malaria during Pregnancy Chapter III: Preventing Malaria Prevention and Control of Malaria during Pregnancy 39 Preventing Malaria: Chapter Objectives List the elements of counseling women about the use of insecticide-treated nets (ITNs) and intermittent preventive treatment (IPT) during pregnancy Describe the use of sulfadoxine-pyrimethamine (SP) for IPT during pregnancy Prevention and Control of Malaria during Pregnancy 40 Insecticide-Treated Nets Kill or repel mosquitoes Prevent physical contact with mosquitoes Kill or repel other insects: Lice Ticks Bedbugs Cockroaches Prevention and Control of Malaria during Pregnancy 41 Insecticide-Treated Nets (cont’d.) Untreated Nets Provide some protection against malaria Do not kill or repel mosquitoes that touch net Do not reduce number of mosquitoes Do not kill other insects like lice, roaches, and bedbugs Are safe for pregnant women, young children, and infants Insecticide-Treated Nets Provide a high level of protection against malaria Kills or repels mosquitoes that touch the net Reduce number of mosquitoes in/outside net Kills other insects such as lice, roaches, and bedbugs Are safe for pregnant women, young children, and infants Prevention and Control of Malaria during Pregnancy 42 Benefits of Insecticide-Treated Nets Prevent mosquito bites Protect against malaria, resulting in less: Anemia Prematurity and low birthweight Risk of maternal and newborn death Help people sleep better Promote growth and development of fetus and newborn Prevention and Control of Malaria during Pregnancy 43 Benefits of Insecticide-Treated Nets: Community Cost less than treating malaria Reduce number of sick children and adults (helping children grow to be healthy and helping working adults remain productive) Reduce number of deaths Prevention and Control of Malaria during Pregnancy 44 Where to Find Insecticide-Treated Nets General merchandise shops Drug shops/pharmacies Markets Public and private health facilities Community health workers NGOs, community-based organizations Prevention and Control of Malaria during Pregnancy 45 How to Use Insecticide-Treated Nets Hang above bed or sleeping mat Tuck under mattress or mat Use every night, all year long Use for everyone, if possible, but give priority to pregnant women, infants, and children Prevention and Control of Malaria during Pregnancy 46 Caring for Insecticide-Treated Nets Handle gently to avoid tears Tie net up during day to avoid damage Regularly inspect for holes, repair if found Nets need to be re-treated regularly to stay effective Keep away from smoke, fire, direct sunlight Prevention and Control of Malaria during Pregnancy 47 Intermittent Preventive Treatment Based on the assumption that every pregnant woman living in an area of high malaria transmission has malaria parasites in her blood or placenta, whether or not she has symptoms of malaria Prevention and Control of Malaria during Pregnancy 48 Intermittent Preventive Treatment Although a pregnant woman with malaria may have no symptoms, malaria can still affect her and her unborn child Prevention and Control of Malaria during Pregnancy 49 Intermittent Preventive Treatment: WHO Recommendation All pregnant women should receive at least two doses of IPT after quickening, during routinely scheduled ANC visits (WHO recommends a schedule of four visits, three after quickening) Presently, the most effective drug for IPT is sulfadoxine-pyrimethamine (SP) Women should receive at least two doses of IPT with SP at ANC visits after quickening, but no more frequently than monthly Prevention and Control of Malaria during Pregnancy 50 Intermittent Preventive Treatment: Dose and Timing A single dose is three tablets of sulfadoxine 500 mg + pyrimethamine 25 mg Healthcare provider should dispense dose and directly observe client taking dose
Slide 51 - Prevention and Control of Malaria during Pregnancy A Workshop for Healthcare Providers Prevention and Control of Malaria during Pregnancy 2 Facts about Malaria 300 million cases each year worldwide 9 of 10 cases occur in Africa A person in Africa dies of malaria every 10 seconds Women and young children are most at risk Affects five times as many people as AIDS, leprosy, measles, and tuberculosis combined Prevention and Control of Malaria during Pregnancy 3 Facts about Malaria and Pregnancy 30 million African women are pregnant yearly Malaria is more frequent and complicated during pregnancy In malaria-endemic areas, malaria during pregnancy may account for: Up to 15% of maternal anemia 5–14% of low birthweight 30% of “preventable” low birthweight Prevention and Control of Malaria during Pregnancy 4 Roll Back Malaria Worldwide partnership Governments, private groups, research organizations, civil society, media Aim to reduce malaria by half by 2010 Free advocacy resources and tools: http://www.rbm.who.int Priority: Prevent poor outcomes caused by malaria in pregnancy Abuja declaration: Goal is for 60% of women in Africa to be sleeping under insecticide-treated nets (ITNs) and getting intermittent preventive treatment (IPT) by 2005 Prevention and Control of Malaria during Pregnancy 5 Malaria Prevention and Treatment during Pregnancy Focused antenatal care (ANC) with health education about malaria Use of insecticide-treated nets (ITNs) Intermittent preventive treatment (IPT) Case management of women with symptoms and signs of malaria Prevention and Control of Malaria during Pregnancy Chapter I: Focused Antenatal Care Prevention and Control of Malaria during Pregnancy 7 Focused Antenatal Care: Chapter Objectives Describe four main components of focused antenatal care (ANC) Discuss frequency and timing of ANC visits Describe essential elements of a birth plan that includes complication readiness Describe interpersonal skills for effective ANC Describe components of record keeping for ANC Prevention and Control of Malaria during Pregnancy 8 Focused Antenatal Care An approach to ANC that emphasizes: Evidence-based, goal-directed actions Individualized, woman-centered care Quality vs. quantity of visits Care by skilled providers Prevention and Control of Malaria during Pregnancy 9 Goal of Focused Antenatal Care To promote maternal and newborn health and survival through: Early detection and treatment of problems and complications Prevention of complications and disease Birth preparedness and complication readiness Health promotion Prevention and Control of Malaria during Pregnancy 10 Traditional Antenatal Care Emphasizes: Ritualistic, “routine” care vs. evidence-based, goal-directed actions Frequent visits Does not emphasize individual client needs Prevention and Control of Malaria during Pregnancy 11 No Longer Recommended Numerous, routine visits Burden to women and healthcare system Routine measurements and examinations: Maternal height and weight Ankle edema Fetal position before 36 weeks Care based on risk assessment Prevention and Control of Malaria during Pregnancy 12 Risk Approach Not an effective ANC strategy because: Complications cannot be predicted—all pregnant women are at risk for developing complications Risk factors are usually not direct cause of complications Many “low risk” women develop complications Have false sense of security Do not know how to recognize/respond to problems Most “high risk” women give birth without complications Inefficient use of scarce resources Prevention and Control of Malaria during Pregnancy 13 Focused Antenatal Care Services Evidence-based, goal-directed actions: Address most prevalent health issues affecting women and newborns Adjusted for specific populations/regions Appropriate to gestational age Based on firm rationale Prevention and Control of Malaria during Pregnancy 14 Focused Antenatal Care Services (cont’d.) Individualized, woman-centered care based on each woman’s: Specific needs and concerns Circumstances History, physical examination, testing Available resources Prevention and Control of Malaria during Pregnancy 15 Focused Antenatal Care Services (cont’d.) Quality vs. quantity of ANC visits: WHO multi-center study Number of visits reduced without affecting outcome for mother or baby Recommendations Content and quality vs. number of visits Goal-oriented care Minimum of four visits Prevention and Control of Malaria during Pregnancy 16 First visit: By 16 weeks or when woman first thinks she is pregnant Second visit: At 24–28 weeks or at least once in second trimester Third visit: At 32 weeks Fourth visit: At 36 weeks Other visits: If complication occurs, followup or referral is needed, woman wants to see provider, or provider changes frequency based on findings (history, exam, testing) or local policy Scheduling and Timing of ANC Visits Prevention and Control of Malaria during Pregnancy 17 Focused Antenatal Care Services (cont’d.) Care by a skilled provider who: Has formal training and experience Has knowledge, skills, and qualifications to deliver safe, effective maternal and newborn healthcare Practices in home, hospital, health center May be a midwife, nurse, doctor, clinical officer, etc. Prevention and Control of Malaria during Pregnancy 18 Early Detection and Treatment Malaria—history and physical exam Fever and accompanying signs/symptoms Region Complicated vs. uncomplicated cases Severe anemia—physical exam, testing Pre-eclampsia/eclampsia—measurement of blood pressure HIV—voluntary counseling and testing Sexually transmitted infections, including syphilis— testing Prevention and Control of Malaria during Pregnancy 19 Prevention: Key Preventive Measures Malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Tetanus toxoid, iron/folate supplements Country/region-specific interventions as appropriate Vitamin A supplements Iodine supplements Presumptive treatment for hookworm Prevention and Control of Malaria during Pregnancy 20 Birth Preparedness and Complication Readiness: Objectives Develop birth plan—exact plan for normal birth and possible complications: Arrangements made in advance by woman and family (with help of skilled provider) Usually not a written document Reviewed/revised at every visit Minimize disorganization at time of birth or in an emergency Ensure timely and appropriate care Prevention and Control of Malaria during Pregnancy 21 Essential Elements of a Birth Plan Facility or Place of Birth: Home or health facility for birth, appropriate facility for emergencies Skilled Provider: To attend birth Provider/Facility Contact Information Transportation: Reliable, accessible, especially for odd hours Funds: Personal savings, emergency funds Decision-Making: Who will make decisions, especially in an emergency Prevention and Control of Malaria during Pregnancy 22 Essential Elements of a Birth Plan (cont’d.) Family and Community Support: Care for family in woman’s absence and birth companion during labor Blood Donor: In case of emergency Needed Items: For clean and safe birth and for newborn care Danger Signs/Signs of Advanced Labor Prevention and Control of Malaria during Pregnancy 23 Danger Signs of Pregnancy Vaginal bleeding Difficulty breathing Fever Severe abdominal pain Severe headache/blurred vision Convulsions/loss of consciousness Labor pains before 37 weeks Prevention and Control of Malaria during Pregnancy 24 Health Education: Objectives Inform and educate the woman with health messages and counseling appropriate to: Individual needs, concerns, circumstances Gestational age Most prevalent health issues Support the woman in making decisions and solving actual or anticipated problems Involve partner and family in supporting/adopting healthy practices Prevention and Control of Malaria during Pregnancy 25 Health Education: Topics Addressed Prevention of malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Other methods Other important issues to be discussed include: Nutrition Care for common discomforts Use of potentially harmful substances Hygiene Rest and activity Prevention and Control of Malaria during Pregnancy 26 Health Education: Topics Addressed (cont’d.) Sexual relations and safer sex Early and exclusive breastfeeding Prevention of tetanus and anemia Voluntary counseling and testing for HIV Prevention of other endemic diseases/deficiencies Prevention and Control of Malaria during Pregnancy 27 Interpersonal Skills Speak in a quiet, gentle tone of voice Listen to woman/family and respond appropriately Encourage them to ask questions and express concerns Allow them to demonstrate understanding of information provided Explain all procedures/actions and obtain permission before proceeding Show respect for cultural beliefs and social norms Be empathetic and nonjudgmental Avoid distractions while conducting the visit Prevention and Control of Malaria during Pregnancy 28 Record Keeping First ANC Visit History Physical examination Testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs Date of next ANC visit Subsequent ANC Visits Interim history Targeted physical examination, testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs (and relevant information on how client obtained and used ITN) Date of next ANC visit Record all information on the ANC chart and clinic card: Prevention and Control of Malaria during Pregnancy Chapter II: Malaria Transmission Prevention and Control of Malaria during Pregnancy 30 Malaria Transmission: Chapter Objectives Define malaria and how it is transmitted Describe extent of malaria in Africa Identify groups at highest risk of malaria infection List effects of malaria on pregnant women and their unborn babies Describe effects of malaria on pregnant women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 31 Malaria Transmission Caused by Plasmodium parasites Spread by female Anopheles mosquitoes infected with parasites Anopheles mosquitoes usually active at night Infected mosquito bites a person Malaria parasites reproduce in human blood Mosquito bites infected person, and goes on to bite and infect another person Prevention and Control of Malaria during Pregnancy 32 Populations Most Affected by Malaria Children under 5 years of age Pregnant women Unborn babies Immigrants from low-transmission areas HIV-infected persons Prevention and Control of Malaria during Pregnancy 33 Effects of Malaria on Pregnant Women All pregnant women in malaria-endemic areas are at risk Parasites attack and destroy red blood cells Malaria causes up to 15% of anemia in pregnancy Can cause severe anemia In Africa, anemia due to malaria causes up to 10,000 maternal deaths per year Prevention and Control of Malaria during Pregnancy 34 Effects on Unborn Babies Parasites hide in placenta Interferes with transfer of oxygen and nutrients to the baby, increasing risk of: Spontaneous abortion Preterm birth Low birthweight—single greatest risk factor for death during first month of life Stillbirth Prevention and Control of Malaria during Pregnancy 35 Effects on Communities Causes missed work and wages Results in frequent school absences Uses scarce resources Causes preventable deaths: increases maternal, newborn, and infant mortality rates Prevention and Control of Malaria during Pregnancy 36 HIV/AIDS and Malaria during Pregnancy HIV/AIDS reduces a woman’s resistance to malaria Intermittent preventive treatment (IPT) given 3 times during pregnancy is effective for women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 37 Summary of Health Education Points Malaria transmitted through mosquito bites Pregnant women and children are most at risk Pregnant women infected with malaria may have no symptoms Women with HIV/AIDS are at higher risk Malaria can lead to severe anemia, spontaneous abortion, low-birthweight babies Malaria is preventable Prevention and Control of Malaria during Pregnancy Chapter III: Preventing Malaria Prevention and Control of Malaria during Pregnancy 39 Preventing Malaria: Chapter Objectives List the elements of counseling women about the use of insecticide-treated nets (ITNs) and intermittent preventive treatment (IPT) during pregnancy Describe the use of sulfadoxine-pyrimethamine (SP) for IPT during pregnancy Prevention and Control of Malaria during Pregnancy 40 Insecticide-Treated Nets Kill or repel mosquitoes Prevent physical contact with mosquitoes Kill or repel other insects: Lice Ticks Bedbugs Cockroaches Prevention and Control of Malaria during Pregnancy 41 Insecticide-Treated Nets (cont’d.) Untreated Nets Provide some protection against malaria Do not kill or repel mosquitoes that touch net Do not reduce number of mosquitoes Do not kill other insects like lice, roaches, and bedbugs Are safe for pregnant women, young children, and infants Insecticide-Treated Nets Provide a high level of protection against malaria Kills or repels mosquitoes that touch the net Reduce number of mosquitoes in/outside net Kills other insects such as lice, roaches, and bedbugs Are safe for pregnant women, young children, and infants Prevention and Control of Malaria during Pregnancy 42 Benefits of Insecticide-Treated Nets Prevent mosquito bites Protect against malaria, resulting in less: Anemia Prematurity and low birthweight Risk of maternal and newborn death Help people sleep better Promote growth and development of fetus and newborn Prevention and Control of Malaria during Pregnancy 43 Benefits of Insecticide-Treated Nets: Community Cost less than treating malaria Reduce number of sick children and adults (helping children grow to be healthy and helping working adults remain productive) Reduce number of deaths Prevention and Control of Malaria during Pregnancy 44 Where to Find Insecticide-Treated Nets General merchandise shops Drug shops/pharmacies Markets Public and private health facilities Community health workers NGOs, community-based organizations Prevention and Control of Malaria during Pregnancy 45 How to Use Insecticide-Treated Nets Hang above bed or sleeping mat Tuck under mattress or mat Use every night, all year long Use for everyone, if possible, but give priority to pregnant women, infants, and children Prevention and Control of Malaria during Pregnancy 46 Caring for Insecticide-Treated Nets Handle gently to avoid tears Tie net up during day to avoid damage Regularly inspect for holes, repair if found Nets need to be re-treated regularly to stay effective Keep away from smoke, fire, direct sunlight Prevention and Control of Malaria during Pregnancy 47 Intermittent Preventive Treatment Based on the assumption that every pregnant woman living in an area of high malaria transmission has malaria parasites in her blood or placenta, whether or not she has symptoms of malaria Prevention and Control of Malaria during Pregnancy 48 Intermittent Preventive Treatment Although a pregnant woman with malaria may have no symptoms, malaria can still affect her and her unborn child Prevention and Control of Malaria during Pregnancy 49 Intermittent Preventive Treatment: WHO Recommendation All pregnant women should receive at least two doses of IPT after quickening, during routinely scheduled ANC visits (WHO recommends a schedule of four visits, three after quickening) Presently, the most effective drug for IPT is sulfadoxine-pyrimethamine (SP) Women should receive at least two doses of IPT with SP at ANC visits after quickening, but no more frequently than monthly Prevention and Control of Malaria during Pregnancy 50 Intermittent Preventive Treatment: Dose and Timing A single dose is three tablets of sulfadoxine 500 mg + pyrimethamine 25 mg Healthcare provider should dispense dose and directly observe client taking dose Prevention and Control of Malaria during Pregnancy 51 Instructions for Giving Intermittent Preventive Treatment Ensure woman is at least 16 weeks pregnant and that quickening has occurred Inquire about use of SP in last 4 weeks Inquire about allergies to SP or other sulfa drugs (especially severe rashes) Explain what you will do; address the woman’s questions Provide cup and clean water
Slide 52 - Prevention and Control of Malaria during Pregnancy A Workshop for Healthcare Providers Prevention and Control of Malaria during Pregnancy 2 Facts about Malaria 300 million cases each year worldwide 9 of 10 cases occur in Africa A person in Africa dies of malaria every 10 seconds Women and young children are most at risk Affects five times as many people as AIDS, leprosy, measles, and tuberculosis combined Prevention and Control of Malaria during Pregnancy 3 Facts about Malaria and Pregnancy 30 million African women are pregnant yearly Malaria is more frequent and complicated during pregnancy In malaria-endemic areas, malaria during pregnancy may account for: Up to 15% of maternal anemia 5–14% of low birthweight 30% of “preventable” low birthweight Prevention and Control of Malaria during Pregnancy 4 Roll Back Malaria Worldwide partnership Governments, private groups, research organizations, civil society, media Aim to reduce malaria by half by 2010 Free advocacy resources and tools: http://www.rbm.who.int Priority: Prevent poor outcomes caused by malaria in pregnancy Abuja declaration: Goal is for 60% of women in Africa to be sleeping under insecticide-treated nets (ITNs) and getting intermittent preventive treatment (IPT) by 2005 Prevention and Control of Malaria during Pregnancy 5 Malaria Prevention and Treatment during Pregnancy Focused antenatal care (ANC) with health education about malaria Use of insecticide-treated nets (ITNs) Intermittent preventive treatment (IPT) Case management of women with symptoms and signs of malaria Prevention and Control of Malaria during Pregnancy Chapter I: Focused Antenatal Care Prevention and Control of Malaria during Pregnancy 7 Focused Antenatal Care: Chapter Objectives Describe four main components of focused antenatal care (ANC) Discuss frequency and timing of ANC visits Describe essential elements of a birth plan that includes complication readiness Describe interpersonal skills for effective ANC Describe components of record keeping for ANC Prevention and Control of Malaria during Pregnancy 8 Focused Antenatal Care An approach to ANC that emphasizes: Evidence-based, goal-directed actions Individualized, woman-centered care Quality vs. quantity of visits Care by skilled providers Prevention and Control of Malaria during Pregnancy 9 Goal of Focused Antenatal Care To promote maternal and newborn health and survival through: Early detection and treatment of problems and complications Prevention of complications and disease Birth preparedness and complication readiness Health promotion Prevention and Control of Malaria during Pregnancy 10 Traditional Antenatal Care Emphasizes: Ritualistic, “routine” care vs. evidence-based, goal-directed actions Frequent visits Does not emphasize individual client needs Prevention and Control of Malaria during Pregnancy 11 No Longer Recommended Numerous, routine visits Burden to women and healthcare system Routine measurements and examinations: Maternal height and weight Ankle edema Fetal position before 36 weeks Care based on risk assessment Prevention and Control of Malaria during Pregnancy 12 Risk Approach Not an effective ANC strategy because: Complications cannot be predicted—all pregnant women are at risk for developing complications Risk factors are usually not direct cause of complications Many “low risk” women develop complications Have false sense of security Do not know how to recognize/respond to problems Most “high risk” women give birth without complications Inefficient use of scarce resources Prevention and Control of Malaria during Pregnancy 13 Focused Antenatal Care Services Evidence-based, goal-directed actions: Address most prevalent health issues affecting women and newborns Adjusted for specific populations/regions Appropriate to gestational age Based on firm rationale Prevention and Control of Malaria during Pregnancy 14 Focused Antenatal Care Services (cont’d.) Individualized, woman-centered care based on each woman’s: Specific needs and concerns Circumstances History, physical examination, testing Available resources Prevention and Control of Malaria during Pregnancy 15 Focused Antenatal Care Services (cont’d.) Quality vs. quantity of ANC visits: WHO multi-center study Number of visits reduced without affecting outcome for mother or baby Recommendations Content and quality vs. number of visits Goal-oriented care Minimum of four visits Prevention and Control of Malaria during Pregnancy 16 First visit: By 16 weeks or when woman first thinks she is pregnant Second visit: At 24–28 weeks or at least once in second trimester Third visit: At 32 weeks Fourth visit: At 36 weeks Other visits: If complication occurs, followup or referral is needed, woman wants to see provider, or provider changes frequency based on findings (history, exam, testing) or local policy Scheduling and Timing of ANC Visits Prevention and Control of Malaria during Pregnancy 17 Focused Antenatal Care Services (cont’d.) Care by a skilled provider who: Has formal training and experience Has knowledge, skills, and qualifications to deliver safe, effective maternal and newborn healthcare Practices in home, hospital, health center May be a midwife, nurse, doctor, clinical officer, etc. Prevention and Control of Malaria during Pregnancy 18 Early Detection and Treatment Malaria—history and physical exam Fever and accompanying signs/symptoms Region Complicated vs. uncomplicated cases Severe anemia—physical exam, testing Pre-eclampsia/eclampsia—measurement of blood pressure HIV—voluntary counseling and testing Sexually transmitted infections, including syphilis— testing Prevention and Control of Malaria during Pregnancy 19 Prevention: Key Preventive Measures Malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Tetanus toxoid, iron/folate supplements Country/region-specific interventions as appropriate Vitamin A supplements Iodine supplements Presumptive treatment for hookworm Prevention and Control of Malaria during Pregnancy 20 Birth Preparedness and Complication Readiness: Objectives Develop birth plan—exact plan for normal birth and possible complications: Arrangements made in advance by woman and family (with help of skilled provider) Usually not a written document Reviewed/revised at every visit Minimize disorganization at time of birth or in an emergency Ensure timely and appropriate care Prevention and Control of Malaria during Pregnancy 21 Essential Elements of a Birth Plan Facility or Place of Birth: Home or health facility for birth, appropriate facility for emergencies Skilled Provider: To attend birth Provider/Facility Contact Information Transportation: Reliable, accessible, especially for odd hours Funds: Personal savings, emergency funds Decision-Making: Who will make decisions, especially in an emergency Prevention and Control of Malaria during Pregnancy 22 Essential Elements of a Birth Plan (cont’d.) Family and Community Support: Care for family in woman’s absence and birth companion during labor Blood Donor: In case of emergency Needed Items: For clean and safe birth and for newborn care Danger Signs/Signs of Advanced Labor Prevention and Control of Malaria during Pregnancy 23 Danger Signs of Pregnancy Vaginal bleeding Difficulty breathing Fever Severe abdominal pain Severe headache/blurred vision Convulsions/loss of consciousness Labor pains before 37 weeks Prevention and Control of Malaria during Pregnancy 24 Health Education: Objectives Inform and educate the woman with health messages and counseling appropriate to: Individual needs, concerns, circumstances Gestational age Most prevalent health issues Support the woman in making decisions and solving actual or anticipated problems Involve partner and family in supporting/adopting healthy practices Prevention and Control of Malaria during Pregnancy 25 Health Education: Topics Addressed Prevention of malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Other methods Other important issues to be discussed include: Nutrition Care for common discomforts Use of potentially harmful substances Hygiene Rest and activity Prevention and Control of Malaria during Pregnancy 26 Health Education: Topics Addressed (cont’d.) Sexual relations and safer sex Early and exclusive breastfeeding Prevention of tetanus and anemia Voluntary counseling and testing for HIV Prevention of other endemic diseases/deficiencies Prevention and Control of Malaria during Pregnancy 27 Interpersonal Skills Speak in a quiet, gentle tone of voice Listen to woman/family and respond appropriately Encourage them to ask questions and express concerns Allow them to demonstrate understanding of information provided Explain all procedures/actions and obtain permission before proceeding Show respect for cultural beliefs and social norms Be empathetic and nonjudgmental Avoid distractions while conducting the visit Prevention and Control of Malaria during Pregnancy 28 Record Keeping First ANC Visit History Physical examination Testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs Date of next ANC visit Subsequent ANC Visits Interim history Targeted physical examination, testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs (and relevant information on how client obtained and used ITN) Date of next ANC visit Record all information on the ANC chart and clinic card: Prevention and Control of Malaria during Pregnancy Chapter II: Malaria Transmission Prevention and Control of Malaria during Pregnancy 30 Malaria Transmission: Chapter Objectives Define malaria and how it is transmitted Describe extent of malaria in Africa Identify groups at highest risk of malaria infection List effects of malaria on pregnant women and their unborn babies Describe effects of malaria on pregnant women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 31 Malaria Transmission Caused by Plasmodium parasites Spread by female Anopheles mosquitoes infected with parasites Anopheles mosquitoes usually active at night Infected mosquito bites a person Malaria parasites reproduce in human blood Mosquito bites infected person, and goes on to bite and infect another person Prevention and Control of Malaria during Pregnancy 32 Populations Most Affected by Malaria Children under 5 years of age Pregnant women Unborn babies Immigrants from low-transmission areas HIV-infected persons Prevention and Control of Malaria during Pregnancy 33 Effects of Malaria on Pregnant Women All pregnant women in malaria-endemic areas are at risk Parasites attack and destroy red blood cells Malaria causes up to 15% of anemia in pregnancy Can cause severe anemia In Africa, anemia due to malaria causes up to 10,000 maternal deaths per year Prevention and Control of Malaria during Pregnancy 34 Effects on Unborn Babies Parasites hide in placenta Interferes with transfer of oxygen and nutrients to the baby, increasing risk of: Spontaneous abortion Preterm birth Low birthweight—single greatest risk factor for death during first month of life Stillbirth Prevention and Control of Malaria during Pregnancy 35 Effects on Communities Causes missed work and wages Results in frequent school absences Uses scarce resources Causes preventable deaths: increases maternal, newborn, and infant mortality rates Prevention and Control of Malaria during Pregnancy 36 HIV/AIDS and Malaria during Pregnancy HIV/AIDS reduces a woman’s resistance to malaria Intermittent preventive treatment (IPT) given 3 times during pregnancy is effective for women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 37 Summary of Health Education Points Malaria transmitted through mosquito bites Pregnant women and children are most at risk Pregnant women infected with malaria may have no symptoms Women with HIV/AIDS are at higher risk Malaria can lead to severe anemia, spontaneous abortion, low-birthweight babies Malaria is preventable Prevention and Control of Malaria during Pregnancy Chapter III: Preventing Malaria Prevention and Control of Malaria during Pregnancy 39 Preventing Malaria: Chapter Objectives List the elements of counseling women about the use of insecticide-treated nets (ITNs) and intermittent preventive treatment (IPT) during pregnancy Describe the use of sulfadoxine-pyrimethamine (SP) for IPT during pregnancy Prevention and Control of Malaria during Pregnancy 40 Insecticide-Treated Nets Kill or repel mosquitoes Prevent physical contact with mosquitoes Kill or repel other insects: Lice Ticks Bedbugs Cockroaches Prevention and Control of Malaria during Pregnancy 41 Insecticide-Treated Nets (cont’d.) Untreated Nets Provide some protection against malaria Do not kill or repel mosquitoes that touch net Do not reduce number of mosquitoes Do not kill other insects like lice, roaches, and bedbugs Are safe for pregnant women, young children, and infants Insecticide-Treated Nets Provide a high level of protection against malaria Kills or repels mosquitoes that touch the net Reduce number of mosquitoes in/outside net Kills other insects such as lice, roaches, and bedbugs Are safe for pregnant women, young children, and infants Prevention and Control of Malaria during Pregnancy 42 Benefits of Insecticide-Treated Nets Prevent mosquito bites Protect against malaria, resulting in less: Anemia Prematurity and low birthweight Risk of maternal and newborn death Help people sleep better Promote growth and development of fetus and newborn Prevention and Control of Malaria during Pregnancy 43 Benefits of Insecticide-Treated Nets: Community Cost less than treating malaria Reduce number of sick children and adults (helping children grow to be healthy and helping working adults remain productive) Reduce number of deaths Prevention and Control of Malaria during Pregnancy 44 Where to Find Insecticide-Treated Nets General merchandise shops Drug shops/pharmacies Markets Public and private health facilities Community health workers NGOs, community-based organizations Prevention and Control of Malaria during Pregnancy 45 How to Use Insecticide-Treated Nets Hang above bed or sleeping mat Tuck under mattress or mat Use every night, all year long Use for everyone, if possible, but give priority to pregnant women, infants, and children Prevention and Control of Malaria during Pregnancy 46 Caring for Insecticide-Treated Nets Handle gently to avoid tears Tie net up during day to avoid damage Regularly inspect for holes, repair if found Nets need to be re-treated regularly to stay effective Keep away from smoke, fire, direct sunlight Prevention and Control of Malaria during Pregnancy 47 Intermittent Preventive Treatment Based on the assumption that every pregnant woman living in an area of high malaria transmission has malaria parasites in her blood or placenta, whether or not she has symptoms of malaria Prevention and Control of Malaria during Pregnancy 48 Intermittent Preventive Treatment Although a pregnant woman with malaria may have no symptoms, malaria can still affect her and her unborn child Prevention and Control of Malaria during Pregnancy 49 Intermittent Preventive Treatment: WHO Recommendation All pregnant women should receive at least two doses of IPT after quickening, during routinely scheduled ANC visits (WHO recommends a schedule of four visits, three after quickening) Presently, the most effective drug for IPT is sulfadoxine-pyrimethamine (SP) Women should receive at least two doses of IPT with SP at ANC visits after quickening, but no more frequently than monthly Prevention and Control of Malaria during Pregnancy 50 Intermittent Preventive Treatment: Dose and Timing A single dose is three tablets of sulfadoxine 500 mg + pyrimethamine 25 mg Healthcare provider should dispense dose and directly observe client taking dose Prevention and Control of Malaria during Pregnancy 51 Instructions for Giving Intermittent Preventive Treatment Ensure woman is at least 16 weeks pregnant and that quickening has occurred Inquire about use of SP in last 4 weeks Inquire about allergies to SP or other sulfa drugs (especially severe rashes) Explain what you will do; address the woman’s questions Provide cup and clean water Prevention and Control of Malaria during Pregnancy 52 Instructions for Giving Intermittent Preventive Treatment (cont’d.) Directly observe woman swallow three tablets of SP Record SP dose on ANC and clinic card Advise the woman when to return: For her next scheduled visit If she has signs of malaria If she has other danger signs Reinforce the importance of using ITNs
Slide 53 - Prevention and Control of Malaria during Pregnancy A Workshop for Healthcare Providers Prevention and Control of Malaria during Pregnancy 2 Facts about Malaria 300 million cases each year worldwide 9 of 10 cases occur in Africa A person in Africa dies of malaria every 10 seconds Women and young children are most at risk Affects five times as many people as AIDS, leprosy, measles, and tuberculosis combined Prevention and Control of Malaria during Pregnancy 3 Facts about Malaria and Pregnancy 30 million African women are pregnant yearly Malaria is more frequent and complicated during pregnancy In malaria-endemic areas, malaria during pregnancy may account for: Up to 15% of maternal anemia 5–14% of low birthweight 30% of “preventable” low birthweight Prevention and Control of Malaria during Pregnancy 4 Roll Back Malaria Worldwide partnership Governments, private groups, research organizations, civil society, media Aim to reduce malaria by half by 2010 Free advocacy resources and tools: http://www.rbm.who.int Priority: Prevent poor outcomes caused by malaria in pregnancy Abuja declaration: Goal is for 60% of women in Africa to be sleeping under insecticide-treated nets (ITNs) and getting intermittent preventive treatment (IPT) by 2005 Prevention and Control of Malaria during Pregnancy 5 Malaria Prevention and Treatment during Pregnancy Focused antenatal care (ANC) with health education about malaria Use of insecticide-treated nets (ITNs) Intermittent preventive treatment (IPT) Case management of women with symptoms and signs of malaria Prevention and Control of Malaria during Pregnancy Chapter I: Focused Antenatal Care Prevention and Control of Malaria during Pregnancy 7 Focused Antenatal Care: Chapter Objectives Describe four main components of focused antenatal care (ANC) Discuss frequency and timing of ANC visits Describe essential elements of a birth plan that includes complication readiness Describe interpersonal skills for effective ANC Describe components of record keeping for ANC Prevention and Control of Malaria during Pregnancy 8 Focused Antenatal Care An approach to ANC that emphasizes: Evidence-based, goal-directed actions Individualized, woman-centered care Quality vs. quantity of visits Care by skilled providers Prevention and Control of Malaria during Pregnancy 9 Goal of Focused Antenatal Care To promote maternal and newborn health and survival through: Early detection and treatment of problems and complications Prevention of complications and disease Birth preparedness and complication readiness Health promotion Prevention and Control of Malaria during Pregnancy 10 Traditional Antenatal Care Emphasizes: Ritualistic, “routine” care vs. evidence-based, goal-directed actions Frequent visits Does not emphasize individual client needs Prevention and Control of Malaria during Pregnancy 11 No Longer Recommended Numerous, routine visits Burden to women and healthcare system Routine measurements and examinations: Maternal height and weight Ankle edema Fetal position before 36 weeks Care based on risk assessment Prevention and Control of Malaria during Pregnancy 12 Risk Approach Not an effective ANC strategy because: Complications cannot be predicted—all pregnant women are at risk for developing complications Risk factors are usually not direct cause of complications Many “low risk” women develop complications Have false sense of security Do not know how to recognize/respond to problems Most “high risk” women give birth without complications Inefficient use of scarce resources Prevention and Control of Malaria during Pregnancy 13 Focused Antenatal Care Services Evidence-based, goal-directed actions: Address most prevalent health issues affecting women and newborns Adjusted for specific populations/regions Appropriate to gestational age Based on firm rationale Prevention and Control of Malaria during Pregnancy 14 Focused Antenatal Care Services (cont’d.) Individualized, woman-centered care based on each woman’s: Specific needs and concerns Circumstances History, physical examination, testing Available resources Prevention and Control of Malaria during Pregnancy 15 Focused Antenatal Care Services (cont’d.) Quality vs. quantity of ANC visits: WHO multi-center study Number of visits reduced without affecting outcome for mother or baby Recommendations Content and quality vs. number of visits Goal-oriented care Minimum of four visits Prevention and Control of Malaria during Pregnancy 16 First visit: By 16 weeks or when woman first thinks she is pregnant Second visit: At 24–28 weeks or at least once in second trimester Third visit: At 32 weeks Fourth visit: At 36 weeks Other visits: If complication occurs, followup or referral is needed, woman wants to see provider, or provider changes frequency based on findings (history, exam, testing) or local policy Scheduling and Timing of ANC Visits Prevention and Control of Malaria during Pregnancy 17 Focused Antenatal Care Services (cont’d.) Care by a skilled provider who: Has formal training and experience Has knowledge, skills, and qualifications to deliver safe, effective maternal and newborn healthcare Practices in home, hospital, health center May be a midwife, nurse, doctor, clinical officer, etc. Prevention and Control of Malaria during Pregnancy 18 Early Detection and Treatment Malaria—history and physical exam Fever and accompanying signs/symptoms Region Complicated vs. uncomplicated cases Severe anemia—physical exam, testing Pre-eclampsia/eclampsia—measurement of blood pressure HIV—voluntary counseling and testing Sexually transmitted infections, including syphilis— testing Prevention and Control of Malaria during Pregnancy 19 Prevention: Key Preventive Measures Malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Tetanus toxoid, iron/folate supplements Country/region-specific interventions as appropriate Vitamin A supplements Iodine supplements Presumptive treatment for hookworm Prevention and Control of Malaria during Pregnancy 20 Birth Preparedness and Complication Readiness: Objectives Develop birth plan—exact plan for normal birth and possible complications: Arrangements made in advance by woman and family (with help of skilled provider) Usually not a written document Reviewed/revised at every visit Minimize disorganization at time of birth or in an emergency Ensure timely and appropriate care Prevention and Control of Malaria during Pregnancy 21 Essential Elements of a Birth Plan Facility or Place of Birth: Home or health facility for birth, appropriate facility for emergencies Skilled Provider: To attend birth Provider/Facility Contact Information Transportation: Reliable, accessible, especially for odd hours Funds: Personal savings, emergency funds Decision-Making: Who will make decisions, especially in an emergency Prevention and Control of Malaria during Pregnancy 22 Essential Elements of a Birth Plan (cont’d.) Family and Community Support: Care for family in woman’s absence and birth companion during labor Blood Donor: In case of emergency Needed Items: For clean and safe birth and for newborn care Danger Signs/Signs of Advanced Labor Prevention and Control of Malaria during Pregnancy 23 Danger Signs of Pregnancy Vaginal bleeding Difficulty breathing Fever Severe abdominal pain Severe headache/blurred vision Convulsions/loss of consciousness Labor pains before 37 weeks Prevention and Control of Malaria during Pregnancy 24 Health Education: Objectives Inform and educate the woman with health messages and counseling appropriate to: Individual needs, concerns, circumstances Gestational age Most prevalent health issues Support the woman in making decisions and solving actual or anticipated problems Involve partner and family in supporting/adopting healthy practices Prevention and Control of Malaria during Pregnancy 25 Health Education: Topics Addressed Prevention of malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Other methods Other important issues to be discussed include: Nutrition Care for common discomforts Use of potentially harmful substances Hygiene Rest and activity Prevention and Control of Malaria during Pregnancy 26 Health Education: Topics Addressed (cont’d.) Sexual relations and safer sex Early and exclusive breastfeeding Prevention of tetanus and anemia Voluntary counseling and testing for HIV Prevention of other endemic diseases/deficiencies Prevention and Control of Malaria during Pregnancy 27 Interpersonal Skills Speak in a quiet, gentle tone of voice Listen to woman/family and respond appropriately Encourage them to ask questions and express concerns Allow them to demonstrate understanding of information provided Explain all procedures/actions and obtain permission before proceeding Show respect for cultural beliefs and social norms Be empathetic and nonjudgmental Avoid distractions while conducting the visit Prevention and Control of Malaria during Pregnancy 28 Record Keeping First ANC Visit History Physical examination Testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs Date of next ANC visit Subsequent ANC Visits Interim history Targeted physical examination, testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs (and relevant information on how client obtained and used ITN) Date of next ANC visit Record all information on the ANC chart and clinic card: Prevention and Control of Malaria during Pregnancy Chapter II: Malaria Transmission Prevention and Control of Malaria during Pregnancy 30 Malaria Transmission: Chapter Objectives Define malaria and how it is transmitted Describe extent of malaria in Africa Identify groups at highest risk of malaria infection List effects of malaria on pregnant women and their unborn babies Describe effects of malaria on pregnant women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 31 Malaria Transmission Caused by Plasmodium parasites Spread by female Anopheles mosquitoes infected with parasites Anopheles mosquitoes usually active at night Infected mosquito bites a person Malaria parasites reproduce in human blood Mosquito bites infected person, and goes on to bite and infect another person Prevention and Control of Malaria during Pregnancy 32 Populations Most Affected by Malaria Children under 5 years of age Pregnant women Unborn babies Immigrants from low-transmission areas HIV-infected persons Prevention and Control of Malaria during Pregnancy 33 Effects of Malaria on Pregnant Women All pregnant women in malaria-endemic areas are at risk Parasites attack and destroy red blood cells Malaria causes up to 15% of anemia in pregnancy Can cause severe anemia In Africa, anemia due to malaria causes up to 10,000 maternal deaths per year Prevention and Control of Malaria during Pregnancy 34 Effects on Unborn Babies Parasites hide in placenta Interferes with transfer of oxygen and nutrients to the baby, increasing risk of: Spontaneous abortion Preterm birth Low birthweight—single greatest risk factor for death during first month of life Stillbirth Prevention and Control of Malaria during Pregnancy 35 Effects on Communities Causes missed work and wages Results in frequent school absences Uses scarce resources Causes preventable deaths: increases maternal, newborn, and infant mortality rates Prevention and Control of Malaria during Pregnancy 36 HIV/AIDS and Malaria during Pregnancy HIV/AIDS reduces a woman’s resistance to malaria Intermittent preventive treatment (IPT) given 3 times during pregnancy is effective for women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 37 Summary of Health Education Points Malaria transmitted through mosquito bites Pregnant women and children are most at risk Pregnant women infected with malaria may have no symptoms Women with HIV/AIDS are at higher risk Malaria can lead to severe anemia, spontaneous abortion, low-birthweight babies Malaria is preventable Prevention and Control of Malaria during Pregnancy Chapter III: Preventing Malaria Prevention and Control of Malaria during Pregnancy 39 Preventing Malaria: Chapter Objectives List the elements of counseling women about the use of insecticide-treated nets (ITNs) and intermittent preventive treatment (IPT) during pregnancy Describe the use of sulfadoxine-pyrimethamine (SP) for IPT during pregnancy Prevention and Control of Malaria during Pregnancy 40 Insecticide-Treated Nets Kill or repel mosquitoes Prevent physical contact with mosquitoes Kill or repel other insects: Lice Ticks Bedbugs Cockroaches Prevention and Control of Malaria during Pregnancy 41 Insecticide-Treated Nets (cont’d.) Untreated Nets Provide some protection against malaria Do not kill or repel mosquitoes that touch net Do not reduce number of mosquitoes Do not kill other insects like lice, roaches, and bedbugs Are safe for pregnant women, young children, and infants Insecticide-Treated Nets Provide a high level of protection against malaria Kills or repels mosquitoes that touch the net Reduce number of mosquitoes in/outside net Kills other insects such as lice, roaches, and bedbugs Are safe for pregnant women, young children, and infants Prevention and Control of Malaria during Pregnancy 42 Benefits of Insecticide-Treated Nets Prevent mosquito bites Protect against malaria, resulting in less: Anemia Prematurity and low birthweight Risk of maternal and newborn death Help people sleep better Promote growth and development of fetus and newborn Prevention and Control of Malaria during Pregnancy 43 Benefits of Insecticide-Treated Nets: Community Cost less than treating malaria Reduce number of sick children and adults (helping children grow to be healthy and helping working adults remain productive) Reduce number of deaths Prevention and Control of Malaria during Pregnancy 44 Where to Find Insecticide-Treated Nets General merchandise shops Drug shops/pharmacies Markets Public and private health facilities Community health workers NGOs, community-based organizations Prevention and Control of Malaria during Pregnancy 45 How to Use Insecticide-Treated Nets Hang above bed or sleeping mat Tuck under mattress or mat Use every night, all year long Use for everyone, if possible, but give priority to pregnant women, infants, and children Prevention and Control of Malaria during Pregnancy 46 Caring for Insecticide-Treated Nets Handle gently to avoid tears Tie net up during day to avoid damage Regularly inspect for holes, repair if found Nets need to be re-treated regularly to stay effective Keep away from smoke, fire, direct sunlight Prevention and Control of Malaria during Pregnancy 47 Intermittent Preventive Treatment Based on the assumption that every pregnant woman living in an area of high malaria transmission has malaria parasites in her blood or placenta, whether or not she has symptoms of malaria Prevention and Control of Malaria during Pregnancy 48 Intermittent Preventive Treatment Although a pregnant woman with malaria may have no symptoms, malaria can still affect her and her unborn child Prevention and Control of Malaria during Pregnancy 49 Intermittent Preventive Treatment: WHO Recommendation All pregnant women should receive at least two doses of IPT after quickening, during routinely scheduled ANC visits (WHO recommends a schedule of four visits, three after quickening) Presently, the most effective drug for IPT is sulfadoxine-pyrimethamine (SP) Women should receive at least two doses of IPT with SP at ANC visits after quickening, but no more frequently than monthly Prevention and Control of Malaria during Pregnancy 50 Intermittent Preventive Treatment: Dose and Timing A single dose is three tablets of sulfadoxine 500 mg + pyrimethamine 25 mg Healthcare provider should dispense dose and directly observe client taking dose Prevention and Control of Malaria during Pregnancy 51 Instructions for Giving Intermittent Preventive Treatment Ensure woman is at least 16 weeks pregnant and that quickening has occurred Inquire about use of SP in last 4 weeks Inquire about allergies to SP or other sulfa drugs (especially severe rashes) Explain what you will do; address the woman’s questions Provide cup and clean water Prevention and Control of Malaria during Pregnancy 52 Instructions for Giving Intermittent Preventive Treatment (cont’d.) Directly observe woman swallow three tablets of SP Record SP dose on ANC and clinic card Advise the woman when to return: For her next scheduled visit If she has signs of malaria If she has other danger signs Reinforce the importance of using ITNs Prevention and Control of Malaria during Pregnancy 53 Intermittent Preventive Treatment: Contraindications to Using SP Do NOT give during first trimester: Be sure quickening has occurred and woman is at least 16 weeks pregnant Do NOT give to women with reported allergy to SP or other sulfa drugs: Ask about sulfa drug allergies before giving SP Do NOT give to women taking co-trimoxazole, or other sulfa-containing drugs: Ask about use of these medicines before giving SP Do not give SP more frequently than monthly: Be sure at least 1 month has passed since the last dose of SP
Slide 54 - Prevention and Control of Malaria during Pregnancy A Workshop for Healthcare Providers Prevention and Control of Malaria during Pregnancy 2 Facts about Malaria 300 million cases each year worldwide 9 of 10 cases occur in Africa A person in Africa dies of malaria every 10 seconds Women and young children are most at risk Affects five times as many people as AIDS, leprosy, measles, and tuberculosis combined Prevention and Control of Malaria during Pregnancy 3 Facts about Malaria and Pregnancy 30 million African women are pregnant yearly Malaria is more frequent and complicated during pregnancy In malaria-endemic areas, malaria during pregnancy may account for: Up to 15% of maternal anemia 5–14% of low birthweight 30% of “preventable” low birthweight Prevention and Control of Malaria during Pregnancy 4 Roll Back Malaria Worldwide partnership Governments, private groups, research organizations, civil society, media Aim to reduce malaria by half by 2010 Free advocacy resources and tools: http://www.rbm.who.int Priority: Prevent poor outcomes caused by malaria in pregnancy Abuja declaration: Goal is for 60% of women in Africa to be sleeping under insecticide-treated nets (ITNs) and getting intermittent preventive treatment (IPT) by 2005 Prevention and Control of Malaria during Pregnancy 5 Malaria Prevention and Treatment during Pregnancy Focused antenatal care (ANC) with health education about malaria Use of insecticide-treated nets (ITNs) Intermittent preventive treatment (IPT) Case management of women with symptoms and signs of malaria Prevention and Control of Malaria during Pregnancy Chapter I: Focused Antenatal Care Prevention and Control of Malaria during Pregnancy 7 Focused Antenatal Care: Chapter Objectives Describe four main components of focused antenatal care (ANC) Discuss frequency and timing of ANC visits Describe essential elements of a birth plan that includes complication readiness Describe interpersonal skills for effective ANC Describe components of record keeping for ANC Prevention and Control of Malaria during Pregnancy 8 Focused Antenatal Care An approach to ANC that emphasizes: Evidence-based, goal-directed actions Individualized, woman-centered care Quality vs. quantity of visits Care by skilled providers Prevention and Control of Malaria during Pregnancy 9 Goal of Focused Antenatal Care To promote maternal and newborn health and survival through: Early detection and treatment of problems and complications Prevention of complications and disease Birth preparedness and complication readiness Health promotion Prevention and Control of Malaria during Pregnancy 10 Traditional Antenatal Care Emphasizes: Ritualistic, “routine” care vs. evidence-based, goal-directed actions Frequent visits Does not emphasize individual client needs Prevention and Control of Malaria during Pregnancy 11 No Longer Recommended Numerous, routine visits Burden to women and healthcare system Routine measurements and examinations: Maternal height and weight Ankle edema Fetal position before 36 weeks Care based on risk assessment Prevention and Control of Malaria during Pregnancy 12 Risk Approach Not an effective ANC strategy because: Complications cannot be predicted—all pregnant women are at risk for developing complications Risk factors are usually not direct cause of complications Many “low risk” women develop complications Have false sense of security Do not know how to recognize/respond to problems Most “high risk” women give birth without complications Inefficient use of scarce resources Prevention and Control of Malaria during Pregnancy 13 Focused Antenatal Care Services Evidence-based, goal-directed actions: Address most prevalent health issues affecting women and newborns Adjusted for specific populations/regions Appropriate to gestational age Based on firm rationale Prevention and Control of Malaria during Pregnancy 14 Focused Antenatal Care Services (cont’d.) Individualized, woman-centered care based on each woman’s: Specific needs and concerns Circumstances History, physical examination, testing Available resources Prevention and Control of Malaria during Pregnancy 15 Focused Antenatal Care Services (cont’d.) Quality vs. quantity of ANC visits: WHO multi-center study Number of visits reduced without affecting outcome for mother or baby Recommendations Content and quality vs. number of visits Goal-oriented care Minimum of four visits Prevention and Control of Malaria during Pregnancy 16 First visit: By 16 weeks or when woman first thinks she is pregnant Second visit: At 24–28 weeks or at least once in second trimester Third visit: At 32 weeks Fourth visit: At 36 weeks Other visits: If complication occurs, followup or referral is needed, woman wants to see provider, or provider changes frequency based on findings (history, exam, testing) or local policy Scheduling and Timing of ANC Visits Prevention and Control of Malaria during Pregnancy 17 Focused Antenatal Care Services (cont’d.) Care by a skilled provider who: Has formal training and experience Has knowledge, skills, and qualifications to deliver safe, effective maternal and newborn healthcare Practices in home, hospital, health center May be a midwife, nurse, doctor, clinical officer, etc. Prevention and Control of Malaria during Pregnancy 18 Early Detection and Treatment Malaria—history and physical exam Fever and accompanying signs/symptoms Region Complicated vs. uncomplicated cases Severe anemia—physical exam, testing Pre-eclampsia/eclampsia—measurement of blood pressure HIV—voluntary counseling and testing Sexually transmitted infections, including syphilis— testing Prevention and Control of Malaria during Pregnancy 19 Prevention: Key Preventive Measures Malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Tetanus toxoid, iron/folate supplements Country/region-specific interventions as appropriate Vitamin A supplements Iodine supplements Presumptive treatment for hookworm Prevention and Control of Malaria during Pregnancy 20 Birth Preparedness and Complication Readiness: Objectives Develop birth plan—exact plan for normal birth and possible complications: Arrangements made in advance by woman and family (with help of skilled provider) Usually not a written document Reviewed/revised at every visit Minimize disorganization at time of birth or in an emergency Ensure timely and appropriate care Prevention and Control of Malaria during Pregnancy 21 Essential Elements of a Birth Plan Facility or Place of Birth: Home or health facility for birth, appropriate facility for emergencies Skilled Provider: To attend birth Provider/Facility Contact Information Transportation: Reliable, accessible, especially for odd hours Funds: Personal savings, emergency funds Decision-Making: Who will make decisions, especially in an emergency Prevention and Control of Malaria during Pregnancy 22 Essential Elements of a Birth Plan (cont’d.) Family and Community Support: Care for family in woman’s absence and birth companion during labor Blood Donor: In case of emergency Needed Items: For clean and safe birth and for newborn care Danger Signs/Signs of Advanced Labor Prevention and Control of Malaria during Pregnancy 23 Danger Signs of Pregnancy Vaginal bleeding Difficulty breathing Fever Severe abdominal pain Severe headache/blurred vision Convulsions/loss of consciousness Labor pains before 37 weeks Prevention and Control of Malaria during Pregnancy 24 Health Education: Objectives Inform and educate the woman with health messages and counseling appropriate to: Individual needs, concerns, circumstances Gestational age Most prevalent health issues Support the woman in making decisions and solving actual or anticipated problems Involve partner and family in supporting/adopting healthy practices Prevention and Control of Malaria during Pregnancy 25 Health Education: Topics Addressed Prevention of malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Other methods Other important issues to be discussed include: Nutrition Care for common discomforts Use of potentially harmful substances Hygiene Rest and activity Prevention and Control of Malaria during Pregnancy 26 Health Education: Topics Addressed (cont’d.) Sexual relations and safer sex Early and exclusive breastfeeding Prevention of tetanus and anemia Voluntary counseling and testing for HIV Prevention of other endemic diseases/deficiencies Prevention and Control of Malaria during Pregnancy 27 Interpersonal Skills Speak in a quiet, gentle tone of voice Listen to woman/family and respond appropriately Encourage them to ask questions and express concerns Allow them to demonstrate understanding of information provided Explain all procedures/actions and obtain permission before proceeding Show respect for cultural beliefs and social norms Be empathetic and nonjudgmental Avoid distractions while conducting the visit Prevention and Control of Malaria during Pregnancy 28 Record Keeping First ANC Visit History Physical examination Testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs Date of next ANC visit Subsequent ANC Visits Interim history Targeted physical examination, testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs (and relevant information on how client obtained and used ITN) Date of next ANC visit Record all information on the ANC chart and clinic card: Prevention and Control of Malaria during Pregnancy Chapter II: Malaria Transmission Prevention and Control of Malaria during Pregnancy 30 Malaria Transmission: Chapter Objectives Define malaria and how it is transmitted Describe extent of malaria in Africa Identify groups at highest risk of malaria infection List effects of malaria on pregnant women and their unborn babies Describe effects of malaria on pregnant women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 31 Malaria Transmission Caused by Plasmodium parasites Spread by female Anopheles mosquitoes infected with parasites Anopheles mosquitoes usually active at night Infected mosquito bites a person Malaria parasites reproduce in human blood Mosquito bites infected person, and goes on to bite and infect another person Prevention and Control of Malaria during Pregnancy 32 Populations Most Affected by Malaria Children under 5 years of age Pregnant women Unborn babies Immigrants from low-transmission areas HIV-infected persons Prevention and Control of Malaria during Pregnancy 33 Effects of Malaria on Pregnant Women All pregnant women in malaria-endemic areas are at risk Parasites attack and destroy red blood cells Malaria causes up to 15% of anemia in pregnancy Can cause severe anemia In Africa, anemia due to malaria causes up to 10,000 maternal deaths per year Prevention and Control of Malaria during Pregnancy 34 Effects on Unborn Babies Parasites hide in placenta Interferes with transfer of oxygen and nutrients to the baby, increasing risk of: Spontaneous abortion Preterm birth Low birthweight—single greatest risk factor for death during first month of life Stillbirth Prevention and Control of Malaria during Pregnancy 35 Effects on Communities Causes missed work and wages Results in frequent school absences Uses scarce resources Causes preventable deaths: increases maternal, newborn, and infant mortality rates Prevention and Control of Malaria during Pregnancy 36 HIV/AIDS and Malaria during Pregnancy HIV/AIDS reduces a woman’s resistance to malaria Intermittent preventive treatment (IPT) given 3 times during pregnancy is effective for women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 37 Summary of Health Education Points Malaria transmitted through mosquito bites Pregnant women and children are most at risk Pregnant women infected with malaria may have no symptoms Women with HIV/AIDS are at higher risk Malaria can lead to severe anemia, spontaneous abortion, low-birthweight babies Malaria is preventable Prevention and Control of Malaria during Pregnancy Chapter III: Preventing Malaria Prevention and Control of Malaria during Pregnancy 39 Preventing Malaria: Chapter Objectives List the elements of counseling women about the use of insecticide-treated nets (ITNs) and intermittent preventive treatment (IPT) during pregnancy Describe the use of sulfadoxine-pyrimethamine (SP) for IPT during pregnancy Prevention and Control of Malaria during Pregnancy 40 Insecticide-Treated Nets Kill or repel mosquitoes Prevent physical contact with mosquitoes Kill or repel other insects: Lice Ticks Bedbugs Cockroaches Prevention and Control of Malaria during Pregnancy 41 Insecticide-Treated Nets (cont’d.) Untreated Nets Provide some protection against malaria Do not kill or repel mosquitoes that touch net Do not reduce number of mosquitoes Do not kill other insects like lice, roaches, and bedbugs Are safe for pregnant women, young children, and infants Insecticide-Treated Nets Provide a high level of protection against malaria Kills or repels mosquitoes that touch the net Reduce number of mosquitoes in/outside net Kills other insects such as lice, roaches, and bedbugs Are safe for pregnant women, young children, and infants Prevention and Control of Malaria during Pregnancy 42 Benefits of Insecticide-Treated Nets Prevent mosquito bites Protect against malaria, resulting in less: Anemia Prematurity and low birthweight Risk of maternal and newborn death Help people sleep better Promote growth and development of fetus and newborn Prevention and Control of Malaria during Pregnancy 43 Benefits of Insecticide-Treated Nets: Community Cost less than treating malaria Reduce number of sick children and adults (helping children grow to be healthy and helping working adults remain productive) Reduce number of deaths Prevention and Control of Malaria during Pregnancy 44 Where to Find Insecticide-Treated Nets General merchandise shops Drug shops/pharmacies Markets Public and private health facilities Community health workers NGOs, community-based organizations Prevention and Control of Malaria during Pregnancy 45 How to Use Insecticide-Treated Nets Hang above bed or sleeping mat Tuck under mattress or mat Use every night, all year long Use for everyone, if possible, but give priority to pregnant women, infants, and children Prevention and Control of Malaria during Pregnancy 46 Caring for Insecticide-Treated Nets Handle gently to avoid tears Tie net up during day to avoid damage Regularly inspect for holes, repair if found Nets need to be re-treated regularly to stay effective Keep away from smoke, fire, direct sunlight Prevention and Control of Malaria during Pregnancy 47 Intermittent Preventive Treatment Based on the assumption that every pregnant woman living in an area of high malaria transmission has malaria parasites in her blood or placenta, whether or not she has symptoms of malaria Prevention and Control of Malaria during Pregnancy 48 Intermittent Preventive Treatment Although a pregnant woman with malaria may have no symptoms, malaria can still affect her and her unborn child Prevention and Control of Malaria during Pregnancy 49 Intermittent Preventive Treatment: WHO Recommendation All pregnant women should receive at least two doses of IPT after quickening, during routinely scheduled ANC visits (WHO recommends a schedule of four visits, three after quickening) Presently, the most effective drug for IPT is sulfadoxine-pyrimethamine (SP) Women should receive at least two doses of IPT with SP at ANC visits after quickening, but no more frequently than monthly Prevention and Control of Malaria during Pregnancy 50 Intermittent Preventive Treatment: Dose and Timing A single dose is three tablets of sulfadoxine 500 mg + pyrimethamine 25 mg Healthcare provider should dispense dose and directly observe client taking dose Prevention and Control of Malaria during Pregnancy 51 Instructions for Giving Intermittent Preventive Treatment Ensure woman is at least 16 weeks pregnant and that quickening has occurred Inquire about use of SP in last 4 weeks Inquire about allergies to SP or other sulfa drugs (especially severe rashes) Explain what you will do; address the woman’s questions Provide cup and clean water Prevention and Control of Malaria during Pregnancy 52 Instructions for Giving Intermittent Preventive Treatment (cont’d.) Directly observe woman swallow three tablets of SP Record SP dose on ANC and clinic card Advise the woman when to return: For her next scheduled visit If she has signs of malaria If she has other danger signs Reinforce the importance of using ITNs Prevention and Control of Malaria during Pregnancy 53 Intermittent Preventive Treatment: Contraindications to Using SP Do NOT give during first trimester: Be sure quickening has occurred and woman is at least 16 weeks pregnant Do NOT give to women with reported allergy to SP or other sulfa drugs: Ask about sulfa drug allergies before giving SP Do NOT give to women taking co-trimoxazole, or other sulfa-containing drugs: Ask about use of these medicines before giving SP Do not give SP more frequently than monthly: Be sure at least 1 month has passed since the last dose of SP Prevention and Control of Malaria during Pregnancy 54 Chemoprophylaxis with Chloroquine: For Women Allergic to Sulfa Drugs* Dose Chloroquine 150 mg Timing 1 4 tablets First ANC visit after 16 weeks 2 4 tablets Second day after first dose 3 2 tablets Third day after first dose Weekly 2 tablets Every week during pregnancy *If chloroquine resistance rates in the country are high, chemoprophylaxis with chloroquine is not recommended.
Slide 55 - Prevention and Control of Malaria during Pregnancy A Workshop for Healthcare Providers Prevention and Control of Malaria during Pregnancy 2 Facts about Malaria 300 million cases each year worldwide 9 of 10 cases occur in Africa A person in Africa dies of malaria every 10 seconds Women and young children are most at risk Affects five times as many people as AIDS, leprosy, measles, and tuberculosis combined Prevention and Control of Malaria during Pregnancy 3 Facts about Malaria and Pregnancy 30 million African women are pregnant yearly Malaria is more frequent and complicated during pregnancy In malaria-endemic areas, malaria during pregnancy may account for: Up to 15% of maternal anemia 5–14% of low birthweight 30% of “preventable” low birthweight Prevention and Control of Malaria during Pregnancy 4 Roll Back Malaria Worldwide partnership Governments, private groups, research organizations, civil society, media Aim to reduce malaria by half by 2010 Free advocacy resources and tools: http://www.rbm.who.int Priority: Prevent poor outcomes caused by malaria in pregnancy Abuja declaration: Goal is for 60% of women in Africa to be sleeping under insecticide-treated nets (ITNs) and getting intermittent preventive treatment (IPT) by 2005 Prevention and Control of Malaria during Pregnancy 5 Malaria Prevention and Treatment during Pregnancy Focused antenatal care (ANC) with health education about malaria Use of insecticide-treated nets (ITNs) Intermittent preventive treatment (IPT) Case management of women with symptoms and signs of malaria Prevention and Control of Malaria during Pregnancy Chapter I: Focused Antenatal Care Prevention and Control of Malaria during Pregnancy 7 Focused Antenatal Care: Chapter Objectives Describe four main components of focused antenatal care (ANC) Discuss frequency and timing of ANC visits Describe essential elements of a birth plan that includes complication readiness Describe interpersonal skills for effective ANC Describe components of record keeping for ANC Prevention and Control of Malaria during Pregnancy 8 Focused Antenatal Care An approach to ANC that emphasizes: Evidence-based, goal-directed actions Individualized, woman-centered care Quality vs. quantity of visits Care by skilled providers Prevention and Control of Malaria during Pregnancy 9 Goal of Focused Antenatal Care To promote maternal and newborn health and survival through: Early detection and treatment of problems and complications Prevention of complications and disease Birth preparedness and complication readiness Health promotion Prevention and Control of Malaria during Pregnancy 10 Traditional Antenatal Care Emphasizes: Ritualistic, “routine” care vs. evidence-based, goal-directed actions Frequent visits Does not emphasize individual client needs Prevention and Control of Malaria during Pregnancy 11 No Longer Recommended Numerous, routine visits Burden to women and healthcare system Routine measurements and examinations: Maternal height and weight Ankle edema Fetal position before 36 weeks Care based on risk assessment Prevention and Control of Malaria during Pregnancy 12 Risk Approach Not an effective ANC strategy because: Complications cannot be predicted—all pregnant women are at risk for developing complications Risk factors are usually not direct cause of complications Many “low risk” women develop complications Have false sense of security Do not know how to recognize/respond to problems Most “high risk” women give birth without complications Inefficient use of scarce resources Prevention and Control of Malaria during Pregnancy 13 Focused Antenatal Care Services Evidence-based, goal-directed actions: Address most prevalent health issues affecting women and newborns Adjusted for specific populations/regions Appropriate to gestational age Based on firm rationale Prevention and Control of Malaria during Pregnancy 14 Focused Antenatal Care Services (cont’d.) Individualized, woman-centered care based on each woman’s: Specific needs and concerns Circumstances History, physical examination, testing Available resources Prevention and Control of Malaria during Pregnancy 15 Focused Antenatal Care Services (cont’d.) Quality vs. quantity of ANC visits: WHO multi-center study Number of visits reduced without affecting outcome for mother or baby Recommendations Content and quality vs. number of visits Goal-oriented care Minimum of four visits Prevention and Control of Malaria during Pregnancy 16 First visit: By 16 weeks or when woman first thinks she is pregnant Second visit: At 24–28 weeks or at least once in second trimester Third visit: At 32 weeks Fourth visit: At 36 weeks Other visits: If complication occurs, followup or referral is needed, woman wants to see provider, or provider changes frequency based on findings (history, exam, testing) or local policy Scheduling and Timing of ANC Visits Prevention and Control of Malaria during Pregnancy 17 Focused Antenatal Care Services (cont’d.) Care by a skilled provider who: Has formal training and experience Has knowledge, skills, and qualifications to deliver safe, effective maternal and newborn healthcare Practices in home, hospital, health center May be a midwife, nurse, doctor, clinical officer, etc. Prevention and Control of Malaria during Pregnancy 18 Early Detection and Treatment Malaria—history and physical exam Fever and accompanying signs/symptoms Region Complicated vs. uncomplicated cases Severe anemia—physical exam, testing Pre-eclampsia/eclampsia—measurement of blood pressure HIV—voluntary counseling and testing Sexually transmitted infections, including syphilis— testing Prevention and Control of Malaria during Pregnancy 19 Prevention: Key Preventive Measures Malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Tetanus toxoid, iron/folate supplements Country/region-specific interventions as appropriate Vitamin A supplements Iodine supplements Presumptive treatment for hookworm Prevention and Control of Malaria during Pregnancy 20 Birth Preparedness and Complication Readiness: Objectives Develop birth plan—exact plan for normal birth and possible complications: Arrangements made in advance by woman and family (with help of skilled provider) Usually not a written document Reviewed/revised at every visit Minimize disorganization at time of birth or in an emergency Ensure timely and appropriate care Prevention and Control of Malaria during Pregnancy 21 Essential Elements of a Birth Plan Facility or Place of Birth: Home or health facility for birth, appropriate facility for emergencies Skilled Provider: To attend birth Provider/Facility Contact Information Transportation: Reliable, accessible, especially for odd hours Funds: Personal savings, emergency funds Decision-Making: Who will make decisions, especially in an emergency Prevention and Control of Malaria during Pregnancy 22 Essential Elements of a Birth Plan (cont’d.) Family and Community Support: Care for family in woman’s absence and birth companion during labor Blood Donor: In case of emergency Needed Items: For clean and safe birth and for newborn care Danger Signs/Signs of Advanced Labor Prevention and Control of Malaria during Pregnancy 23 Danger Signs of Pregnancy Vaginal bleeding Difficulty breathing Fever Severe abdominal pain Severe headache/blurred vision Convulsions/loss of consciousness Labor pains before 37 weeks Prevention and Control of Malaria during Pregnancy 24 Health Education: Objectives Inform and educate the woman with health messages and counseling appropriate to: Individual needs, concerns, circumstances Gestational age Most prevalent health issues Support the woman in making decisions and solving actual or anticipated problems Involve partner and family in supporting/adopting healthy practices Prevention and Control of Malaria during Pregnancy 25 Health Education: Topics Addressed Prevention of malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Other methods Other important issues to be discussed include: Nutrition Care for common discomforts Use of potentially harmful substances Hygiene Rest and activity Prevention and Control of Malaria during Pregnancy 26 Health Education: Topics Addressed (cont’d.) Sexual relations and safer sex Early and exclusive breastfeeding Prevention of tetanus and anemia Voluntary counseling and testing for HIV Prevention of other endemic diseases/deficiencies Prevention and Control of Malaria during Pregnancy 27 Interpersonal Skills Speak in a quiet, gentle tone of voice Listen to woman/family and respond appropriately Encourage them to ask questions and express concerns Allow them to demonstrate understanding of information provided Explain all procedures/actions and obtain permission before proceeding Show respect for cultural beliefs and social norms Be empathetic and nonjudgmental Avoid distractions while conducting the visit Prevention and Control of Malaria during Pregnancy 28 Record Keeping First ANC Visit History Physical examination Testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs Date of next ANC visit Subsequent ANC Visits Interim history Targeted physical examination, testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs (and relevant information on how client obtained and used ITN) Date of next ANC visit Record all information on the ANC chart and clinic card: Prevention and Control of Malaria during Pregnancy Chapter II: Malaria Transmission Prevention and Control of Malaria during Pregnancy 30 Malaria Transmission: Chapter Objectives Define malaria and how it is transmitted Describe extent of malaria in Africa Identify groups at highest risk of malaria infection List effects of malaria on pregnant women and their unborn babies Describe effects of malaria on pregnant women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 31 Malaria Transmission Caused by Plasmodium parasites Spread by female Anopheles mosquitoes infected with parasites Anopheles mosquitoes usually active at night Infected mosquito bites a person Malaria parasites reproduce in human blood Mosquito bites infected person, and goes on to bite and infect another person Prevention and Control of Malaria during Pregnancy 32 Populations Most Affected by Malaria Children under 5 years of age Pregnant women Unborn babies Immigrants from low-transmission areas HIV-infected persons Prevention and Control of Malaria during Pregnancy 33 Effects of Malaria on Pregnant Women All pregnant women in malaria-endemic areas are at risk Parasites attack and destroy red blood cells Malaria causes up to 15% of anemia in pregnancy Can cause severe anemia In Africa, anemia due to malaria causes up to 10,000 maternal deaths per year Prevention and Control of Malaria during Pregnancy 34 Effects on Unborn Babies Parasites hide in placenta Interferes with transfer of oxygen and nutrients to the baby, increasing risk of: Spontaneous abortion Preterm birth Low birthweight—single greatest risk factor for death during first month of life Stillbirth Prevention and Control of Malaria during Pregnancy 35 Effects on Communities Causes missed work and wages Results in frequent school absences Uses scarce resources Causes preventable deaths: increases maternal, newborn, and infant mortality rates Prevention and Control of Malaria during Pregnancy 36 HIV/AIDS and Malaria during Pregnancy HIV/AIDS reduces a woman’s resistance to malaria Intermittent preventive treatment (IPT) given 3 times during pregnancy is effective for women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 37 Summary of Health Education Points Malaria transmitted through mosquito bites Pregnant women and children are most at risk Pregnant women infected with malaria may have no symptoms Women with HIV/AIDS are at higher risk Malaria can lead to severe anemia, spontaneous abortion, low-birthweight babies Malaria is preventable Prevention and Control of Malaria during Pregnancy Chapter III: Preventing Malaria Prevention and Control of Malaria during Pregnancy 39 Preventing Malaria: Chapter Objectives List the elements of counseling women about the use of insecticide-treated nets (ITNs) and intermittent preventive treatment (IPT) during pregnancy Describe the use of sulfadoxine-pyrimethamine (SP) for IPT during pregnancy Prevention and Control of Malaria during Pregnancy 40 Insecticide-Treated Nets Kill or repel mosquitoes Prevent physical contact with mosquitoes Kill or repel other insects: Lice Ticks Bedbugs Cockroaches Prevention and Control of Malaria during Pregnancy 41 Insecticide-Treated Nets (cont’d.) Untreated Nets Provide some protection against malaria Do not kill or repel mosquitoes that touch net Do not reduce number of mosquitoes Do not kill other insects like lice, roaches, and bedbugs Are safe for pregnant women, young children, and infants Insecticide-Treated Nets Provide a high level of protection against malaria Kills or repels mosquitoes that touch the net Reduce number of mosquitoes in/outside net Kills other insects such as lice, roaches, and bedbugs Are safe for pregnant women, young children, and infants Prevention and Control of Malaria during Pregnancy 42 Benefits of Insecticide-Treated Nets Prevent mosquito bites Protect against malaria, resulting in less: Anemia Prematurity and low birthweight Risk of maternal and newborn death Help people sleep better Promote growth and development of fetus and newborn Prevention and Control of Malaria during Pregnancy 43 Benefits of Insecticide-Treated Nets: Community Cost less than treating malaria Reduce number of sick children and adults (helping children grow to be healthy and helping working adults remain productive) Reduce number of deaths Prevention and Control of Malaria during Pregnancy 44 Where to Find Insecticide-Treated Nets General merchandise shops Drug shops/pharmacies Markets Public and private health facilities Community health workers NGOs, community-based organizations Prevention and Control of Malaria during Pregnancy 45 How to Use Insecticide-Treated Nets Hang above bed or sleeping mat Tuck under mattress or mat Use every night, all year long Use for everyone, if possible, but give priority to pregnant women, infants, and children Prevention and Control of Malaria during Pregnancy 46 Caring for Insecticide-Treated Nets Handle gently to avoid tears Tie net up during day to avoid damage Regularly inspect for holes, repair if found Nets need to be re-treated regularly to stay effective Keep away from smoke, fire, direct sunlight Prevention and Control of Malaria during Pregnancy 47 Intermittent Preventive Treatment Based on the assumption that every pregnant woman living in an area of high malaria transmission has malaria parasites in her blood or placenta, whether or not she has symptoms of malaria Prevention and Control of Malaria during Pregnancy 48 Intermittent Preventive Treatment Although a pregnant woman with malaria may have no symptoms, malaria can still affect her and her unborn child Prevention and Control of Malaria during Pregnancy 49 Intermittent Preventive Treatment: WHO Recommendation All pregnant women should receive at least two doses of IPT after quickening, during routinely scheduled ANC visits (WHO recommends a schedule of four visits, three after quickening) Presently, the most effective drug for IPT is sulfadoxine-pyrimethamine (SP) Women should receive at least two doses of IPT with SP at ANC visits after quickening, but no more frequently than monthly Prevention and Control of Malaria during Pregnancy 50 Intermittent Preventive Treatment: Dose and Timing A single dose is three tablets of sulfadoxine 500 mg + pyrimethamine 25 mg Healthcare provider should dispense dose and directly observe client taking dose Prevention and Control of Malaria during Pregnancy 51 Instructions for Giving Intermittent Preventive Treatment Ensure woman is at least 16 weeks pregnant and that quickening has occurred Inquire about use of SP in last 4 weeks Inquire about allergies to SP or other sulfa drugs (especially severe rashes) Explain what you will do; address the woman’s questions Provide cup and clean water Prevention and Control of Malaria during Pregnancy 52 Instructions for Giving Intermittent Preventive Treatment (cont’d.) Directly observe woman swallow three tablets of SP Record SP dose on ANC and clinic card Advise the woman when to return: For her next scheduled visit If she has signs of malaria If she has other danger signs Reinforce the importance of using ITNs Prevention and Control of Malaria during Pregnancy 53 Intermittent Preventive Treatment: Contraindications to Using SP Do NOT give during first trimester: Be sure quickening has occurred and woman is at least 16 weeks pregnant Do NOT give to women with reported allergy to SP or other sulfa drugs: Ask about sulfa drug allergies before giving SP Do NOT give to women taking co-trimoxazole, or other sulfa-containing drugs: Ask about use of these medicines before giving SP Do not give SP more frequently than monthly: Be sure at least 1 month has passed since the last dose of SP Prevention and Control of Malaria during Pregnancy 54 Chemoprophylaxis with Chloroquine: For Women Allergic to Sulfa Drugs* Dose Chloroquine 150 mg Timing 1 4 tablets First ANC visit after 16 weeks 2 4 tablets Second day after first dose 3 2 tablets Third day after first dose Weekly 2 tablets Every week during pregnancy *If chloroquine resistance rates in the country are high, chemoprophylaxis with chloroquine is not recommended. Prevention and Control of Malaria during Pregnancy 55 Summary of Health Education Points Pregnant women should sleep under ITNs every night By preventing malaria, IPT reduces the incidence of maternal anemia, spontaneous abortion, preterm birth, stillbirth, and low birthweight IPT should be administered to pregnant women at regularly scheduled ANC visits after quickening, but not more often than monthly
Slide 56 - Prevention and Control of Malaria during Pregnancy A Workshop for Healthcare Providers Prevention and Control of Malaria during Pregnancy 2 Facts about Malaria 300 million cases each year worldwide 9 of 10 cases occur in Africa A person in Africa dies of malaria every 10 seconds Women and young children are most at risk Affects five times as many people as AIDS, leprosy, measles, and tuberculosis combined Prevention and Control of Malaria during Pregnancy 3 Facts about Malaria and Pregnancy 30 million African women are pregnant yearly Malaria is more frequent and complicated during pregnancy In malaria-endemic areas, malaria during pregnancy may account for: Up to 15% of maternal anemia 5–14% of low birthweight 30% of “preventable” low birthweight Prevention and Control of Malaria during Pregnancy 4 Roll Back Malaria Worldwide partnership Governments, private groups, research organizations, civil society, media Aim to reduce malaria by half by 2010 Free advocacy resources and tools: http://www.rbm.who.int Priority: Prevent poor outcomes caused by malaria in pregnancy Abuja declaration: Goal is for 60% of women in Africa to be sleeping under insecticide-treated nets (ITNs) and getting intermittent preventive treatment (IPT) by 2005 Prevention and Control of Malaria during Pregnancy 5 Malaria Prevention and Treatment during Pregnancy Focused antenatal care (ANC) with health education about malaria Use of insecticide-treated nets (ITNs) Intermittent preventive treatment (IPT) Case management of women with symptoms and signs of malaria Prevention and Control of Malaria during Pregnancy Chapter I: Focused Antenatal Care Prevention and Control of Malaria during Pregnancy 7 Focused Antenatal Care: Chapter Objectives Describe four main components of focused antenatal care (ANC) Discuss frequency and timing of ANC visits Describe essential elements of a birth plan that includes complication readiness Describe interpersonal skills for effective ANC Describe components of record keeping for ANC Prevention and Control of Malaria during Pregnancy 8 Focused Antenatal Care An approach to ANC that emphasizes: Evidence-based, goal-directed actions Individualized, woman-centered care Quality vs. quantity of visits Care by skilled providers Prevention and Control of Malaria during Pregnancy 9 Goal of Focused Antenatal Care To promote maternal and newborn health and survival through: Early detection and treatment of problems and complications Prevention of complications and disease Birth preparedness and complication readiness Health promotion Prevention and Control of Malaria during Pregnancy 10 Traditional Antenatal Care Emphasizes: Ritualistic, “routine” care vs. evidence-based, goal-directed actions Frequent visits Does not emphasize individual client needs Prevention and Control of Malaria during Pregnancy 11 No Longer Recommended Numerous, routine visits Burden to women and healthcare system Routine measurements and examinations: Maternal height and weight Ankle edema Fetal position before 36 weeks Care based on risk assessment Prevention and Control of Malaria during Pregnancy 12 Risk Approach Not an effective ANC strategy because: Complications cannot be predicted—all pregnant women are at risk for developing complications Risk factors are usually not direct cause of complications Many “low risk” women develop complications Have false sense of security Do not know how to recognize/respond to problems Most “high risk” women give birth without complications Inefficient use of scarce resources Prevention and Control of Malaria during Pregnancy 13 Focused Antenatal Care Services Evidence-based, goal-directed actions: Address most prevalent health issues affecting women and newborns Adjusted for specific populations/regions Appropriate to gestational age Based on firm rationale Prevention and Control of Malaria during Pregnancy 14 Focused Antenatal Care Services (cont’d.) Individualized, woman-centered care based on each woman’s: Specific needs and concerns Circumstances History, physical examination, testing Available resources Prevention and Control of Malaria during Pregnancy 15 Focused Antenatal Care Services (cont’d.) Quality vs. quantity of ANC visits: WHO multi-center study Number of visits reduced without affecting outcome for mother or baby Recommendations Content and quality vs. number of visits Goal-oriented care Minimum of four visits Prevention and Control of Malaria during Pregnancy 16 First visit: By 16 weeks or when woman first thinks she is pregnant Second visit: At 24–28 weeks or at least once in second trimester Third visit: At 32 weeks Fourth visit: At 36 weeks Other visits: If complication occurs, followup or referral is needed, woman wants to see provider, or provider changes frequency based on findings (history, exam, testing) or local policy Scheduling and Timing of ANC Visits Prevention and Control of Malaria during Pregnancy 17 Focused Antenatal Care Services (cont’d.) Care by a skilled provider who: Has formal training and experience Has knowledge, skills, and qualifications to deliver safe, effective maternal and newborn healthcare Practices in home, hospital, health center May be a midwife, nurse, doctor, clinical officer, etc. Prevention and Control of Malaria during Pregnancy 18 Early Detection and Treatment Malaria—history and physical exam Fever and accompanying signs/symptoms Region Complicated vs. uncomplicated cases Severe anemia—physical exam, testing Pre-eclampsia/eclampsia—measurement of blood pressure HIV—voluntary counseling and testing Sexually transmitted infections, including syphilis— testing Prevention and Control of Malaria during Pregnancy 19 Prevention: Key Preventive Measures Malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Tetanus toxoid, iron/folate supplements Country/region-specific interventions as appropriate Vitamin A supplements Iodine supplements Presumptive treatment for hookworm Prevention and Control of Malaria during Pregnancy 20 Birth Preparedness and Complication Readiness: Objectives Develop birth plan—exact plan for normal birth and possible complications: Arrangements made in advance by woman and family (with help of skilled provider) Usually not a written document Reviewed/revised at every visit Minimize disorganization at time of birth or in an emergency Ensure timely and appropriate care Prevention and Control of Malaria during Pregnancy 21 Essential Elements of a Birth Plan Facility or Place of Birth: Home or health facility for birth, appropriate facility for emergencies Skilled Provider: To attend birth Provider/Facility Contact Information Transportation: Reliable, accessible, especially for odd hours Funds: Personal savings, emergency funds Decision-Making: Who will make decisions, especially in an emergency Prevention and Control of Malaria during Pregnancy 22 Essential Elements of a Birth Plan (cont’d.) Family and Community Support: Care for family in woman’s absence and birth companion during labor Blood Donor: In case of emergency Needed Items: For clean and safe birth and for newborn care Danger Signs/Signs of Advanced Labor Prevention and Control of Malaria during Pregnancy 23 Danger Signs of Pregnancy Vaginal bleeding Difficulty breathing Fever Severe abdominal pain Severe headache/blurred vision Convulsions/loss of consciousness Labor pains before 37 weeks Prevention and Control of Malaria during Pregnancy 24 Health Education: Objectives Inform and educate the woman with health messages and counseling appropriate to: Individual needs, concerns, circumstances Gestational age Most prevalent health issues Support the woman in making decisions and solving actual or anticipated problems Involve partner and family in supporting/adopting healthy practices Prevention and Control of Malaria during Pregnancy 25 Health Education: Topics Addressed Prevention of malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Other methods Other important issues to be discussed include: Nutrition Care for common discomforts Use of potentially harmful substances Hygiene Rest and activity Prevention and Control of Malaria during Pregnancy 26 Health Education: Topics Addressed (cont’d.) Sexual relations and safer sex Early and exclusive breastfeeding Prevention of tetanus and anemia Voluntary counseling and testing for HIV Prevention of other endemic diseases/deficiencies Prevention and Control of Malaria during Pregnancy 27 Interpersonal Skills Speak in a quiet, gentle tone of voice Listen to woman/family and respond appropriately Encourage them to ask questions and express concerns Allow them to demonstrate understanding of information provided Explain all procedures/actions and obtain permission before proceeding Show respect for cultural beliefs and social norms Be empathetic and nonjudgmental Avoid distractions while conducting the visit Prevention and Control of Malaria during Pregnancy 28 Record Keeping First ANC Visit History Physical examination Testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs Date of next ANC visit Subsequent ANC Visits Interim history Targeted physical examination, testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs (and relevant information on how client obtained and used ITN) Date of next ANC visit Record all information on the ANC chart and clinic card: Prevention and Control of Malaria during Pregnancy Chapter II: Malaria Transmission Prevention and Control of Malaria during Pregnancy 30 Malaria Transmission: Chapter Objectives Define malaria and how it is transmitted Describe extent of malaria in Africa Identify groups at highest risk of malaria infection List effects of malaria on pregnant women and their unborn babies Describe effects of malaria on pregnant women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 31 Malaria Transmission Caused by Plasmodium parasites Spread by female Anopheles mosquitoes infected with parasites Anopheles mosquitoes usually active at night Infected mosquito bites a person Malaria parasites reproduce in human blood Mosquito bites infected person, and goes on to bite and infect another person Prevention and Control of Malaria during Pregnancy 32 Populations Most Affected by Malaria Children under 5 years of age Pregnant women Unborn babies Immigrants from low-transmission areas HIV-infected persons Prevention and Control of Malaria during Pregnancy 33 Effects of Malaria on Pregnant Women All pregnant women in malaria-endemic areas are at risk Parasites attack and destroy red blood cells Malaria causes up to 15% of anemia in pregnancy Can cause severe anemia In Africa, anemia due to malaria causes up to 10,000 maternal deaths per year Prevention and Control of Malaria during Pregnancy 34 Effects on Unborn Babies Parasites hide in placenta Interferes with transfer of oxygen and nutrients to the baby, increasing risk of: Spontaneous abortion Preterm birth Low birthweight—single greatest risk factor for death during first month of life Stillbirth Prevention and Control of Malaria during Pregnancy 35 Effects on Communities Causes missed work and wages Results in frequent school absences Uses scarce resources Causes preventable deaths: increases maternal, newborn, and infant mortality rates Prevention and Control of Malaria during Pregnancy 36 HIV/AIDS and Malaria during Pregnancy HIV/AIDS reduces a woman’s resistance to malaria Intermittent preventive treatment (IPT) given 3 times during pregnancy is effective for women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 37 Summary of Health Education Points Malaria transmitted through mosquito bites Pregnant women and children are most at risk Pregnant women infected with malaria may have no symptoms Women with HIV/AIDS are at higher risk Malaria can lead to severe anemia, spontaneous abortion, low-birthweight babies Malaria is preventable Prevention and Control of Malaria during Pregnancy Chapter III: Preventing Malaria Prevention and Control of Malaria during Pregnancy 39 Preventing Malaria: Chapter Objectives List the elements of counseling women about the use of insecticide-treated nets (ITNs) and intermittent preventive treatment (IPT) during pregnancy Describe the use of sulfadoxine-pyrimethamine (SP) for IPT during pregnancy Prevention and Control of Malaria during Pregnancy 40 Insecticide-Treated Nets Kill or repel mosquitoes Prevent physical contact with mosquitoes Kill or repel other insects: Lice Ticks Bedbugs Cockroaches Prevention and Control of Malaria during Pregnancy 41 Insecticide-Treated Nets (cont’d.) Untreated Nets Provide some protection against malaria Do not kill or repel mosquitoes that touch net Do not reduce number of mosquitoes Do not kill other insects like lice, roaches, and bedbugs Are safe for pregnant women, young children, and infants Insecticide-Treated Nets Provide a high level of protection against malaria Kills or repels mosquitoes that touch the net Reduce number of mosquitoes in/outside net Kills other insects such as lice, roaches, and bedbugs Are safe for pregnant women, young children, and infants Prevention and Control of Malaria during Pregnancy 42 Benefits of Insecticide-Treated Nets Prevent mosquito bites Protect against malaria, resulting in less: Anemia Prematurity and low birthweight Risk of maternal and newborn death Help people sleep better Promote growth and development of fetus and newborn Prevention and Control of Malaria during Pregnancy 43 Benefits of Insecticide-Treated Nets: Community Cost less than treating malaria Reduce number of sick children and adults (helping children grow to be healthy and helping working adults remain productive) Reduce number of deaths Prevention and Control of Malaria during Pregnancy 44 Where to Find Insecticide-Treated Nets General merchandise shops Drug shops/pharmacies Markets Public and private health facilities Community health workers NGOs, community-based organizations Prevention and Control of Malaria during Pregnancy 45 How to Use Insecticide-Treated Nets Hang above bed or sleeping mat Tuck under mattress or mat Use every night, all year long Use for everyone, if possible, but give priority to pregnant women, infants, and children Prevention and Control of Malaria during Pregnancy 46 Caring for Insecticide-Treated Nets Handle gently to avoid tears Tie net up during day to avoid damage Regularly inspect for holes, repair if found Nets need to be re-treated regularly to stay effective Keep away from smoke, fire, direct sunlight Prevention and Control of Malaria during Pregnancy 47 Intermittent Preventive Treatment Based on the assumption that every pregnant woman living in an area of high malaria transmission has malaria parasites in her blood or placenta, whether or not she has symptoms of malaria Prevention and Control of Malaria during Pregnancy 48 Intermittent Preventive Treatment Although a pregnant woman with malaria may have no symptoms, malaria can still affect her and her unborn child Prevention and Control of Malaria during Pregnancy 49 Intermittent Preventive Treatment: WHO Recommendation All pregnant women should receive at least two doses of IPT after quickening, during routinely scheduled ANC visits (WHO recommends a schedule of four visits, three after quickening) Presently, the most effective drug for IPT is sulfadoxine-pyrimethamine (SP) Women should receive at least two doses of IPT with SP at ANC visits after quickening, but no more frequently than monthly Prevention and Control of Malaria during Pregnancy 50 Intermittent Preventive Treatment: Dose and Timing A single dose is three tablets of sulfadoxine 500 mg + pyrimethamine 25 mg Healthcare provider should dispense dose and directly observe client taking dose Prevention and Control of Malaria during Pregnancy 51 Instructions for Giving Intermittent Preventive Treatment Ensure woman is at least 16 weeks pregnant and that quickening has occurred Inquire about use of SP in last 4 weeks Inquire about allergies to SP or other sulfa drugs (especially severe rashes) Explain what you will do; address the woman’s questions Provide cup and clean water Prevention and Control of Malaria during Pregnancy 52 Instructions for Giving Intermittent Preventive Treatment (cont’d.) Directly observe woman swallow three tablets of SP Record SP dose on ANC and clinic card Advise the woman when to return: For her next scheduled visit If she has signs of malaria If she has other danger signs Reinforce the importance of using ITNs Prevention and Control of Malaria during Pregnancy 53 Intermittent Preventive Treatment: Contraindications to Using SP Do NOT give during first trimester: Be sure quickening has occurred and woman is at least 16 weeks pregnant Do NOT give to women with reported allergy to SP or other sulfa drugs: Ask about sulfa drug allergies before giving SP Do NOT give to women taking co-trimoxazole, or other sulfa-containing drugs: Ask about use of these medicines before giving SP Do not give SP more frequently than monthly: Be sure at least 1 month has passed since the last dose of SP Prevention and Control of Malaria during Pregnancy 54 Chemoprophylaxis with Chloroquine: For Women Allergic to Sulfa Drugs* Dose Chloroquine 150 mg Timing 1 4 tablets First ANC visit after 16 weeks 2 4 tablets Second day after first dose 3 2 tablets Third day after first dose Weekly 2 tablets Every week during pregnancy *If chloroquine resistance rates in the country are high, chemoprophylaxis with chloroquine is not recommended. Prevention and Control of Malaria during Pregnancy 55 Summary of Health Education Points Pregnant women should sleep under ITNs every night By preventing malaria, IPT reduces the incidence of maternal anemia, spontaneous abortion, preterm birth, stillbirth, and low birthweight IPT should be administered to pregnant women at regularly scheduled ANC visits after quickening, but not more often than monthly Prevention and Control of Malaria during Pregnancy Chapter IV: Detection and Treatment
Slide 57 - Prevention and Control of Malaria during Pregnancy A Workshop for Healthcare Providers Prevention and Control of Malaria during Pregnancy 2 Facts about Malaria 300 million cases each year worldwide 9 of 10 cases occur in Africa A person in Africa dies of malaria every 10 seconds Women and young children are most at risk Affects five times as many people as AIDS, leprosy, measles, and tuberculosis combined Prevention and Control of Malaria during Pregnancy 3 Facts about Malaria and Pregnancy 30 million African women are pregnant yearly Malaria is more frequent and complicated during pregnancy In malaria-endemic areas, malaria during pregnancy may account for: Up to 15% of maternal anemia 5–14% of low birthweight 30% of “preventable” low birthweight Prevention and Control of Malaria during Pregnancy 4 Roll Back Malaria Worldwide partnership Governments, private groups, research organizations, civil society, media Aim to reduce malaria by half by 2010 Free advocacy resources and tools: http://www.rbm.who.int Priority: Prevent poor outcomes caused by malaria in pregnancy Abuja declaration: Goal is for 60% of women in Africa to be sleeping under insecticide-treated nets (ITNs) and getting intermittent preventive treatment (IPT) by 2005 Prevention and Control of Malaria during Pregnancy 5 Malaria Prevention and Treatment during Pregnancy Focused antenatal care (ANC) with health education about malaria Use of insecticide-treated nets (ITNs) Intermittent preventive treatment (IPT) Case management of women with symptoms and signs of malaria Prevention and Control of Malaria during Pregnancy Chapter I: Focused Antenatal Care Prevention and Control of Malaria during Pregnancy 7 Focused Antenatal Care: Chapter Objectives Describe four main components of focused antenatal care (ANC) Discuss frequency and timing of ANC visits Describe essential elements of a birth plan that includes complication readiness Describe interpersonal skills for effective ANC Describe components of record keeping for ANC Prevention and Control of Malaria during Pregnancy 8 Focused Antenatal Care An approach to ANC that emphasizes: Evidence-based, goal-directed actions Individualized, woman-centered care Quality vs. quantity of visits Care by skilled providers Prevention and Control of Malaria during Pregnancy 9 Goal of Focused Antenatal Care To promote maternal and newborn health and survival through: Early detection and treatment of problems and complications Prevention of complications and disease Birth preparedness and complication readiness Health promotion Prevention and Control of Malaria during Pregnancy 10 Traditional Antenatal Care Emphasizes: Ritualistic, “routine” care vs. evidence-based, goal-directed actions Frequent visits Does not emphasize individual client needs Prevention and Control of Malaria during Pregnancy 11 No Longer Recommended Numerous, routine visits Burden to women and healthcare system Routine measurements and examinations: Maternal height and weight Ankle edema Fetal position before 36 weeks Care based on risk assessment Prevention and Control of Malaria during Pregnancy 12 Risk Approach Not an effective ANC strategy because: Complications cannot be predicted—all pregnant women are at risk for developing complications Risk factors are usually not direct cause of complications Many “low risk” women develop complications Have false sense of security Do not know how to recognize/respond to problems Most “high risk” women give birth without complications Inefficient use of scarce resources Prevention and Control of Malaria during Pregnancy 13 Focused Antenatal Care Services Evidence-based, goal-directed actions: Address most prevalent health issues affecting women and newborns Adjusted for specific populations/regions Appropriate to gestational age Based on firm rationale Prevention and Control of Malaria during Pregnancy 14 Focused Antenatal Care Services (cont’d.) Individualized, woman-centered care based on each woman’s: Specific needs and concerns Circumstances History, physical examination, testing Available resources Prevention and Control of Malaria during Pregnancy 15 Focused Antenatal Care Services (cont’d.) Quality vs. quantity of ANC visits: WHO multi-center study Number of visits reduced without affecting outcome for mother or baby Recommendations Content and quality vs. number of visits Goal-oriented care Minimum of four visits Prevention and Control of Malaria during Pregnancy 16 First visit: By 16 weeks or when woman first thinks she is pregnant Second visit: At 24–28 weeks or at least once in second trimester Third visit: At 32 weeks Fourth visit: At 36 weeks Other visits: If complication occurs, followup or referral is needed, woman wants to see provider, or provider changes frequency based on findings (history, exam, testing) or local policy Scheduling and Timing of ANC Visits Prevention and Control of Malaria during Pregnancy 17 Focused Antenatal Care Services (cont’d.) Care by a skilled provider who: Has formal training and experience Has knowledge, skills, and qualifications to deliver safe, effective maternal and newborn healthcare Practices in home, hospital, health center May be a midwife, nurse, doctor, clinical officer, etc. Prevention and Control of Malaria during Pregnancy 18 Early Detection and Treatment Malaria—history and physical exam Fever and accompanying signs/symptoms Region Complicated vs. uncomplicated cases Severe anemia—physical exam, testing Pre-eclampsia/eclampsia—measurement of blood pressure HIV—voluntary counseling and testing Sexually transmitted infections, including syphilis— testing Prevention and Control of Malaria during Pregnancy 19 Prevention: Key Preventive Measures Malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Tetanus toxoid, iron/folate supplements Country/region-specific interventions as appropriate Vitamin A supplements Iodine supplements Presumptive treatment for hookworm Prevention and Control of Malaria during Pregnancy 20 Birth Preparedness and Complication Readiness: Objectives Develop birth plan—exact plan for normal birth and possible complications: Arrangements made in advance by woman and family (with help of skilled provider) Usually not a written document Reviewed/revised at every visit Minimize disorganization at time of birth or in an emergency Ensure timely and appropriate care Prevention and Control of Malaria during Pregnancy 21 Essential Elements of a Birth Plan Facility or Place of Birth: Home or health facility for birth, appropriate facility for emergencies Skilled Provider: To attend birth Provider/Facility Contact Information Transportation: Reliable, accessible, especially for odd hours Funds: Personal savings, emergency funds Decision-Making: Who will make decisions, especially in an emergency Prevention and Control of Malaria during Pregnancy 22 Essential Elements of a Birth Plan (cont’d.) Family and Community Support: Care for family in woman’s absence and birth companion during labor Blood Donor: In case of emergency Needed Items: For clean and safe birth and for newborn care Danger Signs/Signs of Advanced Labor Prevention and Control of Malaria during Pregnancy 23 Danger Signs of Pregnancy Vaginal bleeding Difficulty breathing Fever Severe abdominal pain Severe headache/blurred vision Convulsions/loss of consciousness Labor pains before 37 weeks Prevention and Control of Malaria during Pregnancy 24 Health Education: Objectives Inform and educate the woman with health messages and counseling appropriate to: Individual needs, concerns, circumstances Gestational age Most prevalent health issues Support the woman in making decisions and solving actual or anticipated problems Involve partner and family in supporting/adopting healthy practices Prevention and Control of Malaria during Pregnancy 25 Health Education: Topics Addressed Prevention of malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Other methods Other important issues to be discussed include: Nutrition Care for common discomforts Use of potentially harmful substances Hygiene Rest and activity Prevention and Control of Malaria during Pregnancy 26 Health Education: Topics Addressed (cont’d.) Sexual relations and safer sex Early and exclusive breastfeeding Prevention of tetanus and anemia Voluntary counseling and testing for HIV Prevention of other endemic diseases/deficiencies Prevention and Control of Malaria during Pregnancy 27 Interpersonal Skills Speak in a quiet, gentle tone of voice Listen to woman/family and respond appropriately Encourage them to ask questions and express concerns Allow them to demonstrate understanding of information provided Explain all procedures/actions and obtain permission before proceeding Show respect for cultural beliefs and social norms Be empathetic and nonjudgmental Avoid distractions while conducting the visit Prevention and Control of Malaria during Pregnancy 28 Record Keeping First ANC Visit History Physical examination Testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs Date of next ANC visit Subsequent ANC Visits Interim history Targeted physical examination, testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs (and relevant information on how client obtained and used ITN) Date of next ANC visit Record all information on the ANC chart and clinic card: Prevention and Control of Malaria during Pregnancy Chapter II: Malaria Transmission Prevention and Control of Malaria during Pregnancy 30 Malaria Transmission: Chapter Objectives Define malaria and how it is transmitted Describe extent of malaria in Africa Identify groups at highest risk of malaria infection List effects of malaria on pregnant women and their unborn babies Describe effects of malaria on pregnant women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 31 Malaria Transmission Caused by Plasmodium parasites Spread by female Anopheles mosquitoes infected with parasites Anopheles mosquitoes usually active at night Infected mosquito bites a person Malaria parasites reproduce in human blood Mosquito bites infected person, and goes on to bite and infect another person Prevention and Control of Malaria during Pregnancy 32 Populations Most Affected by Malaria Children under 5 years of age Pregnant women Unborn babies Immigrants from low-transmission areas HIV-infected persons Prevention and Control of Malaria during Pregnancy 33 Effects of Malaria on Pregnant Women All pregnant women in malaria-endemic areas are at risk Parasites attack and destroy red blood cells Malaria causes up to 15% of anemia in pregnancy Can cause severe anemia In Africa, anemia due to malaria causes up to 10,000 maternal deaths per year Prevention and Control of Malaria during Pregnancy 34 Effects on Unborn Babies Parasites hide in placenta Interferes with transfer of oxygen and nutrients to the baby, increasing risk of: Spontaneous abortion Preterm birth Low birthweight—single greatest risk factor for death during first month of life Stillbirth Prevention and Control of Malaria during Pregnancy 35 Effects on Communities Causes missed work and wages Results in frequent school absences Uses scarce resources Causes preventable deaths: increases maternal, newborn, and infant mortality rates Prevention and Control of Malaria during Pregnancy 36 HIV/AIDS and Malaria during Pregnancy HIV/AIDS reduces a woman’s resistance to malaria Intermittent preventive treatment (IPT) given 3 times during pregnancy is effective for women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 37 Summary of Health Education Points Malaria transmitted through mosquito bites Pregnant women and children are most at risk Pregnant women infected with malaria may have no symptoms Women with HIV/AIDS are at higher risk Malaria can lead to severe anemia, spontaneous abortion, low-birthweight babies Malaria is preventable Prevention and Control of Malaria during Pregnancy Chapter III: Preventing Malaria Prevention and Control of Malaria during Pregnancy 39 Preventing Malaria: Chapter Objectives List the elements of counseling women about the use of insecticide-treated nets (ITNs) and intermittent preventive treatment (IPT) during pregnancy Describe the use of sulfadoxine-pyrimethamine (SP) for IPT during pregnancy Prevention and Control of Malaria during Pregnancy 40 Insecticide-Treated Nets Kill or repel mosquitoes Prevent physical contact with mosquitoes Kill or repel other insects: Lice Ticks Bedbugs Cockroaches Prevention and Control of Malaria during Pregnancy 41 Insecticide-Treated Nets (cont’d.) Untreated Nets Provide some protection against malaria Do not kill or repel mosquitoes that touch net Do not reduce number of mosquitoes Do not kill other insects like lice, roaches, and bedbugs Are safe for pregnant women, young children, and infants Insecticide-Treated Nets Provide a high level of protection against malaria Kills or repels mosquitoes that touch the net Reduce number of mosquitoes in/outside net Kills other insects such as lice, roaches, and bedbugs Are safe for pregnant women, young children, and infants Prevention and Control of Malaria during Pregnancy 42 Benefits of Insecticide-Treated Nets Prevent mosquito bites Protect against malaria, resulting in less: Anemia Prematurity and low birthweight Risk of maternal and newborn death Help people sleep better Promote growth and development of fetus and newborn Prevention and Control of Malaria during Pregnancy 43 Benefits of Insecticide-Treated Nets: Community Cost less than treating malaria Reduce number of sick children and adults (helping children grow to be healthy and helping working adults remain productive) Reduce number of deaths Prevention and Control of Malaria during Pregnancy 44 Where to Find Insecticide-Treated Nets General merchandise shops Drug shops/pharmacies Markets Public and private health facilities Community health workers NGOs, community-based organizations Prevention and Control of Malaria during Pregnancy 45 How to Use Insecticide-Treated Nets Hang above bed or sleeping mat Tuck under mattress or mat Use every night, all year long Use for everyone, if possible, but give priority to pregnant women, infants, and children Prevention and Control of Malaria during Pregnancy 46 Caring for Insecticide-Treated Nets Handle gently to avoid tears Tie net up during day to avoid damage Regularly inspect for holes, repair if found Nets need to be re-treated regularly to stay effective Keep away from smoke, fire, direct sunlight Prevention and Control of Malaria during Pregnancy 47 Intermittent Preventive Treatment Based on the assumption that every pregnant woman living in an area of high malaria transmission has malaria parasites in her blood or placenta, whether or not she has symptoms of malaria Prevention and Control of Malaria during Pregnancy 48 Intermittent Preventive Treatment Although a pregnant woman with malaria may have no symptoms, malaria can still affect her and her unborn child Prevention and Control of Malaria during Pregnancy 49 Intermittent Preventive Treatment: WHO Recommendation All pregnant women should receive at least two doses of IPT after quickening, during routinely scheduled ANC visits (WHO recommends a schedule of four visits, three after quickening) Presently, the most effective drug for IPT is sulfadoxine-pyrimethamine (SP) Women should receive at least two doses of IPT with SP at ANC visits after quickening, but no more frequently than monthly Prevention and Control of Malaria during Pregnancy 50 Intermittent Preventive Treatment: Dose and Timing A single dose is three tablets of sulfadoxine 500 mg + pyrimethamine 25 mg Healthcare provider should dispense dose and directly observe client taking dose Prevention and Control of Malaria during Pregnancy 51 Instructions for Giving Intermittent Preventive Treatment Ensure woman is at least 16 weeks pregnant and that quickening has occurred Inquire about use of SP in last 4 weeks Inquire about allergies to SP or other sulfa drugs (especially severe rashes) Explain what you will do; address the woman’s questions Provide cup and clean water Prevention and Control of Malaria during Pregnancy 52 Instructions for Giving Intermittent Preventive Treatment (cont’d.) Directly observe woman swallow three tablets of SP Record SP dose on ANC and clinic card Advise the woman when to return: For her next scheduled visit If she has signs of malaria If she has other danger signs Reinforce the importance of using ITNs Prevention and Control of Malaria during Pregnancy 53 Intermittent Preventive Treatment: Contraindications to Using SP Do NOT give during first trimester: Be sure quickening has occurred and woman is at least 16 weeks pregnant Do NOT give to women with reported allergy to SP or other sulfa drugs: Ask about sulfa drug allergies before giving SP Do NOT give to women taking co-trimoxazole, or other sulfa-containing drugs: Ask about use of these medicines before giving SP Do not give SP more frequently than monthly: Be sure at least 1 month has passed since the last dose of SP Prevention and Control of Malaria during Pregnancy 54 Chemoprophylaxis with Chloroquine: For Women Allergic to Sulfa Drugs* Dose Chloroquine 150 mg Timing 1 4 tablets First ANC visit after 16 weeks 2 4 tablets Second day after first dose 3 2 tablets Third day after first dose Weekly 2 tablets Every week during pregnancy *If chloroquine resistance rates in the country are high, chemoprophylaxis with chloroquine is not recommended. Prevention and Control of Malaria during Pregnancy 55 Summary of Health Education Points Pregnant women should sleep under ITNs every night By preventing malaria, IPT reduces the incidence of maternal anemia, spontaneous abortion, preterm birth, stillbirth, and low birthweight IPT should be administered to pregnant women at regularly scheduled ANC visits after quickening, but not more often than monthly Prevention and Control of Malaria during Pregnancy Chapter IV: Detection and Treatment Prevention and Control of Malaria during Pregnancy 57 Malaria Detection and Treatment: Chapter Objectives Identify causes of fever during pregnancy List the signs and symptoms of uncomplicated and complicated malaria Describe the treatment for uncomplicated malaria during pregnancy Explain the steps to appropriately refer a pregnant woman who has complicated malaria
Slide 58 - Prevention and Control of Malaria during Pregnancy A Workshop for Healthcare Providers Prevention and Control of Malaria during Pregnancy 2 Facts about Malaria 300 million cases each year worldwide 9 of 10 cases occur in Africa A person in Africa dies of malaria every 10 seconds Women and young children are most at risk Affects five times as many people as AIDS, leprosy, measles, and tuberculosis combined Prevention and Control of Malaria during Pregnancy 3 Facts about Malaria and Pregnancy 30 million African women are pregnant yearly Malaria is more frequent and complicated during pregnancy In malaria-endemic areas, malaria during pregnancy may account for: Up to 15% of maternal anemia 5–14% of low birthweight 30% of “preventable” low birthweight Prevention and Control of Malaria during Pregnancy 4 Roll Back Malaria Worldwide partnership Governments, private groups, research organizations, civil society, media Aim to reduce malaria by half by 2010 Free advocacy resources and tools: http://www.rbm.who.int Priority: Prevent poor outcomes caused by malaria in pregnancy Abuja declaration: Goal is for 60% of women in Africa to be sleeping under insecticide-treated nets (ITNs) and getting intermittent preventive treatment (IPT) by 2005 Prevention and Control of Malaria during Pregnancy 5 Malaria Prevention and Treatment during Pregnancy Focused antenatal care (ANC) with health education about malaria Use of insecticide-treated nets (ITNs) Intermittent preventive treatment (IPT) Case management of women with symptoms and signs of malaria Prevention and Control of Malaria during Pregnancy Chapter I: Focused Antenatal Care Prevention and Control of Malaria during Pregnancy 7 Focused Antenatal Care: Chapter Objectives Describe four main components of focused antenatal care (ANC) Discuss frequency and timing of ANC visits Describe essential elements of a birth plan that includes complication readiness Describe interpersonal skills for effective ANC Describe components of record keeping for ANC Prevention and Control of Malaria during Pregnancy 8 Focused Antenatal Care An approach to ANC that emphasizes: Evidence-based, goal-directed actions Individualized, woman-centered care Quality vs. quantity of visits Care by skilled providers Prevention and Control of Malaria during Pregnancy 9 Goal of Focused Antenatal Care To promote maternal and newborn health and survival through: Early detection and treatment of problems and complications Prevention of complications and disease Birth preparedness and complication readiness Health promotion Prevention and Control of Malaria during Pregnancy 10 Traditional Antenatal Care Emphasizes: Ritualistic, “routine” care vs. evidence-based, goal-directed actions Frequent visits Does not emphasize individual client needs Prevention and Control of Malaria during Pregnancy 11 No Longer Recommended Numerous, routine visits Burden to women and healthcare system Routine measurements and examinations: Maternal height and weight Ankle edema Fetal position before 36 weeks Care based on risk assessment Prevention and Control of Malaria during Pregnancy 12 Risk Approach Not an effective ANC strategy because: Complications cannot be predicted—all pregnant women are at risk for developing complications Risk factors are usually not direct cause of complications Many “low risk” women develop complications Have false sense of security Do not know how to recognize/respond to problems Most “high risk” women give birth without complications Inefficient use of scarce resources Prevention and Control of Malaria during Pregnancy 13 Focused Antenatal Care Services Evidence-based, goal-directed actions: Address most prevalent health issues affecting women and newborns Adjusted for specific populations/regions Appropriate to gestational age Based on firm rationale Prevention and Control of Malaria during Pregnancy 14 Focused Antenatal Care Services (cont’d.) Individualized, woman-centered care based on each woman’s: Specific needs and concerns Circumstances History, physical examination, testing Available resources Prevention and Control of Malaria during Pregnancy 15 Focused Antenatal Care Services (cont’d.) Quality vs. quantity of ANC visits: WHO multi-center study Number of visits reduced without affecting outcome for mother or baby Recommendations Content and quality vs. number of visits Goal-oriented care Minimum of four visits Prevention and Control of Malaria during Pregnancy 16 First visit: By 16 weeks or when woman first thinks she is pregnant Second visit: At 24–28 weeks or at least once in second trimester Third visit: At 32 weeks Fourth visit: At 36 weeks Other visits: If complication occurs, followup or referral is needed, woman wants to see provider, or provider changes frequency based on findings (history, exam, testing) or local policy Scheduling and Timing of ANC Visits Prevention and Control of Malaria during Pregnancy 17 Focused Antenatal Care Services (cont’d.) Care by a skilled provider who: Has formal training and experience Has knowledge, skills, and qualifications to deliver safe, effective maternal and newborn healthcare Practices in home, hospital, health center May be a midwife, nurse, doctor, clinical officer, etc. Prevention and Control of Malaria during Pregnancy 18 Early Detection and Treatment Malaria—history and physical exam Fever and accompanying signs/symptoms Region Complicated vs. uncomplicated cases Severe anemia—physical exam, testing Pre-eclampsia/eclampsia—measurement of blood pressure HIV—voluntary counseling and testing Sexually transmitted infections, including syphilis— testing Prevention and Control of Malaria during Pregnancy 19 Prevention: Key Preventive Measures Malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Tetanus toxoid, iron/folate supplements Country/region-specific interventions as appropriate Vitamin A supplements Iodine supplements Presumptive treatment for hookworm Prevention and Control of Malaria during Pregnancy 20 Birth Preparedness and Complication Readiness: Objectives Develop birth plan—exact plan for normal birth and possible complications: Arrangements made in advance by woman and family (with help of skilled provider) Usually not a written document Reviewed/revised at every visit Minimize disorganization at time of birth or in an emergency Ensure timely and appropriate care Prevention and Control of Malaria during Pregnancy 21 Essential Elements of a Birth Plan Facility or Place of Birth: Home or health facility for birth, appropriate facility for emergencies Skilled Provider: To attend birth Provider/Facility Contact Information Transportation: Reliable, accessible, especially for odd hours Funds: Personal savings, emergency funds Decision-Making: Who will make decisions, especially in an emergency Prevention and Control of Malaria during Pregnancy 22 Essential Elements of a Birth Plan (cont’d.) Family and Community Support: Care for family in woman’s absence and birth companion during labor Blood Donor: In case of emergency Needed Items: For clean and safe birth and for newborn care Danger Signs/Signs of Advanced Labor Prevention and Control of Malaria during Pregnancy 23 Danger Signs of Pregnancy Vaginal bleeding Difficulty breathing Fever Severe abdominal pain Severe headache/blurred vision Convulsions/loss of consciousness Labor pains before 37 weeks Prevention and Control of Malaria during Pregnancy 24 Health Education: Objectives Inform and educate the woman with health messages and counseling appropriate to: Individual needs, concerns, circumstances Gestational age Most prevalent health issues Support the woman in making decisions and solving actual or anticipated problems Involve partner and family in supporting/adopting healthy practices Prevention and Control of Malaria during Pregnancy 25 Health Education: Topics Addressed Prevention of malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Other methods Other important issues to be discussed include: Nutrition Care for common discomforts Use of potentially harmful substances Hygiene Rest and activity Prevention and Control of Malaria during Pregnancy 26 Health Education: Topics Addressed (cont’d.) Sexual relations and safer sex Early and exclusive breastfeeding Prevention of tetanus and anemia Voluntary counseling and testing for HIV Prevention of other endemic diseases/deficiencies Prevention and Control of Malaria during Pregnancy 27 Interpersonal Skills Speak in a quiet, gentle tone of voice Listen to woman/family and respond appropriately Encourage them to ask questions and express concerns Allow them to demonstrate understanding of information provided Explain all procedures/actions and obtain permission before proceeding Show respect for cultural beliefs and social norms Be empathetic and nonjudgmental Avoid distractions while conducting the visit Prevention and Control of Malaria during Pregnancy 28 Record Keeping First ANC Visit History Physical examination Testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs Date of next ANC visit Subsequent ANC Visits Interim history Targeted physical examination, testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs (and relevant information on how client obtained and used ITN) Date of next ANC visit Record all information on the ANC chart and clinic card: Prevention and Control of Malaria during Pregnancy Chapter II: Malaria Transmission Prevention and Control of Malaria during Pregnancy 30 Malaria Transmission: Chapter Objectives Define malaria and how it is transmitted Describe extent of malaria in Africa Identify groups at highest risk of malaria infection List effects of malaria on pregnant women and their unborn babies Describe effects of malaria on pregnant women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 31 Malaria Transmission Caused by Plasmodium parasites Spread by female Anopheles mosquitoes infected with parasites Anopheles mosquitoes usually active at night Infected mosquito bites a person Malaria parasites reproduce in human blood Mosquito bites infected person, and goes on to bite and infect another person Prevention and Control of Malaria during Pregnancy 32 Populations Most Affected by Malaria Children under 5 years of age Pregnant women Unborn babies Immigrants from low-transmission areas HIV-infected persons Prevention and Control of Malaria during Pregnancy 33 Effects of Malaria on Pregnant Women All pregnant women in malaria-endemic areas are at risk Parasites attack and destroy red blood cells Malaria causes up to 15% of anemia in pregnancy Can cause severe anemia In Africa, anemia due to malaria causes up to 10,000 maternal deaths per year Prevention and Control of Malaria during Pregnancy 34 Effects on Unborn Babies Parasites hide in placenta Interferes with transfer of oxygen and nutrients to the baby, increasing risk of: Spontaneous abortion Preterm birth Low birthweight—single greatest risk factor for death during first month of life Stillbirth Prevention and Control of Malaria during Pregnancy 35 Effects on Communities Causes missed work and wages Results in frequent school absences Uses scarce resources Causes preventable deaths: increases maternal, newborn, and infant mortality rates Prevention and Control of Malaria during Pregnancy 36 HIV/AIDS and Malaria during Pregnancy HIV/AIDS reduces a woman’s resistance to malaria Intermittent preventive treatment (IPT) given 3 times during pregnancy is effective for women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 37 Summary of Health Education Points Malaria transmitted through mosquito bites Pregnant women and children are most at risk Pregnant women infected with malaria may have no symptoms Women with HIV/AIDS are at higher risk Malaria can lead to severe anemia, spontaneous abortion, low-birthweight babies Malaria is preventable Prevention and Control of Malaria during Pregnancy Chapter III: Preventing Malaria Prevention and Control of Malaria during Pregnancy 39 Preventing Malaria: Chapter Objectives List the elements of counseling women about the use of insecticide-treated nets (ITNs) and intermittent preventive treatment (IPT) during pregnancy Describe the use of sulfadoxine-pyrimethamine (SP) for IPT during pregnancy Prevention and Control of Malaria during Pregnancy 40 Insecticide-Treated Nets Kill or repel mosquitoes Prevent physical contact with mosquitoes Kill or repel other insects: Lice Ticks Bedbugs Cockroaches Prevention and Control of Malaria during Pregnancy 41 Insecticide-Treated Nets (cont’d.) Untreated Nets Provide some protection against malaria Do not kill or repel mosquitoes that touch net Do not reduce number of mosquitoes Do not kill other insects like lice, roaches, and bedbugs Are safe for pregnant women, young children, and infants Insecticide-Treated Nets Provide a high level of protection against malaria Kills or repels mosquitoes that touch the net Reduce number of mosquitoes in/outside net Kills other insects such as lice, roaches, and bedbugs Are safe for pregnant women, young children, and infants Prevention and Control of Malaria during Pregnancy 42 Benefits of Insecticide-Treated Nets Prevent mosquito bites Protect against malaria, resulting in less: Anemia Prematurity and low birthweight Risk of maternal and newborn death Help people sleep better Promote growth and development of fetus and newborn Prevention and Control of Malaria during Pregnancy 43 Benefits of Insecticide-Treated Nets: Community Cost less than treating malaria Reduce number of sick children and adults (helping children grow to be healthy and helping working adults remain productive) Reduce number of deaths Prevention and Control of Malaria during Pregnancy 44 Where to Find Insecticide-Treated Nets General merchandise shops Drug shops/pharmacies Markets Public and private health facilities Community health workers NGOs, community-based organizations Prevention and Control of Malaria during Pregnancy 45 How to Use Insecticide-Treated Nets Hang above bed or sleeping mat Tuck under mattress or mat Use every night, all year long Use for everyone, if possible, but give priority to pregnant women, infants, and children Prevention and Control of Malaria during Pregnancy 46 Caring for Insecticide-Treated Nets Handle gently to avoid tears Tie net up during day to avoid damage Regularly inspect for holes, repair if found Nets need to be re-treated regularly to stay effective Keep away from smoke, fire, direct sunlight Prevention and Control of Malaria during Pregnancy 47 Intermittent Preventive Treatment Based on the assumption that every pregnant woman living in an area of high malaria transmission has malaria parasites in her blood or placenta, whether or not she has symptoms of malaria Prevention and Control of Malaria during Pregnancy 48 Intermittent Preventive Treatment Although a pregnant woman with malaria may have no symptoms, malaria can still affect her and her unborn child Prevention and Control of Malaria during Pregnancy 49 Intermittent Preventive Treatment: WHO Recommendation All pregnant women should receive at least two doses of IPT after quickening, during routinely scheduled ANC visits (WHO recommends a schedule of four visits, three after quickening) Presently, the most effective drug for IPT is sulfadoxine-pyrimethamine (SP) Women should receive at least two doses of IPT with SP at ANC visits after quickening, but no more frequently than monthly Prevention and Control of Malaria during Pregnancy 50 Intermittent Preventive Treatment: Dose and Timing A single dose is three tablets of sulfadoxine 500 mg + pyrimethamine 25 mg Healthcare provider should dispense dose and directly observe client taking dose Prevention and Control of Malaria during Pregnancy 51 Instructions for Giving Intermittent Preventive Treatment Ensure woman is at least 16 weeks pregnant and that quickening has occurred Inquire about use of SP in last 4 weeks Inquire about allergies to SP or other sulfa drugs (especially severe rashes) Explain what you will do; address the woman’s questions Provide cup and clean water Prevention and Control of Malaria during Pregnancy 52 Instructions for Giving Intermittent Preventive Treatment (cont’d.) Directly observe woman swallow three tablets of SP Record SP dose on ANC and clinic card Advise the woman when to return: For her next scheduled visit If she has signs of malaria If she has other danger signs Reinforce the importance of using ITNs Prevention and Control of Malaria during Pregnancy 53 Intermittent Preventive Treatment: Contraindications to Using SP Do NOT give during first trimester: Be sure quickening has occurred and woman is at least 16 weeks pregnant Do NOT give to women with reported allergy to SP or other sulfa drugs: Ask about sulfa drug allergies before giving SP Do NOT give to women taking co-trimoxazole, or other sulfa-containing drugs: Ask about use of these medicines before giving SP Do not give SP more frequently than monthly: Be sure at least 1 month has passed since the last dose of SP Prevention and Control of Malaria during Pregnancy 54 Chemoprophylaxis with Chloroquine: For Women Allergic to Sulfa Drugs* Dose Chloroquine 150 mg Timing 1 4 tablets First ANC visit after 16 weeks 2 4 tablets Second day after first dose 3 2 tablets Third day after first dose Weekly 2 tablets Every week during pregnancy *If chloroquine resistance rates in the country are high, chemoprophylaxis with chloroquine is not recommended. Prevention and Control of Malaria during Pregnancy 55 Summary of Health Education Points Pregnant women should sleep under ITNs every night By preventing malaria, IPT reduces the incidence of maternal anemia, spontaneous abortion, preterm birth, stillbirth, and low birthweight IPT should be administered to pregnant women at regularly scheduled ANC visits after quickening, but not more often than monthly Prevention and Control of Malaria during Pregnancy Chapter IV: Detection and Treatment Prevention and Control of Malaria during Pregnancy 57 Malaria Detection and Treatment: Chapter Objectives Identify causes of fever during pregnancy List the signs and symptoms of uncomplicated and complicated malaria Describe the treatment for uncomplicated malaria during pregnancy Explain the steps to appropriately refer a pregnant woman who has complicated malaria Prevention and Control of Malaria during Pregnancy 58 Detecting Malaria Symptoms Fever Chills Headaches Muscle/joint pains Lab exam of blood from a finger prick
Slide 59 - Prevention and Control of Malaria during Pregnancy A Workshop for Healthcare Providers Prevention and Control of Malaria during Pregnancy 2 Facts about Malaria 300 million cases each year worldwide 9 of 10 cases occur in Africa A person in Africa dies of malaria every 10 seconds Women and young children are most at risk Affects five times as many people as AIDS, leprosy, measles, and tuberculosis combined Prevention and Control of Malaria during Pregnancy 3 Facts about Malaria and Pregnancy 30 million African women are pregnant yearly Malaria is more frequent and complicated during pregnancy In malaria-endemic areas, malaria during pregnancy may account for: Up to 15% of maternal anemia 5–14% of low birthweight 30% of “preventable” low birthweight Prevention and Control of Malaria during Pregnancy 4 Roll Back Malaria Worldwide partnership Governments, private groups, research organizations, civil society, media Aim to reduce malaria by half by 2010 Free advocacy resources and tools: http://www.rbm.who.int Priority: Prevent poor outcomes caused by malaria in pregnancy Abuja declaration: Goal is for 60% of women in Africa to be sleeping under insecticide-treated nets (ITNs) and getting intermittent preventive treatment (IPT) by 2005 Prevention and Control of Malaria during Pregnancy 5 Malaria Prevention and Treatment during Pregnancy Focused antenatal care (ANC) with health education about malaria Use of insecticide-treated nets (ITNs) Intermittent preventive treatment (IPT) Case management of women with symptoms and signs of malaria Prevention and Control of Malaria during Pregnancy Chapter I: Focused Antenatal Care Prevention and Control of Malaria during Pregnancy 7 Focused Antenatal Care: Chapter Objectives Describe four main components of focused antenatal care (ANC) Discuss frequency and timing of ANC visits Describe essential elements of a birth plan that includes complication readiness Describe interpersonal skills for effective ANC Describe components of record keeping for ANC Prevention and Control of Malaria during Pregnancy 8 Focused Antenatal Care An approach to ANC that emphasizes: Evidence-based, goal-directed actions Individualized, woman-centered care Quality vs. quantity of visits Care by skilled providers Prevention and Control of Malaria during Pregnancy 9 Goal of Focused Antenatal Care To promote maternal and newborn health and survival through: Early detection and treatment of problems and complications Prevention of complications and disease Birth preparedness and complication readiness Health promotion Prevention and Control of Malaria during Pregnancy 10 Traditional Antenatal Care Emphasizes: Ritualistic, “routine” care vs. evidence-based, goal-directed actions Frequent visits Does not emphasize individual client needs Prevention and Control of Malaria during Pregnancy 11 No Longer Recommended Numerous, routine visits Burden to women and healthcare system Routine measurements and examinations: Maternal height and weight Ankle edema Fetal position before 36 weeks Care based on risk assessment Prevention and Control of Malaria during Pregnancy 12 Risk Approach Not an effective ANC strategy because: Complications cannot be predicted—all pregnant women are at risk for developing complications Risk factors are usually not direct cause of complications Many “low risk” women develop complications Have false sense of security Do not know how to recognize/respond to problems Most “high risk” women give birth without complications Inefficient use of scarce resources Prevention and Control of Malaria during Pregnancy 13 Focused Antenatal Care Services Evidence-based, goal-directed actions: Address most prevalent health issues affecting women and newborns Adjusted for specific populations/regions Appropriate to gestational age Based on firm rationale Prevention and Control of Malaria during Pregnancy 14 Focused Antenatal Care Services (cont’d.) Individualized, woman-centered care based on each woman’s: Specific needs and concerns Circumstances History, physical examination, testing Available resources Prevention and Control of Malaria during Pregnancy 15 Focused Antenatal Care Services (cont’d.) Quality vs. quantity of ANC visits: WHO multi-center study Number of visits reduced without affecting outcome for mother or baby Recommendations Content and quality vs. number of visits Goal-oriented care Minimum of four visits Prevention and Control of Malaria during Pregnancy 16 First visit: By 16 weeks or when woman first thinks she is pregnant Second visit: At 24–28 weeks or at least once in second trimester Third visit: At 32 weeks Fourth visit: At 36 weeks Other visits: If complication occurs, followup or referral is needed, woman wants to see provider, or provider changes frequency based on findings (history, exam, testing) or local policy Scheduling and Timing of ANC Visits Prevention and Control of Malaria during Pregnancy 17 Focused Antenatal Care Services (cont’d.) Care by a skilled provider who: Has formal training and experience Has knowledge, skills, and qualifications to deliver safe, effective maternal and newborn healthcare Practices in home, hospital, health center May be a midwife, nurse, doctor, clinical officer, etc. Prevention and Control of Malaria during Pregnancy 18 Early Detection and Treatment Malaria—history and physical exam Fever and accompanying signs/symptoms Region Complicated vs. uncomplicated cases Severe anemia—physical exam, testing Pre-eclampsia/eclampsia—measurement of blood pressure HIV—voluntary counseling and testing Sexually transmitted infections, including syphilis— testing Prevention and Control of Malaria during Pregnancy 19 Prevention: Key Preventive Measures Malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Tetanus toxoid, iron/folate supplements Country/region-specific interventions as appropriate Vitamin A supplements Iodine supplements Presumptive treatment for hookworm Prevention and Control of Malaria during Pregnancy 20 Birth Preparedness and Complication Readiness: Objectives Develop birth plan—exact plan for normal birth and possible complications: Arrangements made in advance by woman and family (with help of skilled provider) Usually not a written document Reviewed/revised at every visit Minimize disorganization at time of birth or in an emergency Ensure timely and appropriate care Prevention and Control of Malaria during Pregnancy 21 Essential Elements of a Birth Plan Facility or Place of Birth: Home or health facility for birth, appropriate facility for emergencies Skilled Provider: To attend birth Provider/Facility Contact Information Transportation: Reliable, accessible, especially for odd hours Funds: Personal savings, emergency funds Decision-Making: Who will make decisions, especially in an emergency Prevention and Control of Malaria during Pregnancy 22 Essential Elements of a Birth Plan (cont’d.) Family and Community Support: Care for family in woman’s absence and birth companion during labor Blood Donor: In case of emergency Needed Items: For clean and safe birth and for newborn care Danger Signs/Signs of Advanced Labor Prevention and Control of Malaria during Pregnancy 23 Danger Signs of Pregnancy Vaginal bleeding Difficulty breathing Fever Severe abdominal pain Severe headache/blurred vision Convulsions/loss of consciousness Labor pains before 37 weeks Prevention and Control of Malaria during Pregnancy 24 Health Education: Objectives Inform and educate the woman with health messages and counseling appropriate to: Individual needs, concerns, circumstances Gestational age Most prevalent health issues Support the woman in making decisions and solving actual or anticipated problems Involve partner and family in supporting/adopting healthy practices Prevention and Control of Malaria during Pregnancy 25 Health Education: Topics Addressed Prevention of malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Other methods Other important issues to be discussed include: Nutrition Care for common discomforts Use of potentially harmful substances Hygiene Rest and activity Prevention and Control of Malaria during Pregnancy 26 Health Education: Topics Addressed (cont’d.) Sexual relations and safer sex Early and exclusive breastfeeding Prevention of tetanus and anemia Voluntary counseling and testing for HIV Prevention of other endemic diseases/deficiencies Prevention and Control of Malaria during Pregnancy 27 Interpersonal Skills Speak in a quiet, gentle tone of voice Listen to woman/family and respond appropriately Encourage them to ask questions and express concerns Allow them to demonstrate understanding of information provided Explain all procedures/actions and obtain permission before proceeding Show respect for cultural beliefs and social norms Be empathetic and nonjudgmental Avoid distractions while conducting the visit Prevention and Control of Malaria during Pregnancy 28 Record Keeping First ANC Visit History Physical examination Testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs Date of next ANC visit Subsequent ANC Visits Interim history Targeted physical examination, testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs (and relevant information on how client obtained and used ITN) Date of next ANC visit Record all information on the ANC chart and clinic card: Prevention and Control of Malaria during Pregnancy Chapter II: Malaria Transmission Prevention and Control of Malaria during Pregnancy 30 Malaria Transmission: Chapter Objectives Define malaria and how it is transmitted Describe extent of malaria in Africa Identify groups at highest risk of malaria infection List effects of malaria on pregnant women and their unborn babies Describe effects of malaria on pregnant women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 31 Malaria Transmission Caused by Plasmodium parasites Spread by female Anopheles mosquitoes infected with parasites Anopheles mosquitoes usually active at night Infected mosquito bites a person Malaria parasites reproduce in human blood Mosquito bites infected person, and goes on to bite and infect another person Prevention and Control of Malaria during Pregnancy 32 Populations Most Affected by Malaria Children under 5 years of age Pregnant women Unborn babies Immigrants from low-transmission areas HIV-infected persons Prevention and Control of Malaria during Pregnancy 33 Effects of Malaria on Pregnant Women All pregnant women in malaria-endemic areas are at risk Parasites attack and destroy red blood cells Malaria causes up to 15% of anemia in pregnancy Can cause severe anemia In Africa, anemia due to malaria causes up to 10,000 maternal deaths per year Prevention and Control of Malaria during Pregnancy 34 Effects on Unborn Babies Parasites hide in placenta Interferes with transfer of oxygen and nutrients to the baby, increasing risk of: Spontaneous abortion Preterm birth Low birthweight—single greatest risk factor for death during first month of life Stillbirth Prevention and Control of Malaria during Pregnancy 35 Effects on Communities Causes missed work and wages Results in frequent school absences Uses scarce resources Causes preventable deaths: increases maternal, newborn, and infant mortality rates Prevention and Control of Malaria during Pregnancy 36 HIV/AIDS and Malaria during Pregnancy HIV/AIDS reduces a woman’s resistance to malaria Intermittent preventive treatment (IPT) given 3 times during pregnancy is effective for women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 37 Summary of Health Education Points Malaria transmitted through mosquito bites Pregnant women and children are most at risk Pregnant women infected with malaria may have no symptoms Women with HIV/AIDS are at higher risk Malaria can lead to severe anemia, spontaneous abortion, low-birthweight babies Malaria is preventable Prevention and Control of Malaria during Pregnancy Chapter III: Preventing Malaria Prevention and Control of Malaria during Pregnancy 39 Preventing Malaria: Chapter Objectives List the elements of counseling women about the use of insecticide-treated nets (ITNs) and intermittent preventive treatment (IPT) during pregnancy Describe the use of sulfadoxine-pyrimethamine (SP) for IPT during pregnancy Prevention and Control of Malaria during Pregnancy 40 Insecticide-Treated Nets Kill or repel mosquitoes Prevent physical contact with mosquitoes Kill or repel other insects: Lice Ticks Bedbugs Cockroaches Prevention and Control of Malaria during Pregnancy 41 Insecticide-Treated Nets (cont’d.) Untreated Nets Provide some protection against malaria Do not kill or repel mosquitoes that touch net Do not reduce number of mosquitoes Do not kill other insects like lice, roaches, and bedbugs Are safe for pregnant women, young children, and infants Insecticide-Treated Nets Provide a high level of protection against malaria Kills or repels mosquitoes that touch the net Reduce number of mosquitoes in/outside net Kills other insects such as lice, roaches, and bedbugs Are safe for pregnant women, young children, and infants Prevention and Control of Malaria during Pregnancy 42 Benefits of Insecticide-Treated Nets Prevent mosquito bites Protect against malaria, resulting in less: Anemia Prematurity and low birthweight Risk of maternal and newborn death Help people sleep better Promote growth and development of fetus and newborn Prevention and Control of Malaria during Pregnancy 43 Benefits of Insecticide-Treated Nets: Community Cost less than treating malaria Reduce number of sick children and adults (helping children grow to be healthy and helping working adults remain productive) Reduce number of deaths Prevention and Control of Malaria during Pregnancy 44 Where to Find Insecticide-Treated Nets General merchandise shops Drug shops/pharmacies Markets Public and private health facilities Community health workers NGOs, community-based organizations Prevention and Control of Malaria during Pregnancy 45 How to Use Insecticide-Treated Nets Hang above bed or sleeping mat Tuck under mattress or mat Use every night, all year long Use for everyone, if possible, but give priority to pregnant women, infants, and children Prevention and Control of Malaria during Pregnancy 46 Caring for Insecticide-Treated Nets Handle gently to avoid tears Tie net up during day to avoid damage Regularly inspect for holes, repair if found Nets need to be re-treated regularly to stay effective Keep away from smoke, fire, direct sunlight Prevention and Control of Malaria during Pregnancy 47 Intermittent Preventive Treatment Based on the assumption that every pregnant woman living in an area of high malaria transmission has malaria parasites in her blood or placenta, whether or not she has symptoms of malaria Prevention and Control of Malaria during Pregnancy 48 Intermittent Preventive Treatment Although a pregnant woman with malaria may have no symptoms, malaria can still affect her and her unborn child Prevention and Control of Malaria during Pregnancy 49 Intermittent Preventive Treatment: WHO Recommendation All pregnant women should receive at least two doses of IPT after quickening, during routinely scheduled ANC visits (WHO recommends a schedule of four visits, three after quickening) Presently, the most effective drug for IPT is sulfadoxine-pyrimethamine (SP) Women should receive at least two doses of IPT with SP at ANC visits after quickening, but no more frequently than monthly Prevention and Control of Malaria during Pregnancy 50 Intermittent Preventive Treatment: Dose and Timing A single dose is three tablets of sulfadoxine 500 mg + pyrimethamine 25 mg Healthcare provider should dispense dose and directly observe client taking dose Prevention and Control of Malaria during Pregnancy 51 Instructions for Giving Intermittent Preventive Treatment Ensure woman is at least 16 weeks pregnant and that quickening has occurred Inquire about use of SP in last 4 weeks Inquire about allergies to SP or other sulfa drugs (especially severe rashes) Explain what you will do; address the woman’s questions Provide cup and clean water Prevention and Control of Malaria during Pregnancy 52 Instructions for Giving Intermittent Preventive Treatment (cont’d.) Directly observe woman swallow three tablets of SP Record SP dose on ANC and clinic card Advise the woman when to return: For her next scheduled visit If she has signs of malaria If she has other danger signs Reinforce the importance of using ITNs Prevention and Control of Malaria during Pregnancy 53 Intermittent Preventive Treatment: Contraindications to Using SP Do NOT give during first trimester: Be sure quickening has occurred and woman is at least 16 weeks pregnant Do NOT give to women with reported allergy to SP or other sulfa drugs: Ask about sulfa drug allergies before giving SP Do NOT give to women taking co-trimoxazole, or other sulfa-containing drugs: Ask about use of these medicines before giving SP Do not give SP more frequently than monthly: Be sure at least 1 month has passed since the last dose of SP Prevention and Control of Malaria during Pregnancy 54 Chemoprophylaxis with Chloroquine: For Women Allergic to Sulfa Drugs* Dose Chloroquine 150 mg Timing 1 4 tablets First ANC visit after 16 weeks 2 4 tablets Second day after first dose 3 2 tablets Third day after first dose Weekly 2 tablets Every week during pregnancy *If chloroquine resistance rates in the country are high, chemoprophylaxis with chloroquine is not recommended. Prevention and Control of Malaria during Pregnancy 55 Summary of Health Education Points Pregnant women should sleep under ITNs every night By preventing malaria, IPT reduces the incidence of maternal anemia, spontaneous abortion, preterm birth, stillbirth, and low birthweight IPT should be administered to pregnant women at regularly scheduled ANC visits after quickening, but not more often than monthly Prevention and Control of Malaria during Pregnancy Chapter IV: Detection and Treatment Prevention and Control of Malaria during Pregnancy 57 Malaria Detection and Treatment: Chapter Objectives Identify causes of fever during pregnancy List the signs and symptoms of uncomplicated and complicated malaria Describe the treatment for uncomplicated malaria during pregnancy Explain the steps to appropriately refer a pregnant woman who has complicated malaria Prevention and Control of Malaria during Pregnancy 58 Detecting Malaria Symptoms Fever Chills Headaches Muscle/joint pains Lab exam of blood from a finger prick Prevention and Control of Malaria during Pregnancy 59 Fever during Pregnancy Temperature of 38° C or higher May be caused by malaria, but also by: Bladder or kidney infection Pneumonia Typhoid Uterine infection Careful history and physical required to rule out other causes
Slide 60 - Prevention and Control of Malaria during Pregnancy A Workshop for Healthcare Providers Prevention and Control of Malaria during Pregnancy 2 Facts about Malaria 300 million cases each year worldwide 9 of 10 cases occur in Africa A person in Africa dies of malaria every 10 seconds Women and young children are most at risk Affects five times as many people as AIDS, leprosy, measles, and tuberculosis combined Prevention and Control of Malaria during Pregnancy 3 Facts about Malaria and Pregnancy 30 million African women are pregnant yearly Malaria is more frequent and complicated during pregnancy In malaria-endemic areas, malaria during pregnancy may account for: Up to 15% of maternal anemia 5–14% of low birthweight 30% of “preventable” low birthweight Prevention and Control of Malaria during Pregnancy 4 Roll Back Malaria Worldwide partnership Governments, private groups, research organizations, civil society, media Aim to reduce malaria by half by 2010 Free advocacy resources and tools: http://www.rbm.who.int Priority: Prevent poor outcomes caused by malaria in pregnancy Abuja declaration: Goal is for 60% of women in Africa to be sleeping under insecticide-treated nets (ITNs) and getting intermittent preventive treatment (IPT) by 2005 Prevention and Control of Malaria during Pregnancy 5 Malaria Prevention and Treatment during Pregnancy Focused antenatal care (ANC) with health education about malaria Use of insecticide-treated nets (ITNs) Intermittent preventive treatment (IPT) Case management of women with symptoms and signs of malaria Prevention and Control of Malaria during Pregnancy Chapter I: Focused Antenatal Care Prevention and Control of Malaria during Pregnancy 7 Focused Antenatal Care: Chapter Objectives Describe four main components of focused antenatal care (ANC) Discuss frequency and timing of ANC visits Describe essential elements of a birth plan that includes complication readiness Describe interpersonal skills for effective ANC Describe components of record keeping for ANC Prevention and Control of Malaria during Pregnancy 8 Focused Antenatal Care An approach to ANC that emphasizes: Evidence-based, goal-directed actions Individualized, woman-centered care Quality vs. quantity of visits Care by skilled providers Prevention and Control of Malaria during Pregnancy 9 Goal of Focused Antenatal Care To promote maternal and newborn health and survival through: Early detection and treatment of problems and complications Prevention of complications and disease Birth preparedness and complication readiness Health promotion Prevention and Control of Malaria during Pregnancy 10 Traditional Antenatal Care Emphasizes: Ritualistic, “routine” care vs. evidence-based, goal-directed actions Frequent visits Does not emphasize individual client needs Prevention and Control of Malaria during Pregnancy 11 No Longer Recommended Numerous, routine visits Burden to women and healthcare system Routine measurements and examinations: Maternal height and weight Ankle edema Fetal position before 36 weeks Care based on risk assessment Prevention and Control of Malaria during Pregnancy 12 Risk Approach Not an effective ANC strategy because: Complications cannot be predicted—all pregnant women are at risk for developing complications Risk factors are usually not direct cause of complications Many “low risk” women develop complications Have false sense of security Do not know how to recognize/respond to problems Most “high risk” women give birth without complications Inefficient use of scarce resources Prevention and Control of Malaria during Pregnancy 13 Focused Antenatal Care Services Evidence-based, goal-directed actions: Address most prevalent health issues affecting women and newborns Adjusted for specific populations/regions Appropriate to gestational age Based on firm rationale Prevention and Control of Malaria during Pregnancy 14 Focused Antenatal Care Services (cont’d.) Individualized, woman-centered care based on each woman’s: Specific needs and concerns Circumstances History, physical examination, testing Available resources Prevention and Control of Malaria during Pregnancy 15 Focused Antenatal Care Services (cont’d.) Quality vs. quantity of ANC visits: WHO multi-center study Number of visits reduced without affecting outcome for mother or baby Recommendations Content and quality vs. number of visits Goal-oriented care Minimum of four visits Prevention and Control of Malaria during Pregnancy 16 First visit: By 16 weeks or when woman first thinks she is pregnant Second visit: At 24–28 weeks or at least once in second trimester Third visit: At 32 weeks Fourth visit: At 36 weeks Other visits: If complication occurs, followup or referral is needed, woman wants to see provider, or provider changes frequency based on findings (history, exam, testing) or local policy Scheduling and Timing of ANC Visits Prevention and Control of Malaria during Pregnancy 17 Focused Antenatal Care Services (cont’d.) Care by a skilled provider who: Has formal training and experience Has knowledge, skills, and qualifications to deliver safe, effective maternal and newborn healthcare Practices in home, hospital, health center May be a midwife, nurse, doctor, clinical officer, etc. Prevention and Control of Malaria during Pregnancy 18 Early Detection and Treatment Malaria—history and physical exam Fever and accompanying signs/symptoms Region Complicated vs. uncomplicated cases Severe anemia—physical exam, testing Pre-eclampsia/eclampsia—measurement of blood pressure HIV—voluntary counseling and testing Sexually transmitted infections, including syphilis— testing Prevention and Control of Malaria during Pregnancy 19 Prevention: Key Preventive Measures Malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Tetanus toxoid, iron/folate supplements Country/region-specific interventions as appropriate Vitamin A supplements Iodine supplements Presumptive treatment for hookworm Prevention and Control of Malaria during Pregnancy 20 Birth Preparedness and Complication Readiness: Objectives Develop birth plan—exact plan for normal birth and possible complications: Arrangements made in advance by woman and family (with help of skilled provider) Usually not a written document Reviewed/revised at every visit Minimize disorganization at time of birth or in an emergency Ensure timely and appropriate care Prevention and Control of Malaria during Pregnancy 21 Essential Elements of a Birth Plan Facility or Place of Birth: Home or health facility for birth, appropriate facility for emergencies Skilled Provider: To attend birth Provider/Facility Contact Information Transportation: Reliable, accessible, especially for odd hours Funds: Personal savings, emergency funds Decision-Making: Who will make decisions, especially in an emergency Prevention and Control of Malaria during Pregnancy 22 Essential Elements of a Birth Plan (cont’d.) Family and Community Support: Care for family in woman’s absence and birth companion during labor Blood Donor: In case of emergency Needed Items: For clean and safe birth and for newborn care Danger Signs/Signs of Advanced Labor Prevention and Control of Malaria during Pregnancy 23 Danger Signs of Pregnancy Vaginal bleeding Difficulty breathing Fever Severe abdominal pain Severe headache/blurred vision Convulsions/loss of consciousness Labor pains before 37 weeks Prevention and Control of Malaria during Pregnancy 24 Health Education: Objectives Inform and educate the woman with health messages and counseling appropriate to: Individual needs, concerns, circumstances Gestational age Most prevalent health issues Support the woman in making decisions and solving actual or anticipated problems Involve partner and family in supporting/adopting healthy practices Prevention and Control of Malaria during Pregnancy 25 Health Education: Topics Addressed Prevention of malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Other methods Other important issues to be discussed include: Nutrition Care for common discomforts Use of potentially harmful substances Hygiene Rest and activity Prevention and Control of Malaria during Pregnancy 26 Health Education: Topics Addressed (cont’d.) Sexual relations and safer sex Early and exclusive breastfeeding Prevention of tetanus and anemia Voluntary counseling and testing for HIV Prevention of other endemic diseases/deficiencies Prevention and Control of Malaria during Pregnancy 27 Interpersonal Skills Speak in a quiet, gentle tone of voice Listen to woman/family and respond appropriately Encourage them to ask questions and express concerns Allow them to demonstrate understanding of information provided Explain all procedures/actions and obtain permission before proceeding Show respect for cultural beliefs and social norms Be empathetic and nonjudgmental Avoid distractions while conducting the visit Prevention and Control of Malaria during Pregnancy 28 Record Keeping First ANC Visit History Physical examination Testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs Date of next ANC visit Subsequent ANC Visits Interim history Targeted physical examination, testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs (and relevant information on how client obtained and used ITN) Date of next ANC visit Record all information on the ANC chart and clinic card: Prevention and Control of Malaria during Pregnancy Chapter II: Malaria Transmission Prevention and Control of Malaria during Pregnancy 30 Malaria Transmission: Chapter Objectives Define malaria and how it is transmitted Describe extent of malaria in Africa Identify groups at highest risk of malaria infection List effects of malaria on pregnant women and their unborn babies Describe effects of malaria on pregnant women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 31 Malaria Transmission Caused by Plasmodium parasites Spread by female Anopheles mosquitoes infected with parasites Anopheles mosquitoes usually active at night Infected mosquito bites a person Malaria parasites reproduce in human blood Mosquito bites infected person, and goes on to bite and infect another person Prevention and Control of Malaria during Pregnancy 32 Populations Most Affected by Malaria Children under 5 years of age Pregnant women Unborn babies Immigrants from low-transmission areas HIV-infected persons Prevention and Control of Malaria during Pregnancy 33 Effects of Malaria on Pregnant Women All pregnant women in malaria-endemic areas are at risk Parasites attack and destroy red blood cells Malaria causes up to 15% of anemia in pregnancy Can cause severe anemia In Africa, anemia due to malaria causes up to 10,000 maternal deaths per year Prevention and Control of Malaria during Pregnancy 34 Effects on Unborn Babies Parasites hide in placenta Interferes with transfer of oxygen and nutrients to the baby, increasing risk of: Spontaneous abortion Preterm birth Low birthweight—single greatest risk factor for death during first month of life Stillbirth Prevention and Control of Malaria during Pregnancy 35 Effects on Communities Causes missed work and wages Results in frequent school absences Uses scarce resources Causes preventable deaths: increases maternal, newborn, and infant mortality rates Prevention and Control of Malaria during Pregnancy 36 HIV/AIDS and Malaria during Pregnancy HIV/AIDS reduces a woman’s resistance to malaria Intermittent preventive treatment (IPT) given 3 times during pregnancy is effective for women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 37 Summary of Health Education Points Malaria transmitted through mosquito bites Pregnant women and children are most at risk Pregnant women infected with malaria may have no symptoms Women with HIV/AIDS are at higher risk Malaria can lead to severe anemia, spontaneous abortion, low-birthweight babies Malaria is preventable Prevention and Control of Malaria during Pregnancy Chapter III: Preventing Malaria Prevention and Control of Malaria during Pregnancy 39 Preventing Malaria: Chapter Objectives List the elements of counseling women about the use of insecticide-treated nets (ITNs) and intermittent preventive treatment (IPT) during pregnancy Describe the use of sulfadoxine-pyrimethamine (SP) for IPT during pregnancy Prevention and Control of Malaria during Pregnancy 40 Insecticide-Treated Nets Kill or repel mosquitoes Prevent physical contact with mosquitoes Kill or repel other insects: Lice Ticks Bedbugs Cockroaches Prevention and Control of Malaria during Pregnancy 41 Insecticide-Treated Nets (cont’d.) Untreated Nets Provide some protection against malaria Do not kill or repel mosquitoes that touch net Do not reduce number of mosquitoes Do not kill other insects like lice, roaches, and bedbugs Are safe for pregnant women, young children, and infants Insecticide-Treated Nets Provide a high level of protection against malaria Kills or repels mosquitoes that touch the net Reduce number of mosquitoes in/outside net Kills other insects such as lice, roaches, and bedbugs Are safe for pregnant women, young children, and infants Prevention and Control of Malaria during Pregnancy 42 Benefits of Insecticide-Treated Nets Prevent mosquito bites Protect against malaria, resulting in less: Anemia Prematurity and low birthweight Risk of maternal and newborn death Help people sleep better Promote growth and development of fetus and newborn Prevention and Control of Malaria during Pregnancy 43 Benefits of Insecticide-Treated Nets: Community Cost less than treating malaria Reduce number of sick children and adults (helping children grow to be healthy and helping working adults remain productive) Reduce number of deaths Prevention and Control of Malaria during Pregnancy 44 Where to Find Insecticide-Treated Nets General merchandise shops Drug shops/pharmacies Markets Public and private health facilities Community health workers NGOs, community-based organizations Prevention and Control of Malaria during Pregnancy 45 How to Use Insecticide-Treated Nets Hang above bed or sleeping mat Tuck under mattress or mat Use every night, all year long Use for everyone, if possible, but give priority to pregnant women, infants, and children Prevention and Control of Malaria during Pregnancy 46 Caring for Insecticide-Treated Nets Handle gently to avoid tears Tie net up during day to avoid damage Regularly inspect for holes, repair if found Nets need to be re-treated regularly to stay effective Keep away from smoke, fire, direct sunlight Prevention and Control of Malaria during Pregnancy 47 Intermittent Preventive Treatment Based on the assumption that every pregnant woman living in an area of high malaria transmission has malaria parasites in her blood or placenta, whether or not she has symptoms of malaria Prevention and Control of Malaria during Pregnancy 48 Intermittent Preventive Treatment Although a pregnant woman with malaria may have no symptoms, malaria can still affect her and her unborn child Prevention and Control of Malaria during Pregnancy 49 Intermittent Preventive Treatment: WHO Recommendation All pregnant women should receive at least two doses of IPT after quickening, during routinely scheduled ANC visits (WHO recommends a schedule of four visits, three after quickening) Presently, the most effective drug for IPT is sulfadoxine-pyrimethamine (SP) Women should receive at least two doses of IPT with SP at ANC visits after quickening, but no more frequently than monthly Prevention and Control of Malaria during Pregnancy 50 Intermittent Preventive Treatment: Dose and Timing A single dose is three tablets of sulfadoxine 500 mg + pyrimethamine 25 mg Healthcare provider should dispense dose and directly observe client taking dose Prevention and Control of Malaria during Pregnancy 51 Instructions for Giving Intermittent Preventive Treatment Ensure woman is at least 16 weeks pregnant and that quickening has occurred Inquire about use of SP in last 4 weeks Inquire about allergies to SP or other sulfa drugs (especially severe rashes) Explain what you will do; address the woman’s questions Provide cup and clean water Prevention and Control of Malaria during Pregnancy 52 Instructions for Giving Intermittent Preventive Treatment (cont’d.) Directly observe woman swallow three tablets of SP Record SP dose on ANC and clinic card Advise the woman when to return: For her next scheduled visit If she has signs of malaria If she has other danger signs Reinforce the importance of using ITNs Prevention and Control of Malaria during Pregnancy 53 Intermittent Preventive Treatment: Contraindications to Using SP Do NOT give during first trimester: Be sure quickening has occurred and woman is at least 16 weeks pregnant Do NOT give to women with reported allergy to SP or other sulfa drugs: Ask about sulfa drug allergies before giving SP Do NOT give to women taking co-trimoxazole, or other sulfa-containing drugs: Ask about use of these medicines before giving SP Do not give SP more frequently than monthly: Be sure at least 1 month has passed since the last dose of SP Prevention and Control of Malaria during Pregnancy 54 Chemoprophylaxis with Chloroquine: For Women Allergic to Sulfa Drugs* Dose Chloroquine 150 mg Timing 1 4 tablets First ANC visit after 16 weeks 2 4 tablets Second day after first dose 3 2 tablets Third day after first dose Weekly 2 tablets Every week during pregnancy *If chloroquine resistance rates in the country are high, chemoprophylaxis with chloroquine is not recommended. Prevention and Control of Malaria during Pregnancy 55 Summary of Health Education Points Pregnant women should sleep under ITNs every night By preventing malaria, IPT reduces the incidence of maternal anemia, spontaneous abortion, preterm birth, stillbirth, and low birthweight IPT should be administered to pregnant women at regularly scheduled ANC visits after quickening, but not more often than monthly Prevention and Control of Malaria during Pregnancy Chapter IV: Detection and Treatment Prevention and Control of Malaria during Pregnancy 57 Malaria Detection and Treatment: Chapter Objectives Identify causes of fever during pregnancy List the signs and symptoms of uncomplicated and complicated malaria Describe the treatment for uncomplicated malaria during pregnancy Explain the steps to appropriately refer a pregnant woman who has complicated malaria Prevention and Control of Malaria during Pregnancy 58 Detecting Malaria Symptoms Fever Chills Headaches Muscle/joint pains Lab exam of blood from a finger prick Prevention and Control of Malaria during Pregnancy 59 Fever during Pregnancy Temperature of 38° C or higher May be caused by malaria, but also by: Bladder or kidney infection Pneumonia Typhoid Uterine infection Careful history and physical required to rule out other causes Prevention and Control of Malaria during Pregnancy 60 Fever during Pregnancy (cont’d.) Ask about or examine for: Type, duration, degree of fever Signs of other infections: Chest pain/difficulty breathing Foul-smelling watery vaginal discharge Tender/painful uterus or abdomen Frequency/urgency/pain in urinating Signs of complicated malaria or other danger signs
Slide 61 - Prevention and Control of Malaria during Pregnancy A Workshop for Healthcare Providers Prevention and Control of Malaria during Pregnancy 2 Facts about Malaria 300 million cases each year worldwide 9 of 10 cases occur in Africa A person in Africa dies of malaria every 10 seconds Women and young children are most at risk Affects five times as many people as AIDS, leprosy, measles, and tuberculosis combined Prevention and Control of Malaria during Pregnancy 3 Facts about Malaria and Pregnancy 30 million African women are pregnant yearly Malaria is more frequent and complicated during pregnancy In malaria-endemic areas, malaria during pregnancy may account for: Up to 15% of maternal anemia 5–14% of low birthweight 30% of “preventable” low birthweight Prevention and Control of Malaria during Pregnancy 4 Roll Back Malaria Worldwide partnership Governments, private groups, research organizations, civil society, media Aim to reduce malaria by half by 2010 Free advocacy resources and tools: http://www.rbm.who.int Priority: Prevent poor outcomes caused by malaria in pregnancy Abuja declaration: Goal is for 60% of women in Africa to be sleeping under insecticide-treated nets (ITNs) and getting intermittent preventive treatment (IPT) by 2005 Prevention and Control of Malaria during Pregnancy 5 Malaria Prevention and Treatment during Pregnancy Focused antenatal care (ANC) with health education about malaria Use of insecticide-treated nets (ITNs) Intermittent preventive treatment (IPT) Case management of women with symptoms and signs of malaria Prevention and Control of Malaria during Pregnancy Chapter I: Focused Antenatal Care Prevention and Control of Malaria during Pregnancy 7 Focused Antenatal Care: Chapter Objectives Describe four main components of focused antenatal care (ANC) Discuss frequency and timing of ANC visits Describe essential elements of a birth plan that includes complication readiness Describe interpersonal skills for effective ANC Describe components of record keeping for ANC Prevention and Control of Malaria during Pregnancy 8 Focused Antenatal Care An approach to ANC that emphasizes: Evidence-based, goal-directed actions Individualized, woman-centered care Quality vs. quantity of visits Care by skilled providers Prevention and Control of Malaria during Pregnancy 9 Goal of Focused Antenatal Care To promote maternal and newborn health and survival through: Early detection and treatment of problems and complications Prevention of complications and disease Birth preparedness and complication readiness Health promotion Prevention and Control of Malaria during Pregnancy 10 Traditional Antenatal Care Emphasizes: Ritualistic, “routine” care vs. evidence-based, goal-directed actions Frequent visits Does not emphasize individual client needs Prevention and Control of Malaria during Pregnancy 11 No Longer Recommended Numerous, routine visits Burden to women and healthcare system Routine measurements and examinations: Maternal height and weight Ankle edema Fetal position before 36 weeks Care based on risk assessment Prevention and Control of Malaria during Pregnancy 12 Risk Approach Not an effective ANC strategy because: Complications cannot be predicted—all pregnant women are at risk for developing complications Risk factors are usually not direct cause of complications Many “low risk” women develop complications Have false sense of security Do not know how to recognize/respond to problems Most “high risk” women give birth without complications Inefficient use of scarce resources Prevention and Control of Malaria during Pregnancy 13 Focused Antenatal Care Services Evidence-based, goal-directed actions: Address most prevalent health issues affecting women and newborns Adjusted for specific populations/regions Appropriate to gestational age Based on firm rationale Prevention and Control of Malaria during Pregnancy 14 Focused Antenatal Care Services (cont’d.) Individualized, woman-centered care based on each woman’s: Specific needs and concerns Circumstances History, physical examination, testing Available resources Prevention and Control of Malaria during Pregnancy 15 Focused Antenatal Care Services (cont’d.) Quality vs. quantity of ANC visits: WHO multi-center study Number of visits reduced without affecting outcome for mother or baby Recommendations Content and quality vs. number of visits Goal-oriented care Minimum of four visits Prevention and Control of Malaria during Pregnancy 16 First visit: By 16 weeks or when woman first thinks she is pregnant Second visit: At 24–28 weeks or at least once in second trimester Third visit: At 32 weeks Fourth visit: At 36 weeks Other visits: If complication occurs, followup or referral is needed, woman wants to see provider, or provider changes frequency based on findings (history, exam, testing) or local policy Scheduling and Timing of ANC Visits Prevention and Control of Malaria during Pregnancy 17 Focused Antenatal Care Services (cont’d.) Care by a skilled provider who: Has formal training and experience Has knowledge, skills, and qualifications to deliver safe, effective maternal and newborn healthcare Practices in home, hospital, health center May be a midwife, nurse, doctor, clinical officer, etc. Prevention and Control of Malaria during Pregnancy 18 Early Detection and Treatment Malaria—history and physical exam Fever and accompanying signs/symptoms Region Complicated vs. uncomplicated cases Severe anemia—physical exam, testing Pre-eclampsia/eclampsia—measurement of blood pressure HIV—voluntary counseling and testing Sexually transmitted infections, including syphilis— testing Prevention and Control of Malaria during Pregnancy 19 Prevention: Key Preventive Measures Malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Tetanus toxoid, iron/folate supplements Country/region-specific interventions as appropriate Vitamin A supplements Iodine supplements Presumptive treatment for hookworm Prevention and Control of Malaria during Pregnancy 20 Birth Preparedness and Complication Readiness: Objectives Develop birth plan—exact plan for normal birth and possible complications: Arrangements made in advance by woman and family (with help of skilled provider) Usually not a written document Reviewed/revised at every visit Minimize disorganization at time of birth or in an emergency Ensure timely and appropriate care Prevention and Control of Malaria during Pregnancy 21 Essential Elements of a Birth Plan Facility or Place of Birth: Home or health facility for birth, appropriate facility for emergencies Skilled Provider: To attend birth Provider/Facility Contact Information Transportation: Reliable, accessible, especially for odd hours Funds: Personal savings, emergency funds Decision-Making: Who will make decisions, especially in an emergency Prevention and Control of Malaria during Pregnancy 22 Essential Elements of a Birth Plan (cont’d.) Family and Community Support: Care for family in woman’s absence and birth companion during labor Blood Donor: In case of emergency Needed Items: For clean and safe birth and for newborn care Danger Signs/Signs of Advanced Labor Prevention and Control of Malaria during Pregnancy 23 Danger Signs of Pregnancy Vaginal bleeding Difficulty breathing Fever Severe abdominal pain Severe headache/blurred vision Convulsions/loss of consciousness Labor pains before 37 weeks Prevention and Control of Malaria during Pregnancy 24 Health Education: Objectives Inform and educate the woman with health messages and counseling appropriate to: Individual needs, concerns, circumstances Gestational age Most prevalent health issues Support the woman in making decisions and solving actual or anticipated problems Involve partner and family in supporting/adopting healthy practices Prevention and Control of Malaria during Pregnancy 25 Health Education: Topics Addressed Prevention of malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Other methods Other important issues to be discussed include: Nutrition Care for common discomforts Use of potentially harmful substances Hygiene Rest and activity Prevention and Control of Malaria during Pregnancy 26 Health Education: Topics Addressed (cont’d.) Sexual relations and safer sex Early and exclusive breastfeeding Prevention of tetanus and anemia Voluntary counseling and testing for HIV Prevention of other endemic diseases/deficiencies Prevention and Control of Malaria during Pregnancy 27 Interpersonal Skills Speak in a quiet, gentle tone of voice Listen to woman/family and respond appropriately Encourage them to ask questions and express concerns Allow them to demonstrate understanding of information provided Explain all procedures/actions and obtain permission before proceeding Show respect for cultural beliefs and social norms Be empathetic and nonjudgmental Avoid distractions while conducting the visit Prevention and Control of Malaria during Pregnancy 28 Record Keeping First ANC Visit History Physical examination Testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs Date of next ANC visit Subsequent ANC Visits Interim history Targeted physical examination, testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs (and relevant information on how client obtained and used ITN) Date of next ANC visit Record all information on the ANC chart and clinic card: Prevention and Control of Malaria during Pregnancy Chapter II: Malaria Transmission Prevention and Control of Malaria during Pregnancy 30 Malaria Transmission: Chapter Objectives Define malaria and how it is transmitted Describe extent of malaria in Africa Identify groups at highest risk of malaria infection List effects of malaria on pregnant women and their unborn babies Describe effects of malaria on pregnant women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 31 Malaria Transmission Caused by Plasmodium parasites Spread by female Anopheles mosquitoes infected with parasites Anopheles mosquitoes usually active at night Infected mosquito bites a person Malaria parasites reproduce in human blood Mosquito bites infected person, and goes on to bite and infect another person Prevention and Control of Malaria during Pregnancy 32 Populations Most Affected by Malaria Children under 5 years of age Pregnant women Unborn babies Immigrants from low-transmission areas HIV-infected persons Prevention and Control of Malaria during Pregnancy 33 Effects of Malaria on Pregnant Women All pregnant women in malaria-endemic areas are at risk Parasites attack and destroy red blood cells Malaria causes up to 15% of anemia in pregnancy Can cause severe anemia In Africa, anemia due to malaria causes up to 10,000 maternal deaths per year Prevention and Control of Malaria during Pregnancy 34 Effects on Unborn Babies Parasites hide in placenta Interferes with transfer of oxygen and nutrients to the baby, increasing risk of: Spontaneous abortion Preterm birth Low birthweight—single greatest risk factor for death during first month of life Stillbirth Prevention and Control of Malaria during Pregnancy 35 Effects on Communities Causes missed work and wages Results in frequent school absences Uses scarce resources Causes preventable deaths: increases maternal, newborn, and infant mortality rates Prevention and Control of Malaria during Pregnancy 36 HIV/AIDS and Malaria during Pregnancy HIV/AIDS reduces a woman’s resistance to malaria Intermittent preventive treatment (IPT) given 3 times during pregnancy is effective for women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 37 Summary of Health Education Points Malaria transmitted through mosquito bites Pregnant women and children are most at risk Pregnant women infected with malaria may have no symptoms Women with HIV/AIDS are at higher risk Malaria can lead to severe anemia, spontaneous abortion, low-birthweight babies Malaria is preventable Prevention and Control of Malaria during Pregnancy Chapter III: Preventing Malaria Prevention and Control of Malaria during Pregnancy 39 Preventing Malaria: Chapter Objectives List the elements of counseling women about the use of insecticide-treated nets (ITNs) and intermittent preventive treatment (IPT) during pregnancy Describe the use of sulfadoxine-pyrimethamine (SP) for IPT during pregnancy Prevention and Control of Malaria during Pregnancy 40 Insecticide-Treated Nets Kill or repel mosquitoes Prevent physical contact with mosquitoes Kill or repel other insects: Lice Ticks Bedbugs Cockroaches Prevention and Control of Malaria during Pregnancy 41 Insecticide-Treated Nets (cont’d.) Untreated Nets Provide some protection against malaria Do not kill or repel mosquitoes that touch net Do not reduce number of mosquitoes Do not kill other insects like lice, roaches, and bedbugs Are safe for pregnant women, young children, and infants Insecticide-Treated Nets Provide a high level of protection against malaria Kills or repels mosquitoes that touch the net Reduce number of mosquitoes in/outside net Kills other insects such as lice, roaches, and bedbugs Are safe for pregnant women, young children, and infants Prevention and Control of Malaria during Pregnancy 42 Benefits of Insecticide-Treated Nets Prevent mosquito bites Protect against malaria, resulting in less: Anemia Prematurity and low birthweight Risk of maternal and newborn death Help people sleep better Promote growth and development of fetus and newborn Prevention and Control of Malaria during Pregnancy 43 Benefits of Insecticide-Treated Nets: Community Cost less than treating malaria Reduce number of sick children and adults (helping children grow to be healthy and helping working adults remain productive) Reduce number of deaths Prevention and Control of Malaria during Pregnancy 44 Where to Find Insecticide-Treated Nets General merchandise shops Drug shops/pharmacies Markets Public and private health facilities Community health workers NGOs, community-based organizations Prevention and Control of Malaria during Pregnancy 45 How to Use Insecticide-Treated Nets Hang above bed or sleeping mat Tuck under mattress or mat Use every night, all year long Use for everyone, if possible, but give priority to pregnant women, infants, and children Prevention and Control of Malaria during Pregnancy 46 Caring for Insecticide-Treated Nets Handle gently to avoid tears Tie net up during day to avoid damage Regularly inspect for holes, repair if found Nets need to be re-treated regularly to stay effective Keep away from smoke, fire, direct sunlight Prevention and Control of Malaria during Pregnancy 47 Intermittent Preventive Treatment Based on the assumption that every pregnant woman living in an area of high malaria transmission has malaria parasites in her blood or placenta, whether or not she has symptoms of malaria Prevention and Control of Malaria during Pregnancy 48 Intermittent Preventive Treatment Although a pregnant woman with malaria may have no symptoms, malaria can still affect her and her unborn child Prevention and Control of Malaria during Pregnancy 49 Intermittent Preventive Treatment: WHO Recommendation All pregnant women should receive at least two doses of IPT after quickening, during routinely scheduled ANC visits (WHO recommends a schedule of four visits, three after quickening) Presently, the most effective drug for IPT is sulfadoxine-pyrimethamine (SP) Women should receive at least two doses of IPT with SP at ANC visits after quickening, but no more frequently than monthly Prevention and Control of Malaria during Pregnancy 50 Intermittent Preventive Treatment: Dose and Timing A single dose is three tablets of sulfadoxine 500 mg + pyrimethamine 25 mg Healthcare provider should dispense dose and directly observe client taking dose Prevention and Control of Malaria during Pregnancy 51 Instructions for Giving Intermittent Preventive Treatment Ensure woman is at least 16 weeks pregnant and that quickening has occurred Inquire about use of SP in last 4 weeks Inquire about allergies to SP or other sulfa drugs (especially severe rashes) Explain what you will do; address the woman’s questions Provide cup and clean water Prevention and Control of Malaria during Pregnancy 52 Instructions for Giving Intermittent Preventive Treatment (cont’d.) Directly observe woman swallow three tablets of SP Record SP dose on ANC and clinic card Advise the woman when to return: For her next scheduled visit If she has signs of malaria If she has other danger signs Reinforce the importance of using ITNs Prevention and Control of Malaria during Pregnancy 53 Intermittent Preventive Treatment: Contraindications to Using SP Do NOT give during first trimester: Be sure quickening has occurred and woman is at least 16 weeks pregnant Do NOT give to women with reported allergy to SP or other sulfa drugs: Ask about sulfa drug allergies before giving SP Do NOT give to women taking co-trimoxazole, or other sulfa-containing drugs: Ask about use of these medicines before giving SP Do not give SP more frequently than monthly: Be sure at least 1 month has passed since the last dose of SP Prevention and Control of Malaria during Pregnancy 54 Chemoprophylaxis with Chloroquine: For Women Allergic to Sulfa Drugs* Dose Chloroquine 150 mg Timing 1 4 tablets First ANC visit after 16 weeks 2 4 tablets Second day after first dose 3 2 tablets Third day after first dose Weekly 2 tablets Every week during pregnancy *If chloroquine resistance rates in the country are high, chemoprophylaxis with chloroquine is not recommended. Prevention and Control of Malaria during Pregnancy 55 Summary of Health Education Points Pregnant women should sleep under ITNs every night By preventing malaria, IPT reduces the incidence of maternal anemia, spontaneous abortion, preterm birth, stillbirth, and low birthweight IPT should be administered to pregnant women at regularly scheduled ANC visits after quickening, but not more often than monthly Prevention and Control of Malaria during Pregnancy Chapter IV: Detection and Treatment Prevention and Control of Malaria during Pregnancy 57 Malaria Detection and Treatment: Chapter Objectives Identify causes of fever during pregnancy List the signs and symptoms of uncomplicated and complicated malaria Describe the treatment for uncomplicated malaria during pregnancy Explain the steps to appropriately refer a pregnant woman who has complicated malaria Prevention and Control of Malaria during Pregnancy 58 Detecting Malaria Symptoms Fever Chills Headaches Muscle/joint pains Lab exam of blood from a finger prick Prevention and Control of Malaria during Pregnancy 59 Fever during Pregnancy Temperature of 38° C or higher May be caused by malaria, but also by: Bladder or kidney infection Pneumonia Typhoid Uterine infection Careful history and physical required to rule out other causes Prevention and Control of Malaria during Pregnancy 60 Fever during Pregnancy (cont’d.) Ask about or examine for: Type, duration, degree of fever Signs of other infections: Chest pain/difficulty breathing Foul-smelling watery vaginal discharge Tender/painful uterus or abdomen Frequency/urgency/pain in urinating Signs of complicated malaria or other danger signs Prevention and Control of Malaria during Pregnancy 61 Types of Malaria Uncomplicated Most common Complicated Life threatening, can affect brain Pregnant women more likely to get complicated malaria than non-pregnant women
Slide 62 - Prevention and Control of Malaria during Pregnancy A Workshop for Healthcare Providers Prevention and Control of Malaria during Pregnancy 2 Facts about Malaria 300 million cases each year worldwide 9 of 10 cases occur in Africa A person in Africa dies of malaria every 10 seconds Women and young children are most at risk Affects five times as many people as AIDS, leprosy, measles, and tuberculosis combined Prevention and Control of Malaria during Pregnancy 3 Facts about Malaria and Pregnancy 30 million African women are pregnant yearly Malaria is more frequent and complicated during pregnancy In malaria-endemic areas, malaria during pregnancy may account for: Up to 15% of maternal anemia 5–14% of low birthweight 30% of “preventable” low birthweight Prevention and Control of Malaria during Pregnancy 4 Roll Back Malaria Worldwide partnership Governments, private groups, research organizations, civil society, media Aim to reduce malaria by half by 2010 Free advocacy resources and tools: http://www.rbm.who.int Priority: Prevent poor outcomes caused by malaria in pregnancy Abuja declaration: Goal is for 60% of women in Africa to be sleeping under insecticide-treated nets (ITNs) and getting intermittent preventive treatment (IPT) by 2005 Prevention and Control of Malaria during Pregnancy 5 Malaria Prevention and Treatment during Pregnancy Focused antenatal care (ANC) with health education about malaria Use of insecticide-treated nets (ITNs) Intermittent preventive treatment (IPT) Case management of women with symptoms and signs of malaria Prevention and Control of Malaria during Pregnancy Chapter I: Focused Antenatal Care Prevention and Control of Malaria during Pregnancy 7 Focused Antenatal Care: Chapter Objectives Describe four main components of focused antenatal care (ANC) Discuss frequency and timing of ANC visits Describe essential elements of a birth plan that includes complication readiness Describe interpersonal skills for effective ANC Describe components of record keeping for ANC Prevention and Control of Malaria during Pregnancy 8 Focused Antenatal Care An approach to ANC that emphasizes: Evidence-based, goal-directed actions Individualized, woman-centered care Quality vs. quantity of visits Care by skilled providers Prevention and Control of Malaria during Pregnancy 9 Goal of Focused Antenatal Care To promote maternal and newborn health and survival through: Early detection and treatment of problems and complications Prevention of complications and disease Birth preparedness and complication readiness Health promotion Prevention and Control of Malaria during Pregnancy 10 Traditional Antenatal Care Emphasizes: Ritualistic, “routine” care vs. evidence-based, goal-directed actions Frequent visits Does not emphasize individual client needs Prevention and Control of Malaria during Pregnancy 11 No Longer Recommended Numerous, routine visits Burden to women and healthcare system Routine measurements and examinations: Maternal height and weight Ankle edema Fetal position before 36 weeks Care based on risk assessment Prevention and Control of Malaria during Pregnancy 12 Risk Approach Not an effective ANC strategy because: Complications cannot be predicted—all pregnant women are at risk for developing complications Risk factors are usually not direct cause of complications Many “low risk” women develop complications Have false sense of security Do not know how to recognize/respond to problems Most “high risk” women give birth without complications Inefficient use of scarce resources Prevention and Control of Malaria during Pregnancy 13 Focused Antenatal Care Services Evidence-based, goal-directed actions: Address most prevalent health issues affecting women and newborns Adjusted for specific populations/regions Appropriate to gestational age Based on firm rationale Prevention and Control of Malaria during Pregnancy 14 Focused Antenatal Care Services (cont’d.) Individualized, woman-centered care based on each woman’s: Specific needs and concerns Circumstances History, physical examination, testing Available resources Prevention and Control of Malaria during Pregnancy 15 Focused Antenatal Care Services (cont’d.) Quality vs. quantity of ANC visits: WHO multi-center study Number of visits reduced without affecting outcome for mother or baby Recommendations Content and quality vs. number of visits Goal-oriented care Minimum of four visits Prevention and Control of Malaria during Pregnancy 16 First visit: By 16 weeks or when woman first thinks she is pregnant Second visit: At 24–28 weeks or at least once in second trimester Third visit: At 32 weeks Fourth visit: At 36 weeks Other visits: If complication occurs, followup or referral is needed, woman wants to see provider, or provider changes frequency based on findings (history, exam, testing) or local policy Scheduling and Timing of ANC Visits Prevention and Control of Malaria during Pregnancy 17 Focused Antenatal Care Services (cont’d.) Care by a skilled provider who: Has formal training and experience Has knowledge, skills, and qualifications to deliver safe, effective maternal and newborn healthcare Practices in home, hospital, health center May be a midwife, nurse, doctor, clinical officer, etc. Prevention and Control of Malaria during Pregnancy 18 Early Detection and Treatment Malaria—history and physical exam Fever and accompanying signs/symptoms Region Complicated vs. uncomplicated cases Severe anemia—physical exam, testing Pre-eclampsia/eclampsia—measurement of blood pressure HIV—voluntary counseling and testing Sexually transmitted infections, including syphilis— testing Prevention and Control of Malaria during Pregnancy 19 Prevention: Key Preventive Measures Malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Tetanus toxoid, iron/folate supplements Country/region-specific interventions as appropriate Vitamin A supplements Iodine supplements Presumptive treatment for hookworm Prevention and Control of Malaria during Pregnancy 20 Birth Preparedness and Complication Readiness: Objectives Develop birth plan—exact plan for normal birth and possible complications: Arrangements made in advance by woman and family (with help of skilled provider) Usually not a written document Reviewed/revised at every visit Minimize disorganization at time of birth or in an emergency Ensure timely and appropriate care Prevention and Control of Malaria during Pregnancy 21 Essential Elements of a Birth Plan Facility or Place of Birth: Home or health facility for birth, appropriate facility for emergencies Skilled Provider: To attend birth Provider/Facility Contact Information Transportation: Reliable, accessible, especially for odd hours Funds: Personal savings, emergency funds Decision-Making: Who will make decisions, especially in an emergency Prevention and Control of Malaria during Pregnancy 22 Essential Elements of a Birth Plan (cont’d.) Family and Community Support: Care for family in woman’s absence and birth companion during labor Blood Donor: In case of emergency Needed Items: For clean and safe birth and for newborn care Danger Signs/Signs of Advanced Labor Prevention and Control of Malaria during Pregnancy 23 Danger Signs of Pregnancy Vaginal bleeding Difficulty breathing Fever Severe abdominal pain Severe headache/blurred vision Convulsions/loss of consciousness Labor pains before 37 weeks Prevention and Control of Malaria during Pregnancy 24 Health Education: Objectives Inform and educate the woman with health messages and counseling appropriate to: Individual needs, concerns, circumstances Gestational age Most prevalent health issues Support the woman in making decisions and solving actual or anticipated problems Involve partner and family in supporting/adopting healthy practices Prevention and Control of Malaria during Pregnancy 25 Health Education: Topics Addressed Prevention of malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Other methods Other important issues to be discussed include: Nutrition Care for common discomforts Use of potentially harmful substances Hygiene Rest and activity Prevention and Control of Malaria during Pregnancy 26 Health Education: Topics Addressed (cont’d.) Sexual relations and safer sex Early and exclusive breastfeeding Prevention of tetanus and anemia Voluntary counseling and testing for HIV Prevention of other endemic diseases/deficiencies Prevention and Control of Malaria during Pregnancy 27 Interpersonal Skills Speak in a quiet, gentle tone of voice Listen to woman/family and respond appropriately Encourage them to ask questions and express concerns Allow them to demonstrate understanding of information provided Explain all procedures/actions and obtain permission before proceeding Show respect for cultural beliefs and social norms Be empathetic and nonjudgmental Avoid distractions while conducting the visit Prevention and Control of Malaria during Pregnancy 28 Record Keeping First ANC Visit History Physical examination Testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs Date of next ANC visit Subsequent ANC Visits Interim history Targeted physical examination, testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs (and relevant information on how client obtained and used ITN) Date of next ANC visit Record all information on the ANC chart and clinic card: Prevention and Control of Malaria during Pregnancy Chapter II: Malaria Transmission Prevention and Control of Malaria during Pregnancy 30 Malaria Transmission: Chapter Objectives Define malaria and how it is transmitted Describe extent of malaria in Africa Identify groups at highest risk of malaria infection List effects of malaria on pregnant women and their unborn babies Describe effects of malaria on pregnant women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 31 Malaria Transmission Caused by Plasmodium parasites Spread by female Anopheles mosquitoes infected with parasites Anopheles mosquitoes usually active at night Infected mosquito bites a person Malaria parasites reproduce in human blood Mosquito bites infected person, and goes on to bite and infect another person Prevention and Control of Malaria during Pregnancy 32 Populations Most Affected by Malaria Children under 5 years of age Pregnant women Unborn babies Immigrants from low-transmission areas HIV-infected persons Prevention and Control of Malaria during Pregnancy 33 Effects of Malaria on Pregnant Women All pregnant women in malaria-endemic areas are at risk Parasites attack and destroy red blood cells Malaria causes up to 15% of anemia in pregnancy Can cause severe anemia In Africa, anemia due to malaria causes up to 10,000 maternal deaths per year Prevention and Control of Malaria during Pregnancy 34 Effects on Unborn Babies Parasites hide in placenta Interferes with transfer of oxygen and nutrients to the baby, increasing risk of: Spontaneous abortion Preterm birth Low birthweight—single greatest risk factor for death during first month of life Stillbirth Prevention and Control of Malaria during Pregnancy 35 Effects on Communities Causes missed work and wages Results in frequent school absences Uses scarce resources Causes preventable deaths: increases maternal, newborn, and infant mortality rates Prevention and Control of Malaria during Pregnancy 36 HIV/AIDS and Malaria during Pregnancy HIV/AIDS reduces a woman’s resistance to malaria Intermittent preventive treatment (IPT) given 3 times during pregnancy is effective for women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 37 Summary of Health Education Points Malaria transmitted through mosquito bites Pregnant women and children are most at risk Pregnant women infected with malaria may have no symptoms Women with HIV/AIDS are at higher risk Malaria can lead to severe anemia, spontaneous abortion, low-birthweight babies Malaria is preventable Prevention and Control of Malaria during Pregnancy Chapter III: Preventing Malaria Prevention and Control of Malaria during Pregnancy 39 Preventing Malaria: Chapter Objectives List the elements of counseling women about the use of insecticide-treated nets (ITNs) and intermittent preventive treatment (IPT) during pregnancy Describe the use of sulfadoxine-pyrimethamine (SP) for IPT during pregnancy Prevention and Control of Malaria during Pregnancy 40 Insecticide-Treated Nets Kill or repel mosquitoes Prevent physical contact with mosquitoes Kill or repel other insects: Lice Ticks Bedbugs Cockroaches Prevention and Control of Malaria during Pregnancy 41 Insecticide-Treated Nets (cont’d.) Untreated Nets Provide some protection against malaria Do not kill or repel mosquitoes that touch net Do not reduce number of mosquitoes Do not kill other insects like lice, roaches, and bedbugs Are safe for pregnant women, young children, and infants Insecticide-Treated Nets Provide a high level of protection against malaria Kills or repels mosquitoes that touch the net Reduce number of mosquitoes in/outside net Kills other insects such as lice, roaches, and bedbugs Are safe for pregnant women, young children, and infants Prevention and Control of Malaria during Pregnancy 42 Benefits of Insecticide-Treated Nets Prevent mosquito bites Protect against malaria, resulting in less: Anemia Prematurity and low birthweight Risk of maternal and newborn death Help people sleep better Promote growth and development of fetus and newborn Prevention and Control of Malaria during Pregnancy 43 Benefits of Insecticide-Treated Nets: Community Cost less than treating malaria Reduce number of sick children and adults (helping children grow to be healthy and helping working adults remain productive) Reduce number of deaths Prevention and Control of Malaria during Pregnancy 44 Where to Find Insecticide-Treated Nets General merchandise shops Drug shops/pharmacies Markets Public and private health facilities Community health workers NGOs, community-based organizations Prevention and Control of Malaria during Pregnancy 45 How to Use Insecticide-Treated Nets Hang above bed or sleeping mat Tuck under mattress or mat Use every night, all year long Use for everyone, if possible, but give priority to pregnant women, infants, and children Prevention and Control of Malaria during Pregnancy 46 Caring for Insecticide-Treated Nets Handle gently to avoid tears Tie net up during day to avoid damage Regularly inspect for holes, repair if found Nets need to be re-treated regularly to stay effective Keep away from smoke, fire, direct sunlight Prevention and Control of Malaria during Pregnancy 47 Intermittent Preventive Treatment Based on the assumption that every pregnant woman living in an area of high malaria transmission has malaria parasites in her blood or placenta, whether or not she has symptoms of malaria Prevention and Control of Malaria during Pregnancy 48 Intermittent Preventive Treatment Although a pregnant woman with malaria may have no symptoms, malaria can still affect her and her unborn child Prevention and Control of Malaria during Pregnancy 49 Intermittent Preventive Treatment: WHO Recommendation All pregnant women should receive at least two doses of IPT after quickening, during routinely scheduled ANC visits (WHO recommends a schedule of four visits, three after quickening) Presently, the most effective drug for IPT is sulfadoxine-pyrimethamine (SP) Women should receive at least two doses of IPT with SP at ANC visits after quickening, but no more frequently than monthly Prevention and Control of Malaria during Pregnancy 50 Intermittent Preventive Treatment: Dose and Timing A single dose is three tablets of sulfadoxine 500 mg + pyrimethamine 25 mg Healthcare provider should dispense dose and directly observe client taking dose Prevention and Control of Malaria during Pregnancy 51 Instructions for Giving Intermittent Preventive Treatment Ensure woman is at least 16 weeks pregnant and that quickening has occurred Inquire about use of SP in last 4 weeks Inquire about allergies to SP or other sulfa drugs (especially severe rashes) Explain what you will do; address the woman’s questions Provide cup and clean water Prevention and Control of Malaria during Pregnancy 52 Instructions for Giving Intermittent Preventive Treatment (cont’d.) Directly observe woman swallow three tablets of SP Record SP dose on ANC and clinic card Advise the woman when to return: For her next scheduled visit If she has signs of malaria If she has other danger signs Reinforce the importance of using ITNs Prevention and Control of Malaria during Pregnancy 53 Intermittent Preventive Treatment: Contraindications to Using SP Do NOT give during first trimester: Be sure quickening has occurred and woman is at least 16 weeks pregnant Do NOT give to women with reported allergy to SP or other sulfa drugs: Ask about sulfa drug allergies before giving SP Do NOT give to women taking co-trimoxazole, or other sulfa-containing drugs: Ask about use of these medicines before giving SP Do not give SP more frequently than monthly: Be sure at least 1 month has passed since the last dose of SP Prevention and Control of Malaria during Pregnancy 54 Chemoprophylaxis with Chloroquine: For Women Allergic to Sulfa Drugs* Dose Chloroquine 150 mg Timing 1 4 tablets First ANC visit after 16 weeks 2 4 tablets Second day after first dose 3 2 tablets Third day after first dose Weekly 2 tablets Every week during pregnancy *If chloroquine resistance rates in the country are high, chemoprophylaxis with chloroquine is not recommended. Prevention and Control of Malaria during Pregnancy 55 Summary of Health Education Points Pregnant women should sleep under ITNs every night By preventing malaria, IPT reduces the incidence of maternal anemia, spontaneous abortion, preterm birth, stillbirth, and low birthweight IPT should be administered to pregnant women at regularly scheduled ANC visits after quickening, but not more often than monthly Prevention and Control of Malaria during Pregnancy Chapter IV: Detection and Treatment Prevention and Control of Malaria during Pregnancy 57 Malaria Detection and Treatment: Chapter Objectives Identify causes of fever during pregnancy List the signs and symptoms of uncomplicated and complicated malaria Describe the treatment for uncomplicated malaria during pregnancy Explain the steps to appropriately refer a pregnant woman who has complicated malaria Prevention and Control of Malaria during Pregnancy 58 Detecting Malaria Symptoms Fever Chills Headaches Muscle/joint pains Lab exam of blood from a finger prick Prevention and Control of Malaria during Pregnancy 59 Fever during Pregnancy Temperature of 38° C or higher May be caused by malaria, but also by: Bladder or kidney infection Pneumonia Typhoid Uterine infection Careful history and physical required to rule out other causes Prevention and Control of Malaria during Pregnancy 60 Fever during Pregnancy (cont’d.) Ask about or examine for: Type, duration, degree of fever Signs of other infections: Chest pain/difficulty breathing Foul-smelling watery vaginal discharge Tender/painful uterus or abdomen Frequency/urgency/pain in urinating Signs of complicated malaria or other danger signs Prevention and Control of Malaria during Pregnancy 61 Types of Malaria Uncomplicated Most common Complicated Life threatening, can affect brain Pregnant women more likely to get complicated malaria than non-pregnant women Prevention and Control of Malaria during Pregnancy 62 Recognizing Malaria in Pregnant Women Uncomplicated Malaria Fever Shivering/chills/rigors Headaches Muscle/joint pains Nausea/vomiting False labor pains Complicated Malaria Signs of uncomplicated malaria PLUS one or more of the following: Dizziness Breathlessness/difficulty breathing Sleepy/drowsy Confusion/coma Sometimes fits, jaundice, severe dehydration
Slide 63 - Prevention and Control of Malaria during Pregnancy A Workshop for Healthcare Providers Prevention and Control of Malaria during Pregnancy 2 Facts about Malaria 300 million cases each year worldwide 9 of 10 cases occur in Africa A person in Africa dies of malaria every 10 seconds Women and young children are most at risk Affects five times as many people as AIDS, leprosy, measles, and tuberculosis combined Prevention and Control of Malaria during Pregnancy 3 Facts about Malaria and Pregnancy 30 million African women are pregnant yearly Malaria is more frequent and complicated during pregnancy In malaria-endemic areas, malaria during pregnancy may account for: Up to 15% of maternal anemia 5–14% of low birthweight 30% of “preventable” low birthweight Prevention and Control of Malaria during Pregnancy 4 Roll Back Malaria Worldwide partnership Governments, private groups, research organizations, civil society, media Aim to reduce malaria by half by 2010 Free advocacy resources and tools: http://www.rbm.who.int Priority: Prevent poor outcomes caused by malaria in pregnancy Abuja declaration: Goal is for 60% of women in Africa to be sleeping under insecticide-treated nets (ITNs) and getting intermittent preventive treatment (IPT) by 2005 Prevention and Control of Malaria during Pregnancy 5 Malaria Prevention and Treatment during Pregnancy Focused antenatal care (ANC) with health education about malaria Use of insecticide-treated nets (ITNs) Intermittent preventive treatment (IPT) Case management of women with symptoms and signs of malaria Prevention and Control of Malaria during Pregnancy Chapter I: Focused Antenatal Care Prevention and Control of Malaria during Pregnancy 7 Focused Antenatal Care: Chapter Objectives Describe four main components of focused antenatal care (ANC) Discuss frequency and timing of ANC visits Describe essential elements of a birth plan that includes complication readiness Describe interpersonal skills for effective ANC Describe components of record keeping for ANC Prevention and Control of Malaria during Pregnancy 8 Focused Antenatal Care An approach to ANC that emphasizes: Evidence-based, goal-directed actions Individualized, woman-centered care Quality vs. quantity of visits Care by skilled providers Prevention and Control of Malaria during Pregnancy 9 Goal of Focused Antenatal Care To promote maternal and newborn health and survival through: Early detection and treatment of problems and complications Prevention of complications and disease Birth preparedness and complication readiness Health promotion Prevention and Control of Malaria during Pregnancy 10 Traditional Antenatal Care Emphasizes: Ritualistic, “routine” care vs. evidence-based, goal-directed actions Frequent visits Does not emphasize individual client needs Prevention and Control of Malaria during Pregnancy 11 No Longer Recommended Numerous, routine visits Burden to women and healthcare system Routine measurements and examinations: Maternal height and weight Ankle edema Fetal position before 36 weeks Care based on risk assessment Prevention and Control of Malaria during Pregnancy 12 Risk Approach Not an effective ANC strategy because: Complications cannot be predicted—all pregnant women are at risk for developing complications Risk factors are usually not direct cause of complications Many “low risk” women develop complications Have false sense of security Do not know how to recognize/respond to problems Most “high risk” women give birth without complications Inefficient use of scarce resources Prevention and Control of Malaria during Pregnancy 13 Focused Antenatal Care Services Evidence-based, goal-directed actions: Address most prevalent health issues affecting women and newborns Adjusted for specific populations/regions Appropriate to gestational age Based on firm rationale Prevention and Control of Malaria during Pregnancy 14 Focused Antenatal Care Services (cont’d.) Individualized, woman-centered care based on each woman’s: Specific needs and concerns Circumstances History, physical examination, testing Available resources Prevention and Control of Malaria during Pregnancy 15 Focused Antenatal Care Services (cont’d.) Quality vs. quantity of ANC visits: WHO multi-center study Number of visits reduced without affecting outcome for mother or baby Recommendations Content and quality vs. number of visits Goal-oriented care Minimum of four visits Prevention and Control of Malaria during Pregnancy 16 First visit: By 16 weeks or when woman first thinks she is pregnant Second visit: At 24–28 weeks or at least once in second trimester Third visit: At 32 weeks Fourth visit: At 36 weeks Other visits: If complication occurs, followup or referral is needed, woman wants to see provider, or provider changes frequency based on findings (history, exam, testing) or local policy Scheduling and Timing of ANC Visits Prevention and Control of Malaria during Pregnancy 17 Focused Antenatal Care Services (cont’d.) Care by a skilled provider who: Has formal training and experience Has knowledge, skills, and qualifications to deliver safe, effective maternal and newborn healthcare Practices in home, hospital, health center May be a midwife, nurse, doctor, clinical officer, etc. Prevention and Control of Malaria during Pregnancy 18 Early Detection and Treatment Malaria—history and physical exam Fever and accompanying signs/symptoms Region Complicated vs. uncomplicated cases Severe anemia—physical exam, testing Pre-eclampsia/eclampsia—measurement of blood pressure HIV—voluntary counseling and testing Sexually transmitted infections, including syphilis— testing Prevention and Control of Malaria during Pregnancy 19 Prevention: Key Preventive Measures Malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Tetanus toxoid, iron/folate supplements Country/region-specific interventions as appropriate Vitamin A supplements Iodine supplements Presumptive treatment for hookworm Prevention and Control of Malaria during Pregnancy 20 Birth Preparedness and Complication Readiness: Objectives Develop birth plan—exact plan for normal birth and possible complications: Arrangements made in advance by woman and family (with help of skilled provider) Usually not a written document Reviewed/revised at every visit Minimize disorganization at time of birth or in an emergency Ensure timely and appropriate care Prevention and Control of Malaria during Pregnancy 21 Essential Elements of a Birth Plan Facility or Place of Birth: Home or health facility for birth, appropriate facility for emergencies Skilled Provider: To attend birth Provider/Facility Contact Information Transportation: Reliable, accessible, especially for odd hours Funds: Personal savings, emergency funds Decision-Making: Who will make decisions, especially in an emergency Prevention and Control of Malaria during Pregnancy 22 Essential Elements of a Birth Plan (cont’d.) Family and Community Support: Care for family in woman’s absence and birth companion during labor Blood Donor: In case of emergency Needed Items: For clean and safe birth and for newborn care Danger Signs/Signs of Advanced Labor Prevention and Control of Malaria during Pregnancy 23 Danger Signs of Pregnancy Vaginal bleeding Difficulty breathing Fever Severe abdominal pain Severe headache/blurred vision Convulsions/loss of consciousness Labor pains before 37 weeks Prevention and Control of Malaria during Pregnancy 24 Health Education: Objectives Inform and educate the woman with health messages and counseling appropriate to: Individual needs, concerns, circumstances Gestational age Most prevalent health issues Support the woman in making decisions and solving actual or anticipated problems Involve partner and family in supporting/adopting healthy practices Prevention and Control of Malaria during Pregnancy 25 Health Education: Topics Addressed Prevention of malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Other methods Other important issues to be discussed include: Nutrition Care for common discomforts Use of potentially harmful substances Hygiene Rest and activity Prevention and Control of Malaria during Pregnancy 26 Health Education: Topics Addressed (cont’d.) Sexual relations and safer sex Early and exclusive breastfeeding Prevention of tetanus and anemia Voluntary counseling and testing for HIV Prevention of other endemic diseases/deficiencies Prevention and Control of Malaria during Pregnancy 27 Interpersonal Skills Speak in a quiet, gentle tone of voice Listen to woman/family and respond appropriately Encourage them to ask questions and express concerns Allow them to demonstrate understanding of information provided Explain all procedures/actions and obtain permission before proceeding Show respect for cultural beliefs and social norms Be empathetic and nonjudgmental Avoid distractions while conducting the visit Prevention and Control of Malaria during Pregnancy 28 Record Keeping First ANC Visit History Physical examination Testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs Date of next ANC visit Subsequent ANC Visits Interim history Targeted physical examination, testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs (and relevant information on how client obtained and used ITN) Date of next ANC visit Record all information on the ANC chart and clinic card: Prevention and Control of Malaria during Pregnancy Chapter II: Malaria Transmission Prevention and Control of Malaria during Pregnancy 30 Malaria Transmission: Chapter Objectives Define malaria and how it is transmitted Describe extent of malaria in Africa Identify groups at highest risk of malaria infection List effects of malaria on pregnant women and their unborn babies Describe effects of malaria on pregnant women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 31 Malaria Transmission Caused by Plasmodium parasites Spread by female Anopheles mosquitoes infected with parasites Anopheles mosquitoes usually active at night Infected mosquito bites a person Malaria parasites reproduce in human blood Mosquito bites infected person, and goes on to bite and infect another person Prevention and Control of Malaria during Pregnancy 32 Populations Most Affected by Malaria Children under 5 years of age Pregnant women Unborn babies Immigrants from low-transmission areas HIV-infected persons Prevention and Control of Malaria during Pregnancy 33 Effects of Malaria on Pregnant Women All pregnant women in malaria-endemic areas are at risk Parasites attack and destroy red blood cells Malaria causes up to 15% of anemia in pregnancy Can cause severe anemia In Africa, anemia due to malaria causes up to 10,000 maternal deaths per year Prevention and Control of Malaria during Pregnancy 34 Effects on Unborn Babies Parasites hide in placenta Interferes with transfer of oxygen and nutrients to the baby, increasing risk of: Spontaneous abortion Preterm birth Low birthweight—single greatest risk factor for death during first month of life Stillbirth Prevention and Control of Malaria during Pregnancy 35 Effects on Communities Causes missed work and wages Results in frequent school absences Uses scarce resources Causes preventable deaths: increases maternal, newborn, and infant mortality rates Prevention and Control of Malaria during Pregnancy 36 HIV/AIDS and Malaria during Pregnancy HIV/AIDS reduces a woman’s resistance to malaria Intermittent preventive treatment (IPT) given 3 times during pregnancy is effective for women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 37 Summary of Health Education Points Malaria transmitted through mosquito bites Pregnant women and children are most at risk Pregnant women infected with malaria may have no symptoms Women with HIV/AIDS are at higher risk Malaria can lead to severe anemia, spontaneous abortion, low-birthweight babies Malaria is preventable Prevention and Control of Malaria during Pregnancy Chapter III: Preventing Malaria Prevention and Control of Malaria during Pregnancy 39 Preventing Malaria: Chapter Objectives List the elements of counseling women about the use of insecticide-treated nets (ITNs) and intermittent preventive treatment (IPT) during pregnancy Describe the use of sulfadoxine-pyrimethamine (SP) for IPT during pregnancy Prevention and Control of Malaria during Pregnancy 40 Insecticide-Treated Nets Kill or repel mosquitoes Prevent physical contact with mosquitoes Kill or repel other insects: Lice Ticks Bedbugs Cockroaches Prevention and Control of Malaria during Pregnancy 41 Insecticide-Treated Nets (cont’d.) Untreated Nets Provide some protection against malaria Do not kill or repel mosquitoes that touch net Do not reduce number of mosquitoes Do not kill other insects like lice, roaches, and bedbugs Are safe for pregnant women, young children, and infants Insecticide-Treated Nets Provide a high level of protection against malaria Kills or repels mosquitoes that touch the net Reduce number of mosquitoes in/outside net Kills other insects such as lice, roaches, and bedbugs Are safe for pregnant women, young children, and infants Prevention and Control of Malaria during Pregnancy 42 Benefits of Insecticide-Treated Nets Prevent mosquito bites Protect against malaria, resulting in less: Anemia Prematurity and low birthweight Risk of maternal and newborn death Help people sleep better Promote growth and development of fetus and newborn Prevention and Control of Malaria during Pregnancy 43 Benefits of Insecticide-Treated Nets: Community Cost less than treating malaria Reduce number of sick children and adults (helping children grow to be healthy and helping working adults remain productive) Reduce number of deaths Prevention and Control of Malaria during Pregnancy 44 Where to Find Insecticide-Treated Nets General merchandise shops Drug shops/pharmacies Markets Public and private health facilities Community health workers NGOs, community-based organizations Prevention and Control of Malaria during Pregnancy 45 How to Use Insecticide-Treated Nets Hang above bed or sleeping mat Tuck under mattress or mat Use every night, all year long Use for everyone, if possible, but give priority to pregnant women, infants, and children Prevention and Control of Malaria during Pregnancy 46 Caring for Insecticide-Treated Nets Handle gently to avoid tears Tie net up during day to avoid damage Regularly inspect for holes, repair if found Nets need to be re-treated regularly to stay effective Keep away from smoke, fire, direct sunlight Prevention and Control of Malaria during Pregnancy 47 Intermittent Preventive Treatment Based on the assumption that every pregnant woman living in an area of high malaria transmission has malaria parasites in her blood or placenta, whether or not she has symptoms of malaria Prevention and Control of Malaria during Pregnancy 48 Intermittent Preventive Treatment Although a pregnant woman with malaria may have no symptoms, malaria can still affect her and her unborn child Prevention and Control of Malaria during Pregnancy 49 Intermittent Preventive Treatment: WHO Recommendation All pregnant women should receive at least two doses of IPT after quickening, during routinely scheduled ANC visits (WHO recommends a schedule of four visits, three after quickening) Presently, the most effective drug for IPT is sulfadoxine-pyrimethamine (SP) Women should receive at least two doses of IPT with SP at ANC visits after quickening, but no more frequently than monthly Prevention and Control of Malaria during Pregnancy 50 Intermittent Preventive Treatment: Dose and Timing A single dose is three tablets of sulfadoxine 500 mg + pyrimethamine 25 mg Healthcare provider should dispense dose and directly observe client taking dose Prevention and Control of Malaria during Pregnancy 51 Instructions for Giving Intermittent Preventive Treatment Ensure woman is at least 16 weeks pregnant and that quickening has occurred Inquire about use of SP in last 4 weeks Inquire about allergies to SP or other sulfa drugs (especially severe rashes) Explain what you will do; address the woman’s questions Provide cup and clean water Prevention and Control of Malaria during Pregnancy 52 Instructions for Giving Intermittent Preventive Treatment (cont’d.) Directly observe woman swallow three tablets of SP Record SP dose on ANC and clinic card Advise the woman when to return: For her next scheduled visit If she has signs of malaria If she has other danger signs Reinforce the importance of using ITNs Prevention and Control of Malaria during Pregnancy 53 Intermittent Preventive Treatment: Contraindications to Using SP Do NOT give during first trimester: Be sure quickening has occurred and woman is at least 16 weeks pregnant Do NOT give to women with reported allergy to SP or other sulfa drugs: Ask about sulfa drug allergies before giving SP Do NOT give to women taking co-trimoxazole, or other sulfa-containing drugs: Ask about use of these medicines before giving SP Do not give SP more frequently than monthly: Be sure at least 1 month has passed since the last dose of SP Prevention and Control of Malaria during Pregnancy 54 Chemoprophylaxis with Chloroquine: For Women Allergic to Sulfa Drugs* Dose Chloroquine 150 mg Timing 1 4 tablets First ANC visit after 16 weeks 2 4 tablets Second day after first dose 3 2 tablets Third day after first dose Weekly 2 tablets Every week during pregnancy *If chloroquine resistance rates in the country are high, chemoprophylaxis with chloroquine is not recommended. Prevention and Control of Malaria during Pregnancy 55 Summary of Health Education Points Pregnant women should sleep under ITNs every night By preventing malaria, IPT reduces the incidence of maternal anemia, spontaneous abortion, preterm birth, stillbirth, and low birthweight IPT should be administered to pregnant women at regularly scheduled ANC visits after quickening, but not more often than monthly Prevention and Control of Malaria during Pregnancy Chapter IV: Detection and Treatment Prevention and Control of Malaria during Pregnancy 57 Malaria Detection and Treatment: Chapter Objectives Identify causes of fever during pregnancy List the signs and symptoms of uncomplicated and complicated malaria Describe the treatment for uncomplicated malaria during pregnancy Explain the steps to appropriately refer a pregnant woman who has complicated malaria Prevention and Control of Malaria during Pregnancy 58 Detecting Malaria Symptoms Fever Chills Headaches Muscle/joint pains Lab exam of blood from a finger prick Prevention and Control of Malaria during Pregnancy 59 Fever during Pregnancy Temperature of 38° C or higher May be caused by malaria, but also by: Bladder or kidney infection Pneumonia Typhoid Uterine infection Careful history and physical required to rule out other causes Prevention and Control of Malaria during Pregnancy 60 Fever during Pregnancy (cont’d.) Ask about or examine for: Type, duration, degree of fever Signs of other infections: Chest pain/difficulty breathing Foul-smelling watery vaginal discharge Tender/painful uterus or abdomen Frequency/urgency/pain in urinating Signs of complicated malaria or other danger signs Prevention and Control of Malaria during Pregnancy 61 Types of Malaria Uncomplicated Most common Complicated Life threatening, can affect brain Pregnant women more likely to get complicated malaria than non-pregnant women Prevention and Control of Malaria during Pregnancy 62 Recognizing Malaria in Pregnant Women Uncomplicated Malaria Fever Shivering/chills/rigors Headaches Muscle/joint pains Nausea/vomiting False labor pains Complicated Malaria Signs of uncomplicated malaria PLUS one or more of the following: Dizziness Breathlessness/difficulty breathing Sleepy/drowsy Confusion/coma Sometimes fits, jaundice, severe dehydration Prevention and Control of Malaria during Pregnancy 63 Recognizing Malaria in Pregnant Women (cont’d.) Refer the woman immediately if you suspect anything other than uncomplicated malaria
Slide 64 - Prevention and Control of Malaria during Pregnancy A Workshop for Healthcare Providers Prevention and Control of Malaria during Pregnancy 2 Facts about Malaria 300 million cases each year worldwide 9 of 10 cases occur in Africa A person in Africa dies of malaria every 10 seconds Women and young children are most at risk Affects five times as many people as AIDS, leprosy, measles, and tuberculosis combined Prevention and Control of Malaria during Pregnancy 3 Facts about Malaria and Pregnancy 30 million African women are pregnant yearly Malaria is more frequent and complicated during pregnancy In malaria-endemic areas, malaria during pregnancy may account for: Up to 15% of maternal anemia 5–14% of low birthweight 30% of “preventable” low birthweight Prevention and Control of Malaria during Pregnancy 4 Roll Back Malaria Worldwide partnership Governments, private groups, research organizations, civil society, media Aim to reduce malaria by half by 2010 Free advocacy resources and tools: http://www.rbm.who.int Priority: Prevent poor outcomes caused by malaria in pregnancy Abuja declaration: Goal is for 60% of women in Africa to be sleeping under insecticide-treated nets (ITNs) and getting intermittent preventive treatment (IPT) by 2005 Prevention and Control of Malaria during Pregnancy 5 Malaria Prevention and Treatment during Pregnancy Focused antenatal care (ANC) with health education about malaria Use of insecticide-treated nets (ITNs) Intermittent preventive treatment (IPT) Case management of women with symptoms and signs of malaria Prevention and Control of Malaria during Pregnancy Chapter I: Focused Antenatal Care Prevention and Control of Malaria during Pregnancy 7 Focused Antenatal Care: Chapter Objectives Describe four main components of focused antenatal care (ANC) Discuss frequency and timing of ANC visits Describe essential elements of a birth plan that includes complication readiness Describe interpersonal skills for effective ANC Describe components of record keeping for ANC Prevention and Control of Malaria during Pregnancy 8 Focused Antenatal Care An approach to ANC that emphasizes: Evidence-based, goal-directed actions Individualized, woman-centered care Quality vs. quantity of visits Care by skilled providers Prevention and Control of Malaria during Pregnancy 9 Goal of Focused Antenatal Care To promote maternal and newborn health and survival through: Early detection and treatment of problems and complications Prevention of complications and disease Birth preparedness and complication readiness Health promotion Prevention and Control of Malaria during Pregnancy 10 Traditional Antenatal Care Emphasizes: Ritualistic, “routine” care vs. evidence-based, goal-directed actions Frequent visits Does not emphasize individual client needs Prevention and Control of Malaria during Pregnancy 11 No Longer Recommended Numerous, routine visits Burden to women and healthcare system Routine measurements and examinations: Maternal height and weight Ankle edema Fetal position before 36 weeks Care based on risk assessment Prevention and Control of Malaria during Pregnancy 12 Risk Approach Not an effective ANC strategy because: Complications cannot be predicted—all pregnant women are at risk for developing complications Risk factors are usually not direct cause of complications Many “low risk” women develop complications Have false sense of security Do not know how to recognize/respond to problems Most “high risk” women give birth without complications Inefficient use of scarce resources Prevention and Control of Malaria during Pregnancy 13 Focused Antenatal Care Services Evidence-based, goal-directed actions: Address most prevalent health issues affecting women and newborns Adjusted for specific populations/regions Appropriate to gestational age Based on firm rationale Prevention and Control of Malaria during Pregnancy 14 Focused Antenatal Care Services (cont’d.) Individualized, woman-centered care based on each woman’s: Specific needs and concerns Circumstances History, physical examination, testing Available resources Prevention and Control of Malaria during Pregnancy 15 Focused Antenatal Care Services (cont’d.) Quality vs. quantity of ANC visits: WHO multi-center study Number of visits reduced without affecting outcome for mother or baby Recommendations Content and quality vs. number of visits Goal-oriented care Minimum of four visits Prevention and Control of Malaria during Pregnancy 16 First visit: By 16 weeks or when woman first thinks she is pregnant Second visit: At 24–28 weeks or at least once in second trimester Third visit: At 32 weeks Fourth visit: At 36 weeks Other visits: If complication occurs, followup or referral is needed, woman wants to see provider, or provider changes frequency based on findings (history, exam, testing) or local policy Scheduling and Timing of ANC Visits Prevention and Control of Malaria during Pregnancy 17 Focused Antenatal Care Services (cont’d.) Care by a skilled provider who: Has formal training and experience Has knowledge, skills, and qualifications to deliver safe, effective maternal and newborn healthcare Practices in home, hospital, health center May be a midwife, nurse, doctor, clinical officer, etc. Prevention and Control of Malaria during Pregnancy 18 Early Detection and Treatment Malaria—history and physical exam Fever and accompanying signs/symptoms Region Complicated vs. uncomplicated cases Severe anemia—physical exam, testing Pre-eclampsia/eclampsia—measurement of blood pressure HIV—voluntary counseling and testing Sexually transmitted infections, including syphilis— testing Prevention and Control of Malaria during Pregnancy 19 Prevention: Key Preventive Measures Malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Tetanus toxoid, iron/folate supplements Country/region-specific interventions as appropriate Vitamin A supplements Iodine supplements Presumptive treatment for hookworm Prevention and Control of Malaria during Pregnancy 20 Birth Preparedness and Complication Readiness: Objectives Develop birth plan—exact plan for normal birth and possible complications: Arrangements made in advance by woman and family (with help of skilled provider) Usually not a written document Reviewed/revised at every visit Minimize disorganization at time of birth or in an emergency Ensure timely and appropriate care Prevention and Control of Malaria during Pregnancy 21 Essential Elements of a Birth Plan Facility or Place of Birth: Home or health facility for birth, appropriate facility for emergencies Skilled Provider: To attend birth Provider/Facility Contact Information Transportation: Reliable, accessible, especially for odd hours Funds: Personal savings, emergency funds Decision-Making: Who will make decisions, especially in an emergency Prevention and Control of Malaria during Pregnancy 22 Essential Elements of a Birth Plan (cont’d.) Family and Community Support: Care for family in woman’s absence and birth companion during labor Blood Donor: In case of emergency Needed Items: For clean and safe birth and for newborn care Danger Signs/Signs of Advanced Labor Prevention and Control of Malaria during Pregnancy 23 Danger Signs of Pregnancy Vaginal bleeding Difficulty breathing Fever Severe abdominal pain Severe headache/blurred vision Convulsions/loss of consciousness Labor pains before 37 weeks Prevention and Control of Malaria during Pregnancy 24 Health Education: Objectives Inform and educate the woman with health messages and counseling appropriate to: Individual needs, concerns, circumstances Gestational age Most prevalent health issues Support the woman in making decisions and solving actual or anticipated problems Involve partner and family in supporting/adopting healthy practices Prevention and Control of Malaria during Pregnancy 25 Health Education: Topics Addressed Prevention of malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Other methods Other important issues to be discussed include: Nutrition Care for common discomforts Use of potentially harmful substances Hygiene Rest and activity Prevention and Control of Malaria during Pregnancy 26 Health Education: Topics Addressed (cont’d.) Sexual relations and safer sex Early and exclusive breastfeeding Prevention of tetanus and anemia Voluntary counseling and testing for HIV Prevention of other endemic diseases/deficiencies Prevention and Control of Malaria during Pregnancy 27 Interpersonal Skills Speak in a quiet, gentle tone of voice Listen to woman/family and respond appropriately Encourage them to ask questions and express concerns Allow them to demonstrate understanding of information provided Explain all procedures/actions and obtain permission before proceeding Show respect for cultural beliefs and social norms Be empathetic and nonjudgmental Avoid distractions while conducting the visit Prevention and Control of Malaria during Pregnancy 28 Record Keeping First ANC Visit History Physical examination Testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs Date of next ANC visit Subsequent ANC Visits Interim history Targeted physical examination, testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs (and relevant information on how client obtained and used ITN) Date of next ANC visit Record all information on the ANC chart and clinic card: Prevention and Control of Malaria during Pregnancy Chapter II: Malaria Transmission Prevention and Control of Malaria during Pregnancy 30 Malaria Transmission: Chapter Objectives Define malaria and how it is transmitted Describe extent of malaria in Africa Identify groups at highest risk of malaria infection List effects of malaria on pregnant women and their unborn babies Describe effects of malaria on pregnant women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 31 Malaria Transmission Caused by Plasmodium parasites Spread by female Anopheles mosquitoes infected with parasites Anopheles mosquitoes usually active at night Infected mosquito bites a person Malaria parasites reproduce in human blood Mosquito bites infected person, and goes on to bite and infect another person Prevention and Control of Malaria during Pregnancy 32 Populations Most Affected by Malaria Children under 5 years of age Pregnant women Unborn babies Immigrants from low-transmission areas HIV-infected persons Prevention and Control of Malaria during Pregnancy 33 Effects of Malaria on Pregnant Women All pregnant women in malaria-endemic areas are at risk Parasites attack and destroy red blood cells Malaria causes up to 15% of anemia in pregnancy Can cause severe anemia In Africa, anemia due to malaria causes up to 10,000 maternal deaths per year Prevention and Control of Malaria during Pregnancy 34 Effects on Unborn Babies Parasites hide in placenta Interferes with transfer of oxygen and nutrients to the baby, increasing risk of: Spontaneous abortion Preterm birth Low birthweight—single greatest risk factor for death during first month of life Stillbirth Prevention and Control of Malaria during Pregnancy 35 Effects on Communities Causes missed work and wages Results in frequent school absences Uses scarce resources Causes preventable deaths: increases maternal, newborn, and infant mortality rates Prevention and Control of Malaria during Pregnancy 36 HIV/AIDS and Malaria during Pregnancy HIV/AIDS reduces a woman’s resistance to malaria Intermittent preventive treatment (IPT) given 3 times during pregnancy is effective for women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 37 Summary of Health Education Points Malaria transmitted through mosquito bites Pregnant women and children are most at risk Pregnant women infected with malaria may have no symptoms Women with HIV/AIDS are at higher risk Malaria can lead to severe anemia, spontaneous abortion, low-birthweight babies Malaria is preventable Prevention and Control of Malaria during Pregnancy Chapter III: Preventing Malaria Prevention and Control of Malaria during Pregnancy 39 Preventing Malaria: Chapter Objectives List the elements of counseling women about the use of insecticide-treated nets (ITNs) and intermittent preventive treatment (IPT) during pregnancy Describe the use of sulfadoxine-pyrimethamine (SP) for IPT during pregnancy Prevention and Control of Malaria during Pregnancy 40 Insecticide-Treated Nets Kill or repel mosquitoes Prevent physical contact with mosquitoes Kill or repel other insects: Lice Ticks Bedbugs Cockroaches Prevention and Control of Malaria during Pregnancy 41 Insecticide-Treated Nets (cont’d.) Untreated Nets Provide some protection against malaria Do not kill or repel mosquitoes that touch net Do not reduce number of mosquitoes Do not kill other insects like lice, roaches, and bedbugs Are safe for pregnant women, young children, and infants Insecticide-Treated Nets Provide a high level of protection against malaria Kills or repels mosquitoes that touch the net Reduce number of mosquitoes in/outside net Kills other insects such as lice, roaches, and bedbugs Are safe for pregnant women, young children, and infants Prevention and Control of Malaria during Pregnancy 42 Benefits of Insecticide-Treated Nets Prevent mosquito bites Protect against malaria, resulting in less: Anemia Prematurity and low birthweight Risk of maternal and newborn death Help people sleep better Promote growth and development of fetus and newborn Prevention and Control of Malaria during Pregnancy 43 Benefits of Insecticide-Treated Nets: Community Cost less than treating malaria Reduce number of sick children and adults (helping children grow to be healthy and helping working adults remain productive) Reduce number of deaths Prevention and Control of Malaria during Pregnancy 44 Where to Find Insecticide-Treated Nets General merchandise shops Drug shops/pharmacies Markets Public and private health facilities Community health workers NGOs, community-based organizations Prevention and Control of Malaria during Pregnancy 45 How to Use Insecticide-Treated Nets Hang above bed or sleeping mat Tuck under mattress or mat Use every night, all year long Use for everyone, if possible, but give priority to pregnant women, infants, and children Prevention and Control of Malaria during Pregnancy 46 Caring for Insecticide-Treated Nets Handle gently to avoid tears Tie net up during day to avoid damage Regularly inspect for holes, repair if found Nets need to be re-treated regularly to stay effective Keep away from smoke, fire, direct sunlight Prevention and Control of Malaria during Pregnancy 47 Intermittent Preventive Treatment Based on the assumption that every pregnant woman living in an area of high malaria transmission has malaria parasites in her blood or placenta, whether or not she has symptoms of malaria Prevention and Control of Malaria during Pregnancy 48 Intermittent Preventive Treatment Although a pregnant woman with malaria may have no symptoms, malaria can still affect her and her unborn child Prevention and Control of Malaria during Pregnancy 49 Intermittent Preventive Treatment: WHO Recommendation All pregnant women should receive at least two doses of IPT after quickening, during routinely scheduled ANC visits (WHO recommends a schedule of four visits, three after quickening) Presently, the most effective drug for IPT is sulfadoxine-pyrimethamine (SP) Women should receive at least two doses of IPT with SP at ANC visits after quickening, but no more frequently than monthly Prevention and Control of Malaria during Pregnancy 50 Intermittent Preventive Treatment: Dose and Timing A single dose is three tablets of sulfadoxine 500 mg + pyrimethamine 25 mg Healthcare provider should dispense dose and directly observe client taking dose Prevention and Control of Malaria during Pregnancy 51 Instructions for Giving Intermittent Preventive Treatment Ensure woman is at least 16 weeks pregnant and that quickening has occurred Inquire about use of SP in last 4 weeks Inquire about allergies to SP or other sulfa drugs (especially severe rashes) Explain what you will do; address the woman’s questions Provide cup and clean water Prevention and Control of Malaria during Pregnancy 52 Instructions for Giving Intermittent Preventive Treatment (cont’d.) Directly observe woman swallow three tablets of SP Record SP dose on ANC and clinic card Advise the woman when to return: For her next scheduled visit If she has signs of malaria If she has other danger signs Reinforce the importance of using ITNs Prevention and Control of Malaria during Pregnancy 53 Intermittent Preventive Treatment: Contraindications to Using SP Do NOT give during first trimester: Be sure quickening has occurred and woman is at least 16 weeks pregnant Do NOT give to women with reported allergy to SP or other sulfa drugs: Ask about sulfa drug allergies before giving SP Do NOT give to women taking co-trimoxazole, or other sulfa-containing drugs: Ask about use of these medicines before giving SP Do not give SP more frequently than monthly: Be sure at least 1 month has passed since the last dose of SP Prevention and Control of Malaria during Pregnancy 54 Chemoprophylaxis with Chloroquine: For Women Allergic to Sulfa Drugs* Dose Chloroquine 150 mg Timing 1 4 tablets First ANC visit after 16 weeks 2 4 tablets Second day after first dose 3 2 tablets Third day after first dose Weekly 2 tablets Every week during pregnancy *If chloroquine resistance rates in the country are high, chemoprophylaxis with chloroquine is not recommended. Prevention and Control of Malaria during Pregnancy 55 Summary of Health Education Points Pregnant women should sleep under ITNs every night By preventing malaria, IPT reduces the incidence of maternal anemia, spontaneous abortion, preterm birth, stillbirth, and low birthweight IPT should be administered to pregnant women at regularly scheduled ANC visits after quickening, but not more often than monthly Prevention and Control of Malaria during Pregnancy Chapter IV: Detection and Treatment Prevention and Control of Malaria during Pregnancy 57 Malaria Detection and Treatment: Chapter Objectives Identify causes of fever during pregnancy List the signs and symptoms of uncomplicated and complicated malaria Describe the treatment for uncomplicated malaria during pregnancy Explain the steps to appropriately refer a pregnant woman who has complicated malaria Prevention and Control of Malaria during Pregnancy 58 Detecting Malaria Symptoms Fever Chills Headaches Muscle/joint pains Lab exam of blood from a finger prick Prevention and Control of Malaria during Pregnancy 59 Fever during Pregnancy Temperature of 38° C or higher May be caused by malaria, but also by: Bladder or kidney infection Pneumonia Typhoid Uterine infection Careful history and physical required to rule out other causes Prevention and Control of Malaria during Pregnancy 60 Fever during Pregnancy (cont’d.) Ask about or examine for: Type, duration, degree of fever Signs of other infections: Chest pain/difficulty breathing Foul-smelling watery vaginal discharge Tender/painful uterus or abdomen Frequency/urgency/pain in urinating Signs of complicated malaria or other danger signs Prevention and Control of Malaria during Pregnancy 61 Types of Malaria Uncomplicated Most common Complicated Life threatening, can affect brain Pregnant women more likely to get complicated malaria than non-pregnant women Prevention and Control of Malaria during Pregnancy 62 Recognizing Malaria in Pregnant Women Uncomplicated Malaria Fever Shivering/chills/rigors Headaches Muscle/joint pains Nausea/vomiting False labor pains Complicated Malaria Signs of uncomplicated malaria PLUS one or more of the following: Dizziness Breathlessness/difficulty breathing Sleepy/drowsy Confusion/coma Sometimes fits, jaundice, severe dehydration Prevention and Control of Malaria during Pregnancy 63 Recognizing Malaria in Pregnant Women (cont’d.) Refer the woman immediately if you suspect anything other than uncomplicated malaria Prevention and Control of Malaria during Pregnancy 64 Case Management Determine whether malaria is uncomplicated or complicated Uncomplicated: Manage according to national protocol Complicated: Refer immediately to higher level of care; consider giving first dose of anti-malarial if available and healthcare provider is familiar with its use
Slide 65 - Prevention and Control of Malaria during Pregnancy A Workshop for Healthcare Providers Prevention and Control of Malaria during Pregnancy 2 Facts about Malaria 300 million cases each year worldwide 9 of 10 cases occur in Africa A person in Africa dies of malaria every 10 seconds Women and young children are most at risk Affects five times as many people as AIDS, leprosy, measles, and tuberculosis combined Prevention and Control of Malaria during Pregnancy 3 Facts about Malaria and Pregnancy 30 million African women are pregnant yearly Malaria is more frequent and complicated during pregnancy In malaria-endemic areas, malaria during pregnancy may account for: Up to 15% of maternal anemia 5–14% of low birthweight 30% of “preventable” low birthweight Prevention and Control of Malaria during Pregnancy 4 Roll Back Malaria Worldwide partnership Governments, private groups, research organizations, civil society, media Aim to reduce malaria by half by 2010 Free advocacy resources and tools: http://www.rbm.who.int Priority: Prevent poor outcomes caused by malaria in pregnancy Abuja declaration: Goal is for 60% of women in Africa to be sleeping under insecticide-treated nets (ITNs) and getting intermittent preventive treatment (IPT) by 2005 Prevention and Control of Malaria during Pregnancy 5 Malaria Prevention and Treatment during Pregnancy Focused antenatal care (ANC) with health education about malaria Use of insecticide-treated nets (ITNs) Intermittent preventive treatment (IPT) Case management of women with symptoms and signs of malaria Prevention and Control of Malaria during Pregnancy Chapter I: Focused Antenatal Care Prevention and Control of Malaria during Pregnancy 7 Focused Antenatal Care: Chapter Objectives Describe four main components of focused antenatal care (ANC) Discuss frequency and timing of ANC visits Describe essential elements of a birth plan that includes complication readiness Describe interpersonal skills for effective ANC Describe components of record keeping for ANC Prevention and Control of Malaria during Pregnancy 8 Focused Antenatal Care An approach to ANC that emphasizes: Evidence-based, goal-directed actions Individualized, woman-centered care Quality vs. quantity of visits Care by skilled providers Prevention and Control of Malaria during Pregnancy 9 Goal of Focused Antenatal Care To promote maternal and newborn health and survival through: Early detection and treatment of problems and complications Prevention of complications and disease Birth preparedness and complication readiness Health promotion Prevention and Control of Malaria during Pregnancy 10 Traditional Antenatal Care Emphasizes: Ritualistic, “routine” care vs. evidence-based, goal-directed actions Frequent visits Does not emphasize individual client needs Prevention and Control of Malaria during Pregnancy 11 No Longer Recommended Numerous, routine visits Burden to women and healthcare system Routine measurements and examinations: Maternal height and weight Ankle edema Fetal position before 36 weeks Care based on risk assessment Prevention and Control of Malaria during Pregnancy 12 Risk Approach Not an effective ANC strategy because: Complications cannot be predicted—all pregnant women are at risk for developing complications Risk factors are usually not direct cause of complications Many “low risk” women develop complications Have false sense of security Do not know how to recognize/respond to problems Most “high risk” women give birth without complications Inefficient use of scarce resources Prevention and Control of Malaria during Pregnancy 13 Focused Antenatal Care Services Evidence-based, goal-directed actions: Address most prevalent health issues affecting women and newborns Adjusted for specific populations/regions Appropriate to gestational age Based on firm rationale Prevention and Control of Malaria during Pregnancy 14 Focused Antenatal Care Services (cont’d.) Individualized, woman-centered care based on each woman’s: Specific needs and concerns Circumstances History, physical examination, testing Available resources Prevention and Control of Malaria during Pregnancy 15 Focused Antenatal Care Services (cont’d.) Quality vs. quantity of ANC visits: WHO multi-center study Number of visits reduced without affecting outcome for mother or baby Recommendations Content and quality vs. number of visits Goal-oriented care Minimum of four visits Prevention and Control of Malaria during Pregnancy 16 First visit: By 16 weeks or when woman first thinks she is pregnant Second visit: At 24–28 weeks or at least once in second trimester Third visit: At 32 weeks Fourth visit: At 36 weeks Other visits: If complication occurs, followup or referral is needed, woman wants to see provider, or provider changes frequency based on findings (history, exam, testing) or local policy Scheduling and Timing of ANC Visits Prevention and Control of Malaria during Pregnancy 17 Focused Antenatal Care Services (cont’d.) Care by a skilled provider who: Has formal training and experience Has knowledge, skills, and qualifications to deliver safe, effective maternal and newborn healthcare Practices in home, hospital, health center May be a midwife, nurse, doctor, clinical officer, etc. Prevention and Control of Malaria during Pregnancy 18 Early Detection and Treatment Malaria—history and physical exam Fever and accompanying signs/symptoms Region Complicated vs. uncomplicated cases Severe anemia—physical exam, testing Pre-eclampsia/eclampsia—measurement of blood pressure HIV—voluntary counseling and testing Sexually transmitted infections, including syphilis— testing Prevention and Control of Malaria during Pregnancy 19 Prevention: Key Preventive Measures Malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Tetanus toxoid, iron/folate supplements Country/region-specific interventions as appropriate Vitamin A supplements Iodine supplements Presumptive treatment for hookworm Prevention and Control of Malaria during Pregnancy 20 Birth Preparedness and Complication Readiness: Objectives Develop birth plan—exact plan for normal birth and possible complications: Arrangements made in advance by woman and family (with help of skilled provider) Usually not a written document Reviewed/revised at every visit Minimize disorganization at time of birth or in an emergency Ensure timely and appropriate care Prevention and Control of Malaria during Pregnancy 21 Essential Elements of a Birth Plan Facility or Place of Birth: Home or health facility for birth, appropriate facility for emergencies Skilled Provider: To attend birth Provider/Facility Contact Information Transportation: Reliable, accessible, especially for odd hours Funds: Personal savings, emergency funds Decision-Making: Who will make decisions, especially in an emergency Prevention and Control of Malaria during Pregnancy 22 Essential Elements of a Birth Plan (cont’d.) Family and Community Support: Care for family in woman’s absence and birth companion during labor Blood Donor: In case of emergency Needed Items: For clean and safe birth and for newborn care Danger Signs/Signs of Advanced Labor Prevention and Control of Malaria during Pregnancy 23 Danger Signs of Pregnancy Vaginal bleeding Difficulty breathing Fever Severe abdominal pain Severe headache/blurred vision Convulsions/loss of consciousness Labor pains before 37 weeks Prevention and Control of Malaria during Pregnancy 24 Health Education: Objectives Inform and educate the woman with health messages and counseling appropriate to: Individual needs, concerns, circumstances Gestational age Most prevalent health issues Support the woman in making decisions and solving actual or anticipated problems Involve partner and family in supporting/adopting healthy practices Prevention and Control of Malaria during Pregnancy 25 Health Education: Topics Addressed Prevention of malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Other methods Other important issues to be discussed include: Nutrition Care for common discomforts Use of potentially harmful substances Hygiene Rest and activity Prevention and Control of Malaria during Pregnancy 26 Health Education: Topics Addressed (cont’d.) Sexual relations and safer sex Early and exclusive breastfeeding Prevention of tetanus and anemia Voluntary counseling and testing for HIV Prevention of other endemic diseases/deficiencies Prevention and Control of Malaria during Pregnancy 27 Interpersonal Skills Speak in a quiet, gentle tone of voice Listen to woman/family and respond appropriately Encourage them to ask questions and express concerns Allow them to demonstrate understanding of information provided Explain all procedures/actions and obtain permission before proceeding Show respect for cultural beliefs and social norms Be empathetic and nonjudgmental Avoid distractions while conducting the visit Prevention and Control of Malaria during Pregnancy 28 Record Keeping First ANC Visit History Physical examination Testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs Date of next ANC visit Subsequent ANC Visits Interim history Targeted physical examination, testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs (and relevant information on how client obtained and used ITN) Date of next ANC visit Record all information on the ANC chart and clinic card: Prevention and Control of Malaria during Pregnancy Chapter II: Malaria Transmission Prevention and Control of Malaria during Pregnancy 30 Malaria Transmission: Chapter Objectives Define malaria and how it is transmitted Describe extent of malaria in Africa Identify groups at highest risk of malaria infection List effects of malaria on pregnant women and their unborn babies Describe effects of malaria on pregnant women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 31 Malaria Transmission Caused by Plasmodium parasites Spread by female Anopheles mosquitoes infected with parasites Anopheles mosquitoes usually active at night Infected mosquito bites a person Malaria parasites reproduce in human blood Mosquito bites infected person, and goes on to bite and infect another person Prevention and Control of Malaria during Pregnancy 32 Populations Most Affected by Malaria Children under 5 years of age Pregnant women Unborn babies Immigrants from low-transmission areas HIV-infected persons Prevention and Control of Malaria during Pregnancy 33 Effects of Malaria on Pregnant Women All pregnant women in malaria-endemic areas are at risk Parasites attack and destroy red blood cells Malaria causes up to 15% of anemia in pregnancy Can cause severe anemia In Africa, anemia due to malaria causes up to 10,000 maternal deaths per year Prevention and Control of Malaria during Pregnancy 34 Effects on Unborn Babies Parasites hide in placenta Interferes with transfer of oxygen and nutrients to the baby, increasing risk of: Spontaneous abortion Preterm birth Low birthweight—single greatest risk factor for death during first month of life Stillbirth Prevention and Control of Malaria during Pregnancy 35 Effects on Communities Causes missed work and wages Results in frequent school absences Uses scarce resources Causes preventable deaths: increases maternal, newborn, and infant mortality rates Prevention and Control of Malaria during Pregnancy 36 HIV/AIDS and Malaria during Pregnancy HIV/AIDS reduces a woman’s resistance to malaria Intermittent preventive treatment (IPT) given 3 times during pregnancy is effective for women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 37 Summary of Health Education Points Malaria transmitted through mosquito bites Pregnant women and children are most at risk Pregnant women infected with malaria may have no symptoms Women with HIV/AIDS are at higher risk Malaria can lead to severe anemia, spontaneous abortion, low-birthweight babies Malaria is preventable Prevention and Control of Malaria during Pregnancy Chapter III: Preventing Malaria Prevention and Control of Malaria during Pregnancy 39 Preventing Malaria: Chapter Objectives List the elements of counseling women about the use of insecticide-treated nets (ITNs) and intermittent preventive treatment (IPT) during pregnancy Describe the use of sulfadoxine-pyrimethamine (SP) for IPT during pregnancy Prevention and Control of Malaria during Pregnancy 40 Insecticide-Treated Nets Kill or repel mosquitoes Prevent physical contact with mosquitoes Kill or repel other insects: Lice Ticks Bedbugs Cockroaches Prevention and Control of Malaria during Pregnancy 41 Insecticide-Treated Nets (cont’d.) Untreated Nets Provide some protection against malaria Do not kill or repel mosquitoes that touch net Do not reduce number of mosquitoes Do not kill other insects like lice, roaches, and bedbugs Are safe for pregnant women, young children, and infants Insecticide-Treated Nets Provide a high level of protection against malaria Kills or repels mosquitoes that touch the net Reduce number of mosquitoes in/outside net Kills other insects such as lice, roaches, and bedbugs Are safe for pregnant women, young children, and infants Prevention and Control of Malaria during Pregnancy 42 Benefits of Insecticide-Treated Nets Prevent mosquito bites Protect against malaria, resulting in less: Anemia Prematurity and low birthweight Risk of maternal and newborn death Help people sleep better Promote growth and development of fetus and newborn Prevention and Control of Malaria during Pregnancy 43 Benefits of Insecticide-Treated Nets: Community Cost less than treating malaria Reduce number of sick children and adults (helping children grow to be healthy and helping working adults remain productive) Reduce number of deaths Prevention and Control of Malaria during Pregnancy 44 Where to Find Insecticide-Treated Nets General merchandise shops Drug shops/pharmacies Markets Public and private health facilities Community health workers NGOs, community-based organizations Prevention and Control of Malaria during Pregnancy 45 How to Use Insecticide-Treated Nets Hang above bed or sleeping mat Tuck under mattress or mat Use every night, all year long Use for everyone, if possible, but give priority to pregnant women, infants, and children Prevention and Control of Malaria during Pregnancy 46 Caring for Insecticide-Treated Nets Handle gently to avoid tears Tie net up during day to avoid damage Regularly inspect for holes, repair if found Nets need to be re-treated regularly to stay effective Keep away from smoke, fire, direct sunlight Prevention and Control of Malaria during Pregnancy 47 Intermittent Preventive Treatment Based on the assumption that every pregnant woman living in an area of high malaria transmission has malaria parasites in her blood or placenta, whether or not she has symptoms of malaria Prevention and Control of Malaria during Pregnancy 48 Intermittent Preventive Treatment Although a pregnant woman with malaria may have no symptoms, malaria can still affect her and her unborn child Prevention and Control of Malaria during Pregnancy 49 Intermittent Preventive Treatment: WHO Recommendation All pregnant women should receive at least two doses of IPT after quickening, during routinely scheduled ANC visits (WHO recommends a schedule of four visits, three after quickening) Presently, the most effective drug for IPT is sulfadoxine-pyrimethamine (SP) Women should receive at least two doses of IPT with SP at ANC visits after quickening, but no more frequently than monthly Prevention and Control of Malaria during Pregnancy 50 Intermittent Preventive Treatment: Dose and Timing A single dose is three tablets of sulfadoxine 500 mg + pyrimethamine 25 mg Healthcare provider should dispense dose and directly observe client taking dose Prevention and Control of Malaria during Pregnancy 51 Instructions for Giving Intermittent Preventive Treatment Ensure woman is at least 16 weeks pregnant and that quickening has occurred Inquire about use of SP in last 4 weeks Inquire about allergies to SP or other sulfa drugs (especially severe rashes) Explain what you will do; address the woman’s questions Provide cup and clean water Prevention and Control of Malaria during Pregnancy 52 Instructions for Giving Intermittent Preventive Treatment (cont’d.) Directly observe woman swallow three tablets of SP Record SP dose on ANC and clinic card Advise the woman when to return: For her next scheduled visit If she has signs of malaria If she has other danger signs Reinforce the importance of using ITNs Prevention and Control of Malaria during Pregnancy 53 Intermittent Preventive Treatment: Contraindications to Using SP Do NOT give during first trimester: Be sure quickening has occurred and woman is at least 16 weeks pregnant Do NOT give to women with reported allergy to SP or other sulfa drugs: Ask about sulfa drug allergies before giving SP Do NOT give to women taking co-trimoxazole, or other sulfa-containing drugs: Ask about use of these medicines before giving SP Do not give SP more frequently than monthly: Be sure at least 1 month has passed since the last dose of SP Prevention and Control of Malaria during Pregnancy 54 Chemoprophylaxis with Chloroquine: For Women Allergic to Sulfa Drugs* Dose Chloroquine 150 mg Timing 1 4 tablets First ANC visit after 16 weeks 2 4 tablets Second day after first dose 3 2 tablets Third day after first dose Weekly 2 tablets Every week during pregnancy *If chloroquine resistance rates in the country are high, chemoprophylaxis with chloroquine is not recommended. Prevention and Control of Malaria during Pregnancy 55 Summary of Health Education Points Pregnant women should sleep under ITNs every night By preventing malaria, IPT reduces the incidence of maternal anemia, spontaneous abortion, preterm birth, stillbirth, and low birthweight IPT should be administered to pregnant women at regularly scheduled ANC visits after quickening, but not more often than monthly Prevention and Control of Malaria during Pregnancy Chapter IV: Detection and Treatment Prevention and Control of Malaria during Pregnancy 57 Malaria Detection and Treatment: Chapter Objectives Identify causes of fever during pregnancy List the signs and symptoms of uncomplicated and complicated malaria Describe the treatment for uncomplicated malaria during pregnancy Explain the steps to appropriately refer a pregnant woman who has complicated malaria Prevention and Control of Malaria during Pregnancy 58 Detecting Malaria Symptoms Fever Chills Headaches Muscle/joint pains Lab exam of blood from a finger prick Prevention and Control of Malaria during Pregnancy 59 Fever during Pregnancy Temperature of 38° C or higher May be caused by malaria, but also by: Bladder or kidney infection Pneumonia Typhoid Uterine infection Careful history and physical required to rule out other causes Prevention and Control of Malaria during Pregnancy 60 Fever during Pregnancy (cont’d.) Ask about or examine for: Type, duration, degree of fever Signs of other infections: Chest pain/difficulty breathing Foul-smelling watery vaginal discharge Tender/painful uterus or abdomen Frequency/urgency/pain in urinating Signs of complicated malaria or other danger signs Prevention and Control of Malaria during Pregnancy 61 Types of Malaria Uncomplicated Most common Complicated Life threatening, can affect brain Pregnant women more likely to get complicated malaria than non-pregnant women Prevention and Control of Malaria during Pregnancy 62 Recognizing Malaria in Pregnant Women Uncomplicated Malaria Fever Shivering/chills/rigors Headaches Muscle/joint pains Nausea/vomiting False labor pains Complicated Malaria Signs of uncomplicated malaria PLUS one or more of the following: Dizziness Breathlessness/difficulty breathing Sleepy/drowsy Confusion/coma Sometimes fits, jaundice, severe dehydration Prevention and Control of Malaria during Pregnancy 63 Recognizing Malaria in Pregnant Women (cont’d.) Refer the woman immediately if you suspect anything other than uncomplicated malaria Prevention and Control of Malaria during Pregnancy 64 Case Management Determine whether malaria is uncomplicated or complicated Uncomplicated: Manage according to national protocol Complicated: Refer immediately to higher level of care; consider giving first dose of anti-malarial if available and healthcare provider is familiar with its use Prevention and Control of Malaria during Pregnancy 65 Case Management: Drugs First-line drug therapy is indicated for uncomplicated malaria Second-line drug therapy is indicated for uncomplicated malaria that has failed to respond to first-line drug In almost all countries, quinine is the drug of choice for complicated malaria
Slide 66 - Prevention and Control of Malaria during Pregnancy A Workshop for Healthcare Providers Prevention and Control of Malaria during Pregnancy 2 Facts about Malaria 300 million cases each year worldwide 9 of 10 cases occur in Africa A person in Africa dies of malaria every 10 seconds Women and young children are most at risk Affects five times as many people as AIDS, leprosy, measles, and tuberculosis combined Prevention and Control of Malaria during Pregnancy 3 Facts about Malaria and Pregnancy 30 million African women are pregnant yearly Malaria is more frequent and complicated during pregnancy In malaria-endemic areas, malaria during pregnancy may account for: Up to 15% of maternal anemia 5–14% of low birthweight 30% of “preventable” low birthweight Prevention and Control of Malaria during Pregnancy 4 Roll Back Malaria Worldwide partnership Governments, private groups, research organizations, civil society, media Aim to reduce malaria by half by 2010 Free advocacy resources and tools: http://www.rbm.who.int Priority: Prevent poor outcomes caused by malaria in pregnancy Abuja declaration: Goal is for 60% of women in Africa to be sleeping under insecticide-treated nets (ITNs) and getting intermittent preventive treatment (IPT) by 2005 Prevention and Control of Malaria during Pregnancy 5 Malaria Prevention and Treatment during Pregnancy Focused antenatal care (ANC) with health education about malaria Use of insecticide-treated nets (ITNs) Intermittent preventive treatment (IPT) Case management of women with symptoms and signs of malaria Prevention and Control of Malaria during Pregnancy Chapter I: Focused Antenatal Care Prevention and Control of Malaria during Pregnancy 7 Focused Antenatal Care: Chapter Objectives Describe four main components of focused antenatal care (ANC) Discuss frequency and timing of ANC visits Describe essential elements of a birth plan that includes complication readiness Describe interpersonal skills for effective ANC Describe components of record keeping for ANC Prevention and Control of Malaria during Pregnancy 8 Focused Antenatal Care An approach to ANC that emphasizes: Evidence-based, goal-directed actions Individualized, woman-centered care Quality vs. quantity of visits Care by skilled providers Prevention and Control of Malaria during Pregnancy 9 Goal of Focused Antenatal Care To promote maternal and newborn health and survival through: Early detection and treatment of problems and complications Prevention of complications and disease Birth preparedness and complication readiness Health promotion Prevention and Control of Malaria during Pregnancy 10 Traditional Antenatal Care Emphasizes: Ritualistic, “routine” care vs. evidence-based, goal-directed actions Frequent visits Does not emphasize individual client needs Prevention and Control of Malaria during Pregnancy 11 No Longer Recommended Numerous, routine visits Burden to women and healthcare system Routine measurements and examinations: Maternal height and weight Ankle edema Fetal position before 36 weeks Care based on risk assessment Prevention and Control of Malaria during Pregnancy 12 Risk Approach Not an effective ANC strategy because: Complications cannot be predicted—all pregnant women are at risk for developing complications Risk factors are usually not direct cause of complications Many “low risk” women develop complications Have false sense of security Do not know how to recognize/respond to problems Most “high risk” women give birth without complications Inefficient use of scarce resources Prevention and Control of Malaria during Pregnancy 13 Focused Antenatal Care Services Evidence-based, goal-directed actions: Address most prevalent health issues affecting women and newborns Adjusted for specific populations/regions Appropriate to gestational age Based on firm rationale Prevention and Control of Malaria during Pregnancy 14 Focused Antenatal Care Services (cont’d.) Individualized, woman-centered care based on each woman’s: Specific needs and concerns Circumstances History, physical examination, testing Available resources Prevention and Control of Malaria during Pregnancy 15 Focused Antenatal Care Services (cont’d.) Quality vs. quantity of ANC visits: WHO multi-center study Number of visits reduced without affecting outcome for mother or baby Recommendations Content and quality vs. number of visits Goal-oriented care Minimum of four visits Prevention and Control of Malaria during Pregnancy 16 First visit: By 16 weeks or when woman first thinks she is pregnant Second visit: At 24–28 weeks or at least once in second trimester Third visit: At 32 weeks Fourth visit: At 36 weeks Other visits: If complication occurs, followup or referral is needed, woman wants to see provider, or provider changes frequency based on findings (history, exam, testing) or local policy Scheduling and Timing of ANC Visits Prevention and Control of Malaria during Pregnancy 17 Focused Antenatal Care Services (cont’d.) Care by a skilled provider who: Has formal training and experience Has knowledge, skills, and qualifications to deliver safe, effective maternal and newborn healthcare Practices in home, hospital, health center May be a midwife, nurse, doctor, clinical officer, etc. Prevention and Control of Malaria during Pregnancy 18 Early Detection and Treatment Malaria—history and physical exam Fever and accompanying signs/symptoms Region Complicated vs. uncomplicated cases Severe anemia—physical exam, testing Pre-eclampsia/eclampsia—measurement of blood pressure HIV—voluntary counseling and testing Sexually transmitted infections, including syphilis— testing Prevention and Control of Malaria during Pregnancy 19 Prevention: Key Preventive Measures Malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Tetanus toxoid, iron/folate supplements Country/region-specific interventions as appropriate Vitamin A supplements Iodine supplements Presumptive treatment for hookworm Prevention and Control of Malaria during Pregnancy 20 Birth Preparedness and Complication Readiness: Objectives Develop birth plan—exact plan for normal birth and possible complications: Arrangements made in advance by woman and family (with help of skilled provider) Usually not a written document Reviewed/revised at every visit Minimize disorganization at time of birth or in an emergency Ensure timely and appropriate care Prevention and Control of Malaria during Pregnancy 21 Essential Elements of a Birth Plan Facility or Place of Birth: Home or health facility for birth, appropriate facility for emergencies Skilled Provider: To attend birth Provider/Facility Contact Information Transportation: Reliable, accessible, especially for odd hours Funds: Personal savings, emergency funds Decision-Making: Who will make decisions, especially in an emergency Prevention and Control of Malaria during Pregnancy 22 Essential Elements of a Birth Plan (cont’d.) Family and Community Support: Care for family in woman’s absence and birth companion during labor Blood Donor: In case of emergency Needed Items: For clean and safe birth and for newborn care Danger Signs/Signs of Advanced Labor Prevention and Control of Malaria during Pregnancy 23 Danger Signs of Pregnancy Vaginal bleeding Difficulty breathing Fever Severe abdominal pain Severe headache/blurred vision Convulsions/loss of consciousness Labor pains before 37 weeks Prevention and Control of Malaria during Pregnancy 24 Health Education: Objectives Inform and educate the woman with health messages and counseling appropriate to: Individual needs, concerns, circumstances Gestational age Most prevalent health issues Support the woman in making decisions and solving actual or anticipated problems Involve partner and family in supporting/adopting healthy practices Prevention and Control of Malaria during Pregnancy 25 Health Education: Topics Addressed Prevention of malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Other methods Other important issues to be discussed include: Nutrition Care for common discomforts Use of potentially harmful substances Hygiene Rest and activity Prevention and Control of Malaria during Pregnancy 26 Health Education: Topics Addressed (cont’d.) Sexual relations and safer sex Early and exclusive breastfeeding Prevention of tetanus and anemia Voluntary counseling and testing for HIV Prevention of other endemic diseases/deficiencies Prevention and Control of Malaria during Pregnancy 27 Interpersonal Skills Speak in a quiet, gentle tone of voice Listen to woman/family and respond appropriately Encourage them to ask questions and express concerns Allow them to demonstrate understanding of information provided Explain all procedures/actions and obtain permission before proceeding Show respect for cultural beliefs and social norms Be empathetic and nonjudgmental Avoid distractions while conducting the visit Prevention and Control of Malaria during Pregnancy 28 Record Keeping First ANC Visit History Physical examination Testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs Date of next ANC visit Subsequent ANC Visits Interim history Targeted physical examination, testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs (and relevant information on how client obtained and used ITN) Date of next ANC visit Record all information on the ANC chart and clinic card: Prevention and Control of Malaria during Pregnancy Chapter II: Malaria Transmission Prevention and Control of Malaria during Pregnancy 30 Malaria Transmission: Chapter Objectives Define malaria and how it is transmitted Describe extent of malaria in Africa Identify groups at highest risk of malaria infection List effects of malaria on pregnant women and their unborn babies Describe effects of malaria on pregnant women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 31 Malaria Transmission Caused by Plasmodium parasites Spread by female Anopheles mosquitoes infected with parasites Anopheles mosquitoes usually active at night Infected mosquito bites a person Malaria parasites reproduce in human blood Mosquito bites infected person, and goes on to bite and infect another person Prevention and Control of Malaria during Pregnancy 32 Populations Most Affected by Malaria Children under 5 years of age Pregnant women Unborn babies Immigrants from low-transmission areas HIV-infected persons Prevention and Control of Malaria during Pregnancy 33 Effects of Malaria on Pregnant Women All pregnant women in malaria-endemic areas are at risk Parasites attack and destroy red blood cells Malaria causes up to 15% of anemia in pregnancy Can cause severe anemia In Africa, anemia due to malaria causes up to 10,000 maternal deaths per year Prevention and Control of Malaria during Pregnancy 34 Effects on Unborn Babies Parasites hide in placenta Interferes with transfer of oxygen and nutrients to the baby, increasing risk of: Spontaneous abortion Preterm birth Low birthweight—single greatest risk factor for death during first month of life Stillbirth Prevention and Control of Malaria during Pregnancy 35 Effects on Communities Causes missed work and wages Results in frequent school absences Uses scarce resources Causes preventable deaths: increases maternal, newborn, and infant mortality rates Prevention and Control of Malaria during Pregnancy 36 HIV/AIDS and Malaria during Pregnancy HIV/AIDS reduces a woman’s resistance to malaria Intermittent preventive treatment (IPT) given 3 times during pregnancy is effective for women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 37 Summary of Health Education Points Malaria transmitted through mosquito bites Pregnant women and children are most at risk Pregnant women infected with malaria may have no symptoms Women with HIV/AIDS are at higher risk Malaria can lead to severe anemia, spontaneous abortion, low-birthweight babies Malaria is preventable Prevention and Control of Malaria during Pregnancy Chapter III: Preventing Malaria Prevention and Control of Malaria during Pregnancy 39 Preventing Malaria: Chapter Objectives List the elements of counseling women about the use of insecticide-treated nets (ITNs) and intermittent preventive treatment (IPT) during pregnancy Describe the use of sulfadoxine-pyrimethamine (SP) for IPT during pregnancy Prevention and Control of Malaria during Pregnancy 40 Insecticide-Treated Nets Kill or repel mosquitoes Prevent physical contact with mosquitoes Kill or repel other insects: Lice Ticks Bedbugs Cockroaches Prevention and Control of Malaria during Pregnancy 41 Insecticide-Treated Nets (cont’d.) Untreated Nets Provide some protection against malaria Do not kill or repel mosquitoes that touch net Do not reduce number of mosquitoes Do not kill other insects like lice, roaches, and bedbugs Are safe for pregnant women, young children, and infants Insecticide-Treated Nets Provide a high level of protection against malaria Kills or repels mosquitoes that touch the net Reduce number of mosquitoes in/outside net Kills other insects such as lice, roaches, and bedbugs Are safe for pregnant women, young children, and infants Prevention and Control of Malaria during Pregnancy 42 Benefits of Insecticide-Treated Nets Prevent mosquito bites Protect against malaria, resulting in less: Anemia Prematurity and low birthweight Risk of maternal and newborn death Help people sleep better Promote growth and development of fetus and newborn Prevention and Control of Malaria during Pregnancy 43 Benefits of Insecticide-Treated Nets: Community Cost less than treating malaria Reduce number of sick children and adults (helping children grow to be healthy and helping working adults remain productive) Reduce number of deaths Prevention and Control of Malaria during Pregnancy 44 Where to Find Insecticide-Treated Nets General merchandise shops Drug shops/pharmacies Markets Public and private health facilities Community health workers NGOs, community-based organizations Prevention and Control of Malaria during Pregnancy 45 How to Use Insecticide-Treated Nets Hang above bed or sleeping mat Tuck under mattress or mat Use every night, all year long Use for everyone, if possible, but give priority to pregnant women, infants, and children Prevention and Control of Malaria during Pregnancy 46 Caring for Insecticide-Treated Nets Handle gently to avoid tears Tie net up during day to avoid damage Regularly inspect for holes, repair if found Nets need to be re-treated regularly to stay effective Keep away from smoke, fire, direct sunlight Prevention and Control of Malaria during Pregnancy 47 Intermittent Preventive Treatment Based on the assumption that every pregnant woman living in an area of high malaria transmission has malaria parasites in her blood or placenta, whether or not she has symptoms of malaria Prevention and Control of Malaria during Pregnancy 48 Intermittent Preventive Treatment Although a pregnant woman with malaria may have no symptoms, malaria can still affect her and her unborn child Prevention and Control of Malaria during Pregnancy 49 Intermittent Preventive Treatment: WHO Recommendation All pregnant women should receive at least two doses of IPT after quickening, during routinely scheduled ANC visits (WHO recommends a schedule of four visits, three after quickening) Presently, the most effective drug for IPT is sulfadoxine-pyrimethamine (SP) Women should receive at least two doses of IPT with SP at ANC visits after quickening, but no more frequently than monthly Prevention and Control of Malaria during Pregnancy 50 Intermittent Preventive Treatment: Dose and Timing A single dose is three tablets of sulfadoxine 500 mg + pyrimethamine 25 mg Healthcare provider should dispense dose and directly observe client taking dose Prevention and Control of Malaria during Pregnancy 51 Instructions for Giving Intermittent Preventive Treatment Ensure woman is at least 16 weeks pregnant and that quickening has occurred Inquire about use of SP in last 4 weeks Inquire about allergies to SP or other sulfa drugs (especially severe rashes) Explain what you will do; address the woman’s questions Provide cup and clean water Prevention and Control of Malaria during Pregnancy 52 Instructions for Giving Intermittent Preventive Treatment (cont’d.) Directly observe woman swallow three tablets of SP Record SP dose on ANC and clinic card Advise the woman when to return: For her next scheduled visit If she has signs of malaria If she has other danger signs Reinforce the importance of using ITNs Prevention and Control of Malaria during Pregnancy 53 Intermittent Preventive Treatment: Contraindications to Using SP Do NOT give during first trimester: Be sure quickening has occurred and woman is at least 16 weeks pregnant Do NOT give to women with reported allergy to SP or other sulfa drugs: Ask about sulfa drug allergies before giving SP Do NOT give to women taking co-trimoxazole, or other sulfa-containing drugs: Ask about use of these medicines before giving SP Do not give SP more frequently than monthly: Be sure at least 1 month has passed since the last dose of SP Prevention and Control of Malaria during Pregnancy 54 Chemoprophylaxis with Chloroquine: For Women Allergic to Sulfa Drugs* Dose Chloroquine 150 mg Timing 1 4 tablets First ANC visit after 16 weeks 2 4 tablets Second day after first dose 3 2 tablets Third day after first dose Weekly 2 tablets Every week during pregnancy *If chloroquine resistance rates in the country are high, chemoprophylaxis with chloroquine is not recommended. Prevention and Control of Malaria during Pregnancy 55 Summary of Health Education Points Pregnant women should sleep under ITNs every night By preventing malaria, IPT reduces the incidence of maternal anemia, spontaneous abortion, preterm birth, stillbirth, and low birthweight IPT should be administered to pregnant women at regularly scheduled ANC visits after quickening, but not more often than monthly Prevention and Control of Malaria during Pregnancy Chapter IV: Detection and Treatment Prevention and Control of Malaria during Pregnancy 57 Malaria Detection and Treatment: Chapter Objectives Identify causes of fever during pregnancy List the signs and symptoms of uncomplicated and complicated malaria Describe the treatment for uncomplicated malaria during pregnancy Explain the steps to appropriately refer a pregnant woman who has complicated malaria Prevention and Control of Malaria during Pregnancy 58 Detecting Malaria Symptoms Fever Chills Headaches Muscle/joint pains Lab exam of blood from a finger prick Prevention and Control of Malaria during Pregnancy 59 Fever during Pregnancy Temperature of 38° C or higher May be caused by malaria, but also by: Bladder or kidney infection Pneumonia Typhoid Uterine infection Careful history and physical required to rule out other causes Prevention and Control of Malaria during Pregnancy 60 Fever during Pregnancy (cont’d.) Ask about or examine for: Type, duration, degree of fever Signs of other infections: Chest pain/difficulty breathing Foul-smelling watery vaginal discharge Tender/painful uterus or abdomen Frequency/urgency/pain in urinating Signs of complicated malaria or other danger signs Prevention and Control of Malaria during Pregnancy 61 Types of Malaria Uncomplicated Most common Complicated Life threatening, can affect brain Pregnant women more likely to get complicated malaria than non-pregnant women Prevention and Control of Malaria during Pregnancy 62 Recognizing Malaria in Pregnant Women Uncomplicated Malaria Fever Shivering/chills/rigors Headaches Muscle/joint pains Nausea/vomiting False labor pains Complicated Malaria Signs of uncomplicated malaria PLUS one or more of the following: Dizziness Breathlessness/difficulty breathing Sleepy/drowsy Confusion/coma Sometimes fits, jaundice, severe dehydration Prevention and Control of Malaria during Pregnancy 63 Recognizing Malaria in Pregnant Women (cont’d.) Refer the woman immediately if you suspect anything other than uncomplicated malaria Prevention and Control of Malaria during Pregnancy 64 Case Management Determine whether malaria is uncomplicated or complicated Uncomplicated: Manage according to national protocol Complicated: Refer immediately to higher level of care; consider giving first dose of anti-malarial if available and healthcare provider is familiar with its use Prevention and Control of Malaria during Pregnancy 65 Case Management: Drugs First-line drug therapy is indicated for uncomplicated malaria Second-line drug therapy is indicated for uncomplicated malaria that has failed to respond to first-line drug In almost all countries, quinine is the drug of choice for complicated malaria Prevention and Control of Malaria during Pregnancy 66 Managing Uncomplicated Malaria Provide first-line anti-malarial drugs Follow country guidelines Manage fever Analgesics, tepid sponging Diagnose and treat anemia Provide fluids
Slide 67 - Prevention and Control of Malaria during Pregnancy A Workshop for Healthcare Providers Prevention and Control of Malaria during Pregnancy 2 Facts about Malaria 300 million cases each year worldwide 9 of 10 cases occur in Africa A person in Africa dies of malaria every 10 seconds Women and young children are most at risk Affects five times as many people as AIDS, leprosy, measles, and tuberculosis combined Prevention and Control of Malaria during Pregnancy 3 Facts about Malaria and Pregnancy 30 million African women are pregnant yearly Malaria is more frequent and complicated during pregnancy In malaria-endemic areas, malaria during pregnancy may account for: Up to 15% of maternal anemia 5–14% of low birthweight 30% of “preventable” low birthweight Prevention and Control of Malaria during Pregnancy 4 Roll Back Malaria Worldwide partnership Governments, private groups, research organizations, civil society, media Aim to reduce malaria by half by 2010 Free advocacy resources and tools: http://www.rbm.who.int Priority: Prevent poor outcomes caused by malaria in pregnancy Abuja declaration: Goal is for 60% of women in Africa to be sleeping under insecticide-treated nets (ITNs) and getting intermittent preventive treatment (IPT) by 2005 Prevention and Control of Malaria during Pregnancy 5 Malaria Prevention and Treatment during Pregnancy Focused antenatal care (ANC) with health education about malaria Use of insecticide-treated nets (ITNs) Intermittent preventive treatment (IPT) Case management of women with symptoms and signs of malaria Prevention and Control of Malaria during Pregnancy Chapter I: Focused Antenatal Care Prevention and Control of Malaria during Pregnancy 7 Focused Antenatal Care: Chapter Objectives Describe four main components of focused antenatal care (ANC) Discuss frequency and timing of ANC visits Describe essential elements of a birth plan that includes complication readiness Describe interpersonal skills for effective ANC Describe components of record keeping for ANC Prevention and Control of Malaria during Pregnancy 8 Focused Antenatal Care An approach to ANC that emphasizes: Evidence-based, goal-directed actions Individualized, woman-centered care Quality vs. quantity of visits Care by skilled providers Prevention and Control of Malaria during Pregnancy 9 Goal of Focused Antenatal Care To promote maternal and newborn health and survival through: Early detection and treatment of problems and complications Prevention of complications and disease Birth preparedness and complication readiness Health promotion Prevention and Control of Malaria during Pregnancy 10 Traditional Antenatal Care Emphasizes: Ritualistic, “routine” care vs. evidence-based, goal-directed actions Frequent visits Does not emphasize individual client needs Prevention and Control of Malaria during Pregnancy 11 No Longer Recommended Numerous, routine visits Burden to women and healthcare system Routine measurements and examinations: Maternal height and weight Ankle edema Fetal position before 36 weeks Care based on risk assessment Prevention and Control of Malaria during Pregnancy 12 Risk Approach Not an effective ANC strategy because: Complications cannot be predicted—all pregnant women are at risk for developing complications Risk factors are usually not direct cause of complications Many “low risk” women develop complications Have false sense of security Do not know how to recognize/respond to problems Most “high risk” women give birth without complications Inefficient use of scarce resources Prevention and Control of Malaria during Pregnancy 13 Focused Antenatal Care Services Evidence-based, goal-directed actions: Address most prevalent health issues affecting women and newborns Adjusted for specific populations/regions Appropriate to gestational age Based on firm rationale Prevention and Control of Malaria during Pregnancy 14 Focused Antenatal Care Services (cont’d.) Individualized, woman-centered care based on each woman’s: Specific needs and concerns Circumstances History, physical examination, testing Available resources Prevention and Control of Malaria during Pregnancy 15 Focused Antenatal Care Services (cont’d.) Quality vs. quantity of ANC visits: WHO multi-center study Number of visits reduced without affecting outcome for mother or baby Recommendations Content and quality vs. number of visits Goal-oriented care Minimum of four visits Prevention and Control of Malaria during Pregnancy 16 First visit: By 16 weeks or when woman first thinks she is pregnant Second visit: At 24–28 weeks or at least once in second trimester Third visit: At 32 weeks Fourth visit: At 36 weeks Other visits: If complication occurs, followup or referral is needed, woman wants to see provider, or provider changes frequency based on findings (history, exam, testing) or local policy Scheduling and Timing of ANC Visits Prevention and Control of Malaria during Pregnancy 17 Focused Antenatal Care Services (cont’d.) Care by a skilled provider who: Has formal training and experience Has knowledge, skills, and qualifications to deliver safe, effective maternal and newborn healthcare Practices in home, hospital, health center May be a midwife, nurse, doctor, clinical officer, etc. Prevention and Control of Malaria during Pregnancy 18 Early Detection and Treatment Malaria—history and physical exam Fever and accompanying signs/symptoms Region Complicated vs. uncomplicated cases Severe anemia—physical exam, testing Pre-eclampsia/eclampsia—measurement of blood pressure HIV—voluntary counseling and testing Sexually transmitted infections, including syphilis— testing Prevention and Control of Malaria during Pregnancy 19 Prevention: Key Preventive Measures Malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Tetanus toxoid, iron/folate supplements Country/region-specific interventions as appropriate Vitamin A supplements Iodine supplements Presumptive treatment for hookworm Prevention and Control of Malaria during Pregnancy 20 Birth Preparedness and Complication Readiness: Objectives Develop birth plan—exact plan for normal birth and possible complications: Arrangements made in advance by woman and family (with help of skilled provider) Usually not a written document Reviewed/revised at every visit Minimize disorganization at time of birth or in an emergency Ensure timely and appropriate care Prevention and Control of Malaria during Pregnancy 21 Essential Elements of a Birth Plan Facility or Place of Birth: Home or health facility for birth, appropriate facility for emergencies Skilled Provider: To attend birth Provider/Facility Contact Information Transportation: Reliable, accessible, especially for odd hours Funds: Personal savings, emergency funds Decision-Making: Who will make decisions, especially in an emergency Prevention and Control of Malaria during Pregnancy 22 Essential Elements of a Birth Plan (cont’d.) Family and Community Support: Care for family in woman’s absence and birth companion during labor Blood Donor: In case of emergency Needed Items: For clean and safe birth and for newborn care Danger Signs/Signs of Advanced Labor Prevention and Control of Malaria during Pregnancy 23 Danger Signs of Pregnancy Vaginal bleeding Difficulty breathing Fever Severe abdominal pain Severe headache/blurred vision Convulsions/loss of consciousness Labor pains before 37 weeks Prevention and Control of Malaria during Pregnancy 24 Health Education: Objectives Inform and educate the woman with health messages and counseling appropriate to: Individual needs, concerns, circumstances Gestational age Most prevalent health issues Support the woman in making decisions and solving actual or anticipated problems Involve partner and family in supporting/adopting healthy practices Prevention and Control of Malaria during Pregnancy 25 Health Education: Topics Addressed Prevention of malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Other methods Other important issues to be discussed include: Nutrition Care for common discomforts Use of potentially harmful substances Hygiene Rest and activity Prevention and Control of Malaria during Pregnancy 26 Health Education: Topics Addressed (cont’d.) Sexual relations and safer sex Early and exclusive breastfeeding Prevention of tetanus and anemia Voluntary counseling and testing for HIV Prevention of other endemic diseases/deficiencies Prevention and Control of Malaria during Pregnancy 27 Interpersonal Skills Speak in a quiet, gentle tone of voice Listen to woman/family and respond appropriately Encourage them to ask questions and express concerns Allow them to demonstrate understanding of information provided Explain all procedures/actions and obtain permission before proceeding Show respect for cultural beliefs and social norms Be empathetic and nonjudgmental Avoid distractions while conducting the visit Prevention and Control of Malaria during Pregnancy 28 Record Keeping First ANC Visit History Physical examination Testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs Date of next ANC visit Subsequent ANC Visits Interim history Targeted physical examination, testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs (and relevant information on how client obtained and used ITN) Date of next ANC visit Record all information on the ANC chart and clinic card: Prevention and Control of Malaria during Pregnancy Chapter II: Malaria Transmission Prevention and Control of Malaria during Pregnancy 30 Malaria Transmission: Chapter Objectives Define malaria and how it is transmitted Describe extent of malaria in Africa Identify groups at highest risk of malaria infection List effects of malaria on pregnant women and their unborn babies Describe effects of malaria on pregnant women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 31 Malaria Transmission Caused by Plasmodium parasites Spread by female Anopheles mosquitoes infected with parasites Anopheles mosquitoes usually active at night Infected mosquito bites a person Malaria parasites reproduce in human blood Mosquito bites infected person, and goes on to bite and infect another person Prevention and Control of Malaria during Pregnancy 32 Populations Most Affected by Malaria Children under 5 years of age Pregnant women Unborn babies Immigrants from low-transmission areas HIV-infected persons Prevention and Control of Malaria during Pregnancy 33 Effects of Malaria on Pregnant Women All pregnant women in malaria-endemic areas are at risk Parasites attack and destroy red blood cells Malaria causes up to 15% of anemia in pregnancy Can cause severe anemia In Africa, anemia due to malaria causes up to 10,000 maternal deaths per year Prevention and Control of Malaria during Pregnancy 34 Effects on Unborn Babies Parasites hide in placenta Interferes with transfer of oxygen and nutrients to the baby, increasing risk of: Spontaneous abortion Preterm birth Low birthweight—single greatest risk factor for death during first month of life Stillbirth Prevention and Control of Malaria during Pregnancy 35 Effects on Communities Causes missed work and wages Results in frequent school absences Uses scarce resources Causes preventable deaths: increases maternal, newborn, and infant mortality rates Prevention and Control of Malaria during Pregnancy 36 HIV/AIDS and Malaria during Pregnancy HIV/AIDS reduces a woman’s resistance to malaria Intermittent preventive treatment (IPT) given 3 times during pregnancy is effective for women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 37 Summary of Health Education Points Malaria transmitted through mosquito bites Pregnant women and children are most at risk Pregnant women infected with malaria may have no symptoms Women with HIV/AIDS are at higher risk Malaria can lead to severe anemia, spontaneous abortion, low-birthweight babies Malaria is preventable Prevention and Control of Malaria during Pregnancy Chapter III: Preventing Malaria Prevention and Control of Malaria during Pregnancy 39 Preventing Malaria: Chapter Objectives List the elements of counseling women about the use of insecticide-treated nets (ITNs) and intermittent preventive treatment (IPT) during pregnancy Describe the use of sulfadoxine-pyrimethamine (SP) for IPT during pregnancy Prevention and Control of Malaria during Pregnancy 40 Insecticide-Treated Nets Kill or repel mosquitoes Prevent physical contact with mosquitoes Kill or repel other insects: Lice Ticks Bedbugs Cockroaches Prevention and Control of Malaria during Pregnancy 41 Insecticide-Treated Nets (cont’d.) Untreated Nets Provide some protection against malaria Do not kill or repel mosquitoes that touch net Do not reduce number of mosquitoes Do not kill other insects like lice, roaches, and bedbugs Are safe for pregnant women, young children, and infants Insecticide-Treated Nets Provide a high level of protection against malaria Kills or repels mosquitoes that touch the net Reduce number of mosquitoes in/outside net Kills other insects such as lice, roaches, and bedbugs Are safe for pregnant women, young children, and infants Prevention and Control of Malaria during Pregnancy 42 Benefits of Insecticide-Treated Nets Prevent mosquito bites Protect against malaria, resulting in less: Anemia Prematurity and low birthweight Risk of maternal and newborn death Help people sleep better Promote growth and development of fetus and newborn Prevention and Control of Malaria during Pregnancy 43 Benefits of Insecticide-Treated Nets: Community Cost less than treating malaria Reduce number of sick children and adults (helping children grow to be healthy and helping working adults remain productive) Reduce number of deaths Prevention and Control of Malaria during Pregnancy 44 Where to Find Insecticide-Treated Nets General merchandise shops Drug shops/pharmacies Markets Public and private health facilities Community health workers NGOs, community-based organizations Prevention and Control of Malaria during Pregnancy 45 How to Use Insecticide-Treated Nets Hang above bed or sleeping mat Tuck under mattress or mat Use every night, all year long Use for everyone, if possible, but give priority to pregnant women, infants, and children Prevention and Control of Malaria during Pregnancy 46 Caring for Insecticide-Treated Nets Handle gently to avoid tears Tie net up during day to avoid damage Regularly inspect for holes, repair if found Nets need to be re-treated regularly to stay effective Keep away from smoke, fire, direct sunlight Prevention and Control of Malaria during Pregnancy 47 Intermittent Preventive Treatment Based on the assumption that every pregnant woman living in an area of high malaria transmission has malaria parasites in her blood or placenta, whether or not she has symptoms of malaria Prevention and Control of Malaria during Pregnancy 48 Intermittent Preventive Treatment Although a pregnant woman with malaria may have no symptoms, malaria can still affect her and her unborn child Prevention and Control of Malaria during Pregnancy 49 Intermittent Preventive Treatment: WHO Recommendation All pregnant women should receive at least two doses of IPT after quickening, during routinely scheduled ANC visits (WHO recommends a schedule of four visits, three after quickening) Presently, the most effective drug for IPT is sulfadoxine-pyrimethamine (SP) Women should receive at least two doses of IPT with SP at ANC visits after quickening, but no more frequently than monthly Prevention and Control of Malaria during Pregnancy 50 Intermittent Preventive Treatment: Dose and Timing A single dose is three tablets of sulfadoxine 500 mg + pyrimethamine 25 mg Healthcare provider should dispense dose and directly observe client taking dose Prevention and Control of Malaria during Pregnancy 51 Instructions for Giving Intermittent Preventive Treatment Ensure woman is at least 16 weeks pregnant and that quickening has occurred Inquire about use of SP in last 4 weeks Inquire about allergies to SP or other sulfa drugs (especially severe rashes) Explain what you will do; address the woman’s questions Provide cup and clean water Prevention and Control of Malaria during Pregnancy 52 Instructions for Giving Intermittent Preventive Treatment (cont’d.) Directly observe woman swallow three tablets of SP Record SP dose on ANC and clinic card Advise the woman when to return: For her next scheduled visit If she has signs of malaria If she has other danger signs Reinforce the importance of using ITNs Prevention and Control of Malaria during Pregnancy 53 Intermittent Preventive Treatment: Contraindications to Using SP Do NOT give during first trimester: Be sure quickening has occurred and woman is at least 16 weeks pregnant Do NOT give to women with reported allergy to SP or other sulfa drugs: Ask about sulfa drug allergies before giving SP Do NOT give to women taking co-trimoxazole, or other sulfa-containing drugs: Ask about use of these medicines before giving SP Do not give SP more frequently than monthly: Be sure at least 1 month has passed since the last dose of SP Prevention and Control of Malaria during Pregnancy 54 Chemoprophylaxis with Chloroquine: For Women Allergic to Sulfa Drugs* Dose Chloroquine 150 mg Timing 1 4 tablets First ANC visit after 16 weeks 2 4 tablets Second day after first dose 3 2 tablets Third day after first dose Weekly 2 tablets Every week during pregnancy *If chloroquine resistance rates in the country are high, chemoprophylaxis with chloroquine is not recommended. Prevention and Control of Malaria during Pregnancy 55 Summary of Health Education Points Pregnant women should sleep under ITNs every night By preventing malaria, IPT reduces the incidence of maternal anemia, spontaneous abortion, preterm birth, stillbirth, and low birthweight IPT should be administered to pregnant women at regularly scheduled ANC visits after quickening, but not more often than monthly Prevention and Control of Malaria during Pregnancy Chapter IV: Detection and Treatment Prevention and Control of Malaria during Pregnancy 57 Malaria Detection and Treatment: Chapter Objectives Identify causes of fever during pregnancy List the signs and symptoms of uncomplicated and complicated malaria Describe the treatment for uncomplicated malaria during pregnancy Explain the steps to appropriately refer a pregnant woman who has complicated malaria Prevention and Control of Malaria during Pregnancy 58 Detecting Malaria Symptoms Fever Chills Headaches Muscle/joint pains Lab exam of blood from a finger prick Prevention and Control of Malaria during Pregnancy 59 Fever during Pregnancy Temperature of 38° C or higher May be caused by malaria, but also by: Bladder or kidney infection Pneumonia Typhoid Uterine infection Careful history and physical required to rule out other causes Prevention and Control of Malaria during Pregnancy 60 Fever during Pregnancy (cont’d.) Ask about or examine for: Type, duration, degree of fever Signs of other infections: Chest pain/difficulty breathing Foul-smelling watery vaginal discharge Tender/painful uterus or abdomen Frequency/urgency/pain in urinating Signs of complicated malaria or other danger signs Prevention and Control of Malaria during Pregnancy 61 Types of Malaria Uncomplicated Most common Complicated Life threatening, can affect brain Pregnant women more likely to get complicated malaria than non-pregnant women Prevention and Control of Malaria during Pregnancy 62 Recognizing Malaria in Pregnant Women Uncomplicated Malaria Fever Shivering/chills/rigors Headaches Muscle/joint pains Nausea/vomiting False labor pains Complicated Malaria Signs of uncomplicated malaria PLUS one or more of the following: Dizziness Breathlessness/difficulty breathing Sleepy/drowsy Confusion/coma Sometimes fits, jaundice, severe dehydration Prevention and Control of Malaria during Pregnancy 63 Recognizing Malaria in Pregnant Women (cont’d.) Refer the woman immediately if you suspect anything other than uncomplicated malaria Prevention and Control of Malaria during Pregnancy 64 Case Management Determine whether malaria is uncomplicated or complicated Uncomplicated: Manage according to national protocol Complicated: Refer immediately to higher level of care; consider giving first dose of anti-malarial if available and healthcare provider is familiar with its use Prevention and Control of Malaria during Pregnancy 65 Case Management: Drugs First-line drug therapy is indicated for uncomplicated malaria Second-line drug therapy is indicated for uncomplicated malaria that has failed to respond to first-line drug In almost all countries, quinine is the drug of choice for complicated malaria Prevention and Control of Malaria during Pregnancy 66 Managing Uncomplicated Malaria Provide first-line anti-malarial drugs Follow country guidelines Manage fever Analgesics, tepid sponging Diagnose and treat anemia Provide fluids Prevention and Control of Malaria during Pregnancy 67 Treating Uncomplicated Malaria Observe client taking anti-malarial drugs Advise client to: Complete course of drugs Return if no improvement in 48 hours Consume iron-rich foods Use ITNs and other preventive measures
Slide 68 - Prevention and Control of Malaria during Pregnancy A Workshop for Healthcare Providers Prevention and Control of Malaria during Pregnancy 2 Facts about Malaria 300 million cases each year worldwide 9 of 10 cases occur in Africa A person in Africa dies of malaria every 10 seconds Women and young children are most at risk Affects five times as many people as AIDS, leprosy, measles, and tuberculosis combined Prevention and Control of Malaria during Pregnancy 3 Facts about Malaria and Pregnancy 30 million African women are pregnant yearly Malaria is more frequent and complicated during pregnancy In malaria-endemic areas, malaria during pregnancy may account for: Up to 15% of maternal anemia 5–14% of low birthweight 30% of “preventable” low birthweight Prevention and Control of Malaria during Pregnancy 4 Roll Back Malaria Worldwide partnership Governments, private groups, research organizations, civil society, media Aim to reduce malaria by half by 2010 Free advocacy resources and tools: http://www.rbm.who.int Priority: Prevent poor outcomes caused by malaria in pregnancy Abuja declaration: Goal is for 60% of women in Africa to be sleeping under insecticide-treated nets (ITNs) and getting intermittent preventive treatment (IPT) by 2005 Prevention and Control of Malaria during Pregnancy 5 Malaria Prevention and Treatment during Pregnancy Focused antenatal care (ANC) with health education about malaria Use of insecticide-treated nets (ITNs) Intermittent preventive treatment (IPT) Case management of women with symptoms and signs of malaria Prevention and Control of Malaria during Pregnancy Chapter I: Focused Antenatal Care Prevention and Control of Malaria during Pregnancy 7 Focused Antenatal Care: Chapter Objectives Describe four main components of focused antenatal care (ANC) Discuss frequency and timing of ANC visits Describe essential elements of a birth plan that includes complication readiness Describe interpersonal skills for effective ANC Describe components of record keeping for ANC Prevention and Control of Malaria during Pregnancy 8 Focused Antenatal Care An approach to ANC that emphasizes: Evidence-based, goal-directed actions Individualized, woman-centered care Quality vs. quantity of visits Care by skilled providers Prevention and Control of Malaria during Pregnancy 9 Goal of Focused Antenatal Care To promote maternal and newborn health and survival through: Early detection and treatment of problems and complications Prevention of complications and disease Birth preparedness and complication readiness Health promotion Prevention and Control of Malaria during Pregnancy 10 Traditional Antenatal Care Emphasizes: Ritualistic, “routine” care vs. evidence-based, goal-directed actions Frequent visits Does not emphasize individual client needs Prevention and Control of Malaria during Pregnancy 11 No Longer Recommended Numerous, routine visits Burden to women and healthcare system Routine measurements and examinations: Maternal height and weight Ankle edema Fetal position before 36 weeks Care based on risk assessment Prevention and Control of Malaria during Pregnancy 12 Risk Approach Not an effective ANC strategy because: Complications cannot be predicted—all pregnant women are at risk for developing complications Risk factors are usually not direct cause of complications Many “low risk” women develop complications Have false sense of security Do not know how to recognize/respond to problems Most “high risk” women give birth without complications Inefficient use of scarce resources Prevention and Control of Malaria during Pregnancy 13 Focused Antenatal Care Services Evidence-based, goal-directed actions: Address most prevalent health issues affecting women and newborns Adjusted for specific populations/regions Appropriate to gestational age Based on firm rationale Prevention and Control of Malaria during Pregnancy 14 Focused Antenatal Care Services (cont’d.) Individualized, woman-centered care based on each woman’s: Specific needs and concerns Circumstances History, physical examination, testing Available resources Prevention and Control of Malaria during Pregnancy 15 Focused Antenatal Care Services (cont’d.) Quality vs. quantity of ANC visits: WHO multi-center study Number of visits reduced without affecting outcome for mother or baby Recommendations Content and quality vs. number of visits Goal-oriented care Minimum of four visits Prevention and Control of Malaria during Pregnancy 16 First visit: By 16 weeks or when woman first thinks she is pregnant Second visit: At 24–28 weeks or at least once in second trimester Third visit: At 32 weeks Fourth visit: At 36 weeks Other visits: If complication occurs, followup or referral is needed, woman wants to see provider, or provider changes frequency based on findings (history, exam, testing) or local policy Scheduling and Timing of ANC Visits Prevention and Control of Malaria during Pregnancy 17 Focused Antenatal Care Services (cont’d.) Care by a skilled provider who: Has formal training and experience Has knowledge, skills, and qualifications to deliver safe, effective maternal and newborn healthcare Practices in home, hospital, health center May be a midwife, nurse, doctor, clinical officer, etc. Prevention and Control of Malaria during Pregnancy 18 Early Detection and Treatment Malaria—history and physical exam Fever and accompanying signs/symptoms Region Complicated vs. uncomplicated cases Severe anemia—physical exam, testing Pre-eclampsia/eclampsia—measurement of blood pressure HIV—voluntary counseling and testing Sexually transmitted infections, including syphilis— testing Prevention and Control of Malaria during Pregnancy 19 Prevention: Key Preventive Measures Malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Tetanus toxoid, iron/folate supplements Country/region-specific interventions as appropriate Vitamin A supplements Iodine supplements Presumptive treatment for hookworm Prevention and Control of Malaria during Pregnancy 20 Birth Preparedness and Complication Readiness: Objectives Develop birth plan—exact plan for normal birth and possible complications: Arrangements made in advance by woman and family (with help of skilled provider) Usually not a written document Reviewed/revised at every visit Minimize disorganization at time of birth or in an emergency Ensure timely and appropriate care Prevention and Control of Malaria during Pregnancy 21 Essential Elements of a Birth Plan Facility or Place of Birth: Home or health facility for birth, appropriate facility for emergencies Skilled Provider: To attend birth Provider/Facility Contact Information Transportation: Reliable, accessible, especially for odd hours Funds: Personal savings, emergency funds Decision-Making: Who will make decisions, especially in an emergency Prevention and Control of Malaria during Pregnancy 22 Essential Elements of a Birth Plan (cont’d.) Family and Community Support: Care for family in woman’s absence and birth companion during labor Blood Donor: In case of emergency Needed Items: For clean and safe birth and for newborn care Danger Signs/Signs of Advanced Labor Prevention and Control of Malaria during Pregnancy 23 Danger Signs of Pregnancy Vaginal bleeding Difficulty breathing Fever Severe abdominal pain Severe headache/blurred vision Convulsions/loss of consciousness Labor pains before 37 weeks Prevention and Control of Malaria during Pregnancy 24 Health Education: Objectives Inform and educate the woman with health messages and counseling appropriate to: Individual needs, concerns, circumstances Gestational age Most prevalent health issues Support the woman in making decisions and solving actual or anticipated problems Involve partner and family in supporting/adopting healthy practices Prevention and Control of Malaria during Pregnancy 25 Health Education: Topics Addressed Prevention of malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Other methods Other important issues to be discussed include: Nutrition Care for common discomforts Use of potentially harmful substances Hygiene Rest and activity Prevention and Control of Malaria during Pregnancy 26 Health Education: Topics Addressed (cont’d.) Sexual relations and safer sex Early and exclusive breastfeeding Prevention of tetanus and anemia Voluntary counseling and testing for HIV Prevention of other endemic diseases/deficiencies Prevention and Control of Malaria during Pregnancy 27 Interpersonal Skills Speak in a quiet, gentle tone of voice Listen to woman/family and respond appropriately Encourage them to ask questions and express concerns Allow them to demonstrate understanding of information provided Explain all procedures/actions and obtain permission before proceeding Show respect for cultural beliefs and social norms Be empathetic and nonjudgmental Avoid distractions while conducting the visit Prevention and Control of Malaria during Pregnancy 28 Record Keeping First ANC Visit History Physical examination Testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs Date of next ANC visit Subsequent ANC Visits Interim history Targeted physical examination, testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs (and relevant information on how client obtained and used ITN) Date of next ANC visit Record all information on the ANC chart and clinic card: Prevention and Control of Malaria during Pregnancy Chapter II: Malaria Transmission Prevention and Control of Malaria during Pregnancy 30 Malaria Transmission: Chapter Objectives Define malaria and how it is transmitted Describe extent of malaria in Africa Identify groups at highest risk of malaria infection List effects of malaria on pregnant women and their unborn babies Describe effects of malaria on pregnant women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 31 Malaria Transmission Caused by Plasmodium parasites Spread by female Anopheles mosquitoes infected with parasites Anopheles mosquitoes usually active at night Infected mosquito bites a person Malaria parasites reproduce in human blood Mosquito bites infected person, and goes on to bite and infect another person Prevention and Control of Malaria during Pregnancy 32 Populations Most Affected by Malaria Children under 5 years of age Pregnant women Unborn babies Immigrants from low-transmission areas HIV-infected persons Prevention and Control of Malaria during Pregnancy 33 Effects of Malaria on Pregnant Women All pregnant women in malaria-endemic areas are at risk Parasites attack and destroy red blood cells Malaria causes up to 15% of anemia in pregnancy Can cause severe anemia In Africa, anemia due to malaria causes up to 10,000 maternal deaths per year Prevention and Control of Malaria during Pregnancy 34 Effects on Unborn Babies Parasites hide in placenta Interferes with transfer of oxygen and nutrients to the baby, increasing risk of: Spontaneous abortion Preterm birth Low birthweight—single greatest risk factor for death during first month of life Stillbirth Prevention and Control of Malaria during Pregnancy 35 Effects on Communities Causes missed work and wages Results in frequent school absences Uses scarce resources Causes preventable deaths: increases maternal, newborn, and infant mortality rates Prevention and Control of Malaria during Pregnancy 36 HIV/AIDS and Malaria during Pregnancy HIV/AIDS reduces a woman’s resistance to malaria Intermittent preventive treatment (IPT) given 3 times during pregnancy is effective for women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 37 Summary of Health Education Points Malaria transmitted through mosquito bites Pregnant women and children are most at risk Pregnant women infected with malaria may have no symptoms Women with HIV/AIDS are at higher risk Malaria can lead to severe anemia, spontaneous abortion, low-birthweight babies Malaria is preventable Prevention and Control of Malaria during Pregnancy Chapter III: Preventing Malaria Prevention and Control of Malaria during Pregnancy 39 Preventing Malaria: Chapter Objectives List the elements of counseling women about the use of insecticide-treated nets (ITNs) and intermittent preventive treatment (IPT) during pregnancy Describe the use of sulfadoxine-pyrimethamine (SP) for IPT during pregnancy Prevention and Control of Malaria during Pregnancy 40 Insecticide-Treated Nets Kill or repel mosquitoes Prevent physical contact with mosquitoes Kill or repel other insects: Lice Ticks Bedbugs Cockroaches Prevention and Control of Malaria during Pregnancy 41 Insecticide-Treated Nets (cont’d.) Untreated Nets Provide some protection against malaria Do not kill or repel mosquitoes that touch net Do not reduce number of mosquitoes Do not kill other insects like lice, roaches, and bedbugs Are safe for pregnant women, young children, and infants Insecticide-Treated Nets Provide a high level of protection against malaria Kills or repels mosquitoes that touch the net Reduce number of mosquitoes in/outside net Kills other insects such as lice, roaches, and bedbugs Are safe for pregnant women, young children, and infants Prevention and Control of Malaria during Pregnancy 42 Benefits of Insecticide-Treated Nets Prevent mosquito bites Protect against malaria, resulting in less: Anemia Prematurity and low birthweight Risk of maternal and newborn death Help people sleep better Promote growth and development of fetus and newborn Prevention and Control of Malaria during Pregnancy 43 Benefits of Insecticide-Treated Nets: Community Cost less than treating malaria Reduce number of sick children and adults (helping children grow to be healthy and helping working adults remain productive) Reduce number of deaths Prevention and Control of Malaria during Pregnancy 44 Where to Find Insecticide-Treated Nets General merchandise shops Drug shops/pharmacies Markets Public and private health facilities Community health workers NGOs, community-based organizations Prevention and Control of Malaria during Pregnancy 45 How to Use Insecticide-Treated Nets Hang above bed or sleeping mat Tuck under mattress or mat Use every night, all year long Use for everyone, if possible, but give priority to pregnant women, infants, and children Prevention and Control of Malaria during Pregnancy 46 Caring for Insecticide-Treated Nets Handle gently to avoid tears Tie net up during day to avoid damage Regularly inspect for holes, repair if found Nets need to be re-treated regularly to stay effective Keep away from smoke, fire, direct sunlight Prevention and Control of Malaria during Pregnancy 47 Intermittent Preventive Treatment Based on the assumption that every pregnant woman living in an area of high malaria transmission has malaria parasites in her blood or placenta, whether or not she has symptoms of malaria Prevention and Control of Malaria during Pregnancy 48 Intermittent Preventive Treatment Although a pregnant woman with malaria may have no symptoms, malaria can still affect her and her unborn child Prevention and Control of Malaria during Pregnancy 49 Intermittent Preventive Treatment: WHO Recommendation All pregnant women should receive at least two doses of IPT after quickening, during routinely scheduled ANC visits (WHO recommends a schedule of four visits, three after quickening) Presently, the most effective drug for IPT is sulfadoxine-pyrimethamine (SP) Women should receive at least two doses of IPT with SP at ANC visits after quickening, but no more frequently than monthly Prevention and Control of Malaria during Pregnancy 50 Intermittent Preventive Treatment: Dose and Timing A single dose is three tablets of sulfadoxine 500 mg + pyrimethamine 25 mg Healthcare provider should dispense dose and directly observe client taking dose Prevention and Control of Malaria during Pregnancy 51 Instructions for Giving Intermittent Preventive Treatment Ensure woman is at least 16 weeks pregnant and that quickening has occurred Inquire about use of SP in last 4 weeks Inquire about allergies to SP or other sulfa drugs (especially severe rashes) Explain what you will do; address the woman’s questions Provide cup and clean water Prevention and Control of Malaria during Pregnancy 52 Instructions for Giving Intermittent Preventive Treatment (cont’d.) Directly observe woman swallow three tablets of SP Record SP dose on ANC and clinic card Advise the woman when to return: For her next scheduled visit If she has signs of malaria If she has other danger signs Reinforce the importance of using ITNs Prevention and Control of Malaria during Pregnancy 53 Intermittent Preventive Treatment: Contraindications to Using SP Do NOT give during first trimester: Be sure quickening has occurred and woman is at least 16 weeks pregnant Do NOT give to women with reported allergy to SP or other sulfa drugs: Ask about sulfa drug allergies before giving SP Do NOT give to women taking co-trimoxazole, or other sulfa-containing drugs: Ask about use of these medicines before giving SP Do not give SP more frequently than monthly: Be sure at least 1 month has passed since the last dose of SP Prevention and Control of Malaria during Pregnancy 54 Chemoprophylaxis with Chloroquine: For Women Allergic to Sulfa Drugs* Dose Chloroquine 150 mg Timing 1 4 tablets First ANC visit after 16 weeks 2 4 tablets Second day after first dose 3 2 tablets Third day after first dose Weekly 2 tablets Every week during pregnancy *If chloroquine resistance rates in the country are high, chemoprophylaxis with chloroquine is not recommended. Prevention and Control of Malaria during Pregnancy 55 Summary of Health Education Points Pregnant women should sleep under ITNs every night By preventing malaria, IPT reduces the incidence of maternal anemia, spontaneous abortion, preterm birth, stillbirth, and low birthweight IPT should be administered to pregnant women at regularly scheduled ANC visits after quickening, but not more often than monthly Prevention and Control of Malaria during Pregnancy Chapter IV: Detection and Treatment Prevention and Control of Malaria during Pregnancy 57 Malaria Detection and Treatment: Chapter Objectives Identify causes of fever during pregnancy List the signs and symptoms of uncomplicated and complicated malaria Describe the treatment for uncomplicated malaria during pregnancy Explain the steps to appropriately refer a pregnant woman who has complicated malaria Prevention and Control of Malaria during Pregnancy 58 Detecting Malaria Symptoms Fever Chills Headaches Muscle/joint pains Lab exam of blood from a finger prick Prevention and Control of Malaria during Pregnancy 59 Fever during Pregnancy Temperature of 38° C or higher May be caused by malaria, but also by: Bladder or kidney infection Pneumonia Typhoid Uterine infection Careful history and physical required to rule out other causes Prevention and Control of Malaria during Pregnancy 60 Fever during Pregnancy (cont’d.) Ask about or examine for: Type, duration, degree of fever Signs of other infections: Chest pain/difficulty breathing Foul-smelling watery vaginal discharge Tender/painful uterus or abdomen Frequency/urgency/pain in urinating Signs of complicated malaria or other danger signs Prevention and Control of Malaria during Pregnancy 61 Types of Malaria Uncomplicated Most common Complicated Life threatening, can affect brain Pregnant women more likely to get complicated malaria than non-pregnant women Prevention and Control of Malaria during Pregnancy 62 Recognizing Malaria in Pregnant Women Uncomplicated Malaria Fever Shivering/chills/rigors Headaches Muscle/joint pains Nausea/vomiting False labor pains Complicated Malaria Signs of uncomplicated malaria PLUS one or more of the following: Dizziness Breathlessness/difficulty breathing Sleepy/drowsy Confusion/coma Sometimes fits, jaundice, severe dehydration Prevention and Control of Malaria during Pregnancy 63 Recognizing Malaria in Pregnant Women (cont’d.) Refer the woman immediately if you suspect anything other than uncomplicated malaria Prevention and Control of Malaria during Pregnancy 64 Case Management Determine whether malaria is uncomplicated or complicated Uncomplicated: Manage according to national protocol Complicated: Refer immediately to higher level of care; consider giving first dose of anti-malarial if available and healthcare provider is familiar with its use Prevention and Control of Malaria during Pregnancy 65 Case Management: Drugs First-line drug therapy is indicated for uncomplicated malaria Second-line drug therapy is indicated for uncomplicated malaria that has failed to respond to first-line drug In almost all countries, quinine is the drug of choice for complicated malaria Prevention and Control of Malaria during Pregnancy 66 Managing Uncomplicated Malaria Provide first-line anti-malarial drugs Follow country guidelines Manage fever Analgesics, tepid sponging Diagnose and treat anemia Provide fluids Prevention and Control of Malaria during Pregnancy 67 Treating Uncomplicated Malaria Observe client taking anti-malarial drugs Advise client to: Complete course of drugs Return if no improvement in 48 hours Consume iron-rich foods Use ITNs and other preventive measures Prevention and Control of Malaria during Pregnancy 68 SP: Contraindications Before 16 weeks of pregnancy SP dose in last 4 weeks Allergies to sulfa drugs (e.g., co-trimoxazole) Currently taking other sulfa drugs Substitute other drug before giving SP
Slide 69 - Prevention and Control of Malaria during Pregnancy A Workshop for Healthcare Providers Prevention and Control of Malaria during Pregnancy 2 Facts about Malaria 300 million cases each year worldwide 9 of 10 cases occur in Africa A person in Africa dies of malaria every 10 seconds Women and young children are most at risk Affects five times as many people as AIDS, leprosy, measles, and tuberculosis combined Prevention and Control of Malaria during Pregnancy 3 Facts about Malaria and Pregnancy 30 million African women are pregnant yearly Malaria is more frequent and complicated during pregnancy In malaria-endemic areas, malaria during pregnancy may account for: Up to 15% of maternal anemia 5–14% of low birthweight 30% of “preventable” low birthweight Prevention and Control of Malaria during Pregnancy 4 Roll Back Malaria Worldwide partnership Governments, private groups, research organizations, civil society, media Aim to reduce malaria by half by 2010 Free advocacy resources and tools: http://www.rbm.who.int Priority: Prevent poor outcomes caused by malaria in pregnancy Abuja declaration: Goal is for 60% of women in Africa to be sleeping under insecticide-treated nets (ITNs) and getting intermittent preventive treatment (IPT) by 2005 Prevention and Control of Malaria during Pregnancy 5 Malaria Prevention and Treatment during Pregnancy Focused antenatal care (ANC) with health education about malaria Use of insecticide-treated nets (ITNs) Intermittent preventive treatment (IPT) Case management of women with symptoms and signs of malaria Prevention and Control of Malaria during Pregnancy Chapter I: Focused Antenatal Care Prevention and Control of Malaria during Pregnancy 7 Focused Antenatal Care: Chapter Objectives Describe four main components of focused antenatal care (ANC) Discuss frequency and timing of ANC visits Describe essential elements of a birth plan that includes complication readiness Describe interpersonal skills for effective ANC Describe components of record keeping for ANC Prevention and Control of Malaria during Pregnancy 8 Focused Antenatal Care An approach to ANC that emphasizes: Evidence-based, goal-directed actions Individualized, woman-centered care Quality vs. quantity of visits Care by skilled providers Prevention and Control of Malaria during Pregnancy 9 Goal of Focused Antenatal Care To promote maternal and newborn health and survival through: Early detection and treatment of problems and complications Prevention of complications and disease Birth preparedness and complication readiness Health promotion Prevention and Control of Malaria during Pregnancy 10 Traditional Antenatal Care Emphasizes: Ritualistic, “routine” care vs. evidence-based, goal-directed actions Frequent visits Does not emphasize individual client needs Prevention and Control of Malaria during Pregnancy 11 No Longer Recommended Numerous, routine visits Burden to women and healthcare system Routine measurements and examinations: Maternal height and weight Ankle edema Fetal position before 36 weeks Care based on risk assessment Prevention and Control of Malaria during Pregnancy 12 Risk Approach Not an effective ANC strategy because: Complications cannot be predicted—all pregnant women are at risk for developing complications Risk factors are usually not direct cause of complications Many “low risk” women develop complications Have false sense of security Do not know how to recognize/respond to problems Most “high risk” women give birth without complications Inefficient use of scarce resources Prevention and Control of Malaria during Pregnancy 13 Focused Antenatal Care Services Evidence-based, goal-directed actions: Address most prevalent health issues affecting women and newborns Adjusted for specific populations/regions Appropriate to gestational age Based on firm rationale Prevention and Control of Malaria during Pregnancy 14 Focused Antenatal Care Services (cont’d.) Individualized, woman-centered care based on each woman’s: Specific needs and concerns Circumstances History, physical examination, testing Available resources Prevention and Control of Malaria during Pregnancy 15 Focused Antenatal Care Services (cont’d.) Quality vs. quantity of ANC visits: WHO multi-center study Number of visits reduced without affecting outcome for mother or baby Recommendations Content and quality vs. number of visits Goal-oriented care Minimum of four visits Prevention and Control of Malaria during Pregnancy 16 First visit: By 16 weeks or when woman first thinks she is pregnant Second visit: At 24–28 weeks or at least once in second trimester Third visit: At 32 weeks Fourth visit: At 36 weeks Other visits: If complication occurs, followup or referral is needed, woman wants to see provider, or provider changes frequency based on findings (history, exam, testing) or local policy Scheduling and Timing of ANC Visits Prevention and Control of Malaria during Pregnancy 17 Focused Antenatal Care Services (cont’d.) Care by a skilled provider who: Has formal training and experience Has knowledge, skills, and qualifications to deliver safe, effective maternal and newborn healthcare Practices in home, hospital, health center May be a midwife, nurse, doctor, clinical officer, etc. Prevention and Control of Malaria during Pregnancy 18 Early Detection and Treatment Malaria—history and physical exam Fever and accompanying signs/symptoms Region Complicated vs. uncomplicated cases Severe anemia—physical exam, testing Pre-eclampsia/eclampsia—measurement of blood pressure HIV—voluntary counseling and testing Sexually transmitted infections, including syphilis— testing Prevention and Control of Malaria during Pregnancy 19 Prevention: Key Preventive Measures Malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Tetanus toxoid, iron/folate supplements Country/region-specific interventions as appropriate Vitamin A supplements Iodine supplements Presumptive treatment for hookworm Prevention and Control of Malaria during Pregnancy 20 Birth Preparedness and Complication Readiness: Objectives Develop birth plan—exact plan for normal birth and possible complications: Arrangements made in advance by woman and family (with help of skilled provider) Usually not a written document Reviewed/revised at every visit Minimize disorganization at time of birth or in an emergency Ensure timely and appropriate care Prevention and Control of Malaria during Pregnancy 21 Essential Elements of a Birth Plan Facility or Place of Birth: Home or health facility for birth, appropriate facility for emergencies Skilled Provider: To attend birth Provider/Facility Contact Information Transportation: Reliable, accessible, especially for odd hours Funds: Personal savings, emergency funds Decision-Making: Who will make decisions, especially in an emergency Prevention and Control of Malaria during Pregnancy 22 Essential Elements of a Birth Plan (cont’d.) Family and Community Support: Care for family in woman’s absence and birth companion during labor Blood Donor: In case of emergency Needed Items: For clean and safe birth and for newborn care Danger Signs/Signs of Advanced Labor Prevention and Control of Malaria during Pregnancy 23 Danger Signs of Pregnancy Vaginal bleeding Difficulty breathing Fever Severe abdominal pain Severe headache/blurred vision Convulsions/loss of consciousness Labor pains before 37 weeks Prevention and Control of Malaria during Pregnancy 24 Health Education: Objectives Inform and educate the woman with health messages and counseling appropriate to: Individual needs, concerns, circumstances Gestational age Most prevalent health issues Support the woman in making decisions and solving actual or anticipated problems Involve partner and family in supporting/adopting healthy practices Prevention and Control of Malaria during Pregnancy 25 Health Education: Topics Addressed Prevention of malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Other methods Other important issues to be discussed include: Nutrition Care for common discomforts Use of potentially harmful substances Hygiene Rest and activity Prevention and Control of Malaria during Pregnancy 26 Health Education: Topics Addressed (cont’d.) Sexual relations and safer sex Early and exclusive breastfeeding Prevention of tetanus and anemia Voluntary counseling and testing for HIV Prevention of other endemic diseases/deficiencies Prevention and Control of Malaria during Pregnancy 27 Interpersonal Skills Speak in a quiet, gentle tone of voice Listen to woman/family and respond appropriately Encourage them to ask questions and express concerns Allow them to demonstrate understanding of information provided Explain all procedures/actions and obtain permission before proceeding Show respect for cultural beliefs and social norms Be empathetic and nonjudgmental Avoid distractions while conducting the visit Prevention and Control of Malaria during Pregnancy 28 Record Keeping First ANC Visit History Physical examination Testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs Date of next ANC visit Subsequent ANC Visits Interim history Targeted physical examination, testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs (and relevant information on how client obtained and used ITN) Date of next ANC visit Record all information on the ANC chart and clinic card: Prevention and Control of Malaria during Pregnancy Chapter II: Malaria Transmission Prevention and Control of Malaria during Pregnancy 30 Malaria Transmission: Chapter Objectives Define malaria and how it is transmitted Describe extent of malaria in Africa Identify groups at highest risk of malaria infection List effects of malaria on pregnant women and their unborn babies Describe effects of malaria on pregnant women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 31 Malaria Transmission Caused by Plasmodium parasites Spread by female Anopheles mosquitoes infected with parasites Anopheles mosquitoes usually active at night Infected mosquito bites a person Malaria parasites reproduce in human blood Mosquito bites infected person, and goes on to bite and infect another person Prevention and Control of Malaria during Pregnancy 32 Populations Most Affected by Malaria Children under 5 years of age Pregnant women Unborn babies Immigrants from low-transmission areas HIV-infected persons Prevention and Control of Malaria during Pregnancy 33 Effects of Malaria on Pregnant Women All pregnant women in malaria-endemic areas are at risk Parasites attack and destroy red blood cells Malaria causes up to 15% of anemia in pregnancy Can cause severe anemia In Africa, anemia due to malaria causes up to 10,000 maternal deaths per year Prevention and Control of Malaria during Pregnancy 34 Effects on Unborn Babies Parasites hide in placenta Interferes with transfer of oxygen and nutrients to the baby, increasing risk of: Spontaneous abortion Preterm birth Low birthweight—single greatest risk factor for death during first month of life Stillbirth Prevention and Control of Malaria during Pregnancy 35 Effects on Communities Causes missed work and wages Results in frequent school absences Uses scarce resources Causes preventable deaths: increases maternal, newborn, and infant mortality rates Prevention and Control of Malaria during Pregnancy 36 HIV/AIDS and Malaria during Pregnancy HIV/AIDS reduces a woman’s resistance to malaria Intermittent preventive treatment (IPT) given 3 times during pregnancy is effective for women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 37 Summary of Health Education Points Malaria transmitted through mosquito bites Pregnant women and children are most at risk Pregnant women infected with malaria may have no symptoms Women with HIV/AIDS are at higher risk Malaria can lead to severe anemia, spontaneous abortion, low-birthweight babies Malaria is preventable Prevention and Control of Malaria during Pregnancy Chapter III: Preventing Malaria Prevention and Control of Malaria during Pregnancy 39 Preventing Malaria: Chapter Objectives List the elements of counseling women about the use of insecticide-treated nets (ITNs) and intermittent preventive treatment (IPT) during pregnancy Describe the use of sulfadoxine-pyrimethamine (SP) for IPT during pregnancy Prevention and Control of Malaria during Pregnancy 40 Insecticide-Treated Nets Kill or repel mosquitoes Prevent physical contact with mosquitoes Kill or repel other insects: Lice Ticks Bedbugs Cockroaches Prevention and Control of Malaria during Pregnancy 41 Insecticide-Treated Nets (cont’d.) Untreated Nets Provide some protection against malaria Do not kill or repel mosquitoes that touch net Do not reduce number of mosquitoes Do not kill other insects like lice, roaches, and bedbugs Are safe for pregnant women, young children, and infants Insecticide-Treated Nets Provide a high level of protection against malaria Kills or repels mosquitoes that touch the net Reduce number of mosquitoes in/outside net Kills other insects such as lice, roaches, and bedbugs Are safe for pregnant women, young children, and infants Prevention and Control of Malaria during Pregnancy 42 Benefits of Insecticide-Treated Nets Prevent mosquito bites Protect against malaria, resulting in less: Anemia Prematurity and low birthweight Risk of maternal and newborn death Help people sleep better Promote growth and development of fetus and newborn Prevention and Control of Malaria during Pregnancy 43 Benefits of Insecticide-Treated Nets: Community Cost less than treating malaria Reduce number of sick children and adults (helping children grow to be healthy and helping working adults remain productive) Reduce number of deaths Prevention and Control of Malaria during Pregnancy 44 Where to Find Insecticide-Treated Nets General merchandise shops Drug shops/pharmacies Markets Public and private health facilities Community health workers NGOs, community-based organizations Prevention and Control of Malaria during Pregnancy 45 How to Use Insecticide-Treated Nets Hang above bed or sleeping mat Tuck under mattress or mat Use every night, all year long Use for everyone, if possible, but give priority to pregnant women, infants, and children Prevention and Control of Malaria during Pregnancy 46 Caring for Insecticide-Treated Nets Handle gently to avoid tears Tie net up during day to avoid damage Regularly inspect for holes, repair if found Nets need to be re-treated regularly to stay effective Keep away from smoke, fire, direct sunlight Prevention and Control of Malaria during Pregnancy 47 Intermittent Preventive Treatment Based on the assumption that every pregnant woman living in an area of high malaria transmission has malaria parasites in her blood or placenta, whether or not she has symptoms of malaria Prevention and Control of Malaria during Pregnancy 48 Intermittent Preventive Treatment Although a pregnant woman with malaria may have no symptoms, malaria can still affect her and her unborn child Prevention and Control of Malaria during Pregnancy 49 Intermittent Preventive Treatment: WHO Recommendation All pregnant women should receive at least two doses of IPT after quickening, during routinely scheduled ANC visits (WHO recommends a schedule of four visits, three after quickening) Presently, the most effective drug for IPT is sulfadoxine-pyrimethamine (SP) Women should receive at least two doses of IPT with SP at ANC visits after quickening, but no more frequently than monthly Prevention and Control of Malaria during Pregnancy 50 Intermittent Preventive Treatment: Dose and Timing A single dose is three tablets of sulfadoxine 500 mg + pyrimethamine 25 mg Healthcare provider should dispense dose and directly observe client taking dose Prevention and Control of Malaria during Pregnancy 51 Instructions for Giving Intermittent Preventive Treatment Ensure woman is at least 16 weeks pregnant and that quickening has occurred Inquire about use of SP in last 4 weeks Inquire about allergies to SP or other sulfa drugs (especially severe rashes) Explain what you will do; address the woman’s questions Provide cup and clean water Prevention and Control of Malaria during Pregnancy 52 Instructions for Giving Intermittent Preventive Treatment (cont’d.) Directly observe woman swallow three tablets of SP Record SP dose on ANC and clinic card Advise the woman when to return: For her next scheduled visit If she has signs of malaria If she has other danger signs Reinforce the importance of using ITNs Prevention and Control of Malaria during Pregnancy 53 Intermittent Preventive Treatment: Contraindications to Using SP Do NOT give during first trimester: Be sure quickening has occurred and woman is at least 16 weeks pregnant Do NOT give to women with reported allergy to SP or other sulfa drugs: Ask about sulfa drug allergies before giving SP Do NOT give to women taking co-trimoxazole, or other sulfa-containing drugs: Ask about use of these medicines before giving SP Do not give SP more frequently than monthly: Be sure at least 1 month has passed since the last dose of SP Prevention and Control of Malaria during Pregnancy 54 Chemoprophylaxis with Chloroquine: For Women Allergic to Sulfa Drugs* Dose Chloroquine 150 mg Timing 1 4 tablets First ANC visit after 16 weeks 2 4 tablets Second day after first dose 3 2 tablets Third day after first dose Weekly 2 tablets Every week during pregnancy *If chloroquine resistance rates in the country are high, chemoprophylaxis with chloroquine is not recommended. Prevention and Control of Malaria during Pregnancy 55 Summary of Health Education Points Pregnant women should sleep under ITNs every night By preventing malaria, IPT reduces the incidence of maternal anemia, spontaneous abortion, preterm birth, stillbirth, and low birthweight IPT should be administered to pregnant women at regularly scheduled ANC visits after quickening, but not more often than monthly Prevention and Control of Malaria during Pregnancy Chapter IV: Detection and Treatment Prevention and Control of Malaria during Pregnancy 57 Malaria Detection and Treatment: Chapter Objectives Identify causes of fever during pregnancy List the signs and symptoms of uncomplicated and complicated malaria Describe the treatment for uncomplicated malaria during pregnancy Explain the steps to appropriately refer a pregnant woman who has complicated malaria Prevention and Control of Malaria during Pregnancy 58 Detecting Malaria Symptoms Fever Chills Headaches Muscle/joint pains Lab exam of blood from a finger prick Prevention and Control of Malaria during Pregnancy 59 Fever during Pregnancy Temperature of 38° C or higher May be caused by malaria, but also by: Bladder or kidney infection Pneumonia Typhoid Uterine infection Careful history and physical required to rule out other causes Prevention and Control of Malaria during Pregnancy 60 Fever during Pregnancy (cont’d.) Ask about or examine for: Type, duration, degree of fever Signs of other infections: Chest pain/difficulty breathing Foul-smelling watery vaginal discharge Tender/painful uterus or abdomen Frequency/urgency/pain in urinating Signs of complicated malaria or other danger signs Prevention and Control of Malaria during Pregnancy 61 Types of Malaria Uncomplicated Most common Complicated Life threatening, can affect brain Pregnant women more likely to get complicated malaria than non-pregnant women Prevention and Control of Malaria during Pregnancy 62 Recognizing Malaria in Pregnant Women Uncomplicated Malaria Fever Shivering/chills/rigors Headaches Muscle/joint pains Nausea/vomiting False labor pains Complicated Malaria Signs of uncomplicated malaria PLUS one or more of the following: Dizziness Breathlessness/difficulty breathing Sleepy/drowsy Confusion/coma Sometimes fits, jaundice, severe dehydration Prevention and Control of Malaria during Pregnancy 63 Recognizing Malaria in Pregnant Women (cont’d.) Refer the woman immediately if you suspect anything other than uncomplicated malaria Prevention and Control of Malaria during Pregnancy 64 Case Management Determine whether malaria is uncomplicated or complicated Uncomplicated: Manage according to national protocol Complicated: Refer immediately to higher level of care; consider giving first dose of anti-malarial if available and healthcare provider is familiar with its use Prevention and Control of Malaria during Pregnancy 65 Case Management: Drugs First-line drug therapy is indicated for uncomplicated malaria Second-line drug therapy is indicated for uncomplicated malaria that has failed to respond to first-line drug In almost all countries, quinine is the drug of choice for complicated malaria Prevention and Control of Malaria during Pregnancy 66 Managing Uncomplicated Malaria Provide first-line anti-malarial drugs Follow country guidelines Manage fever Analgesics, tepid sponging Diagnose and treat anemia Provide fluids Prevention and Control of Malaria during Pregnancy 67 Treating Uncomplicated Malaria Observe client taking anti-malarial drugs Advise client to: Complete course of drugs Return if no improvement in 48 hours Consume iron-rich foods Use ITNs and other preventive measures Prevention and Control of Malaria during Pregnancy 68 SP: Contraindications Before 16 weeks of pregnancy SP dose in last 4 weeks Allergies to sulfa drugs (e.g., co-trimoxazole) Currently taking other sulfa drugs Substitute other drug before giving SP Prevention and Control of Malaria during Pregnancy 69 Treatment Problems Vomiting within 30 minutes Repeat dose of SP Itching Warm or cool baths Use lotions/skin creams Give Piriton™ or Phenergan® Stomach upset/irritation Take chloroquine with food or sugar Reduce intake of caffeine and greasy foods
Slide 70 - Prevention and Control of Malaria during Pregnancy A Workshop for Healthcare Providers Prevention and Control of Malaria during Pregnancy 2 Facts about Malaria 300 million cases each year worldwide 9 of 10 cases occur in Africa A person in Africa dies of malaria every 10 seconds Women and young children are most at risk Affects five times as many people as AIDS, leprosy, measles, and tuberculosis combined Prevention and Control of Malaria during Pregnancy 3 Facts about Malaria and Pregnancy 30 million African women are pregnant yearly Malaria is more frequent and complicated during pregnancy In malaria-endemic areas, malaria during pregnancy may account for: Up to 15% of maternal anemia 5–14% of low birthweight 30% of “preventable” low birthweight Prevention and Control of Malaria during Pregnancy 4 Roll Back Malaria Worldwide partnership Governments, private groups, research organizations, civil society, media Aim to reduce malaria by half by 2010 Free advocacy resources and tools: http://www.rbm.who.int Priority: Prevent poor outcomes caused by malaria in pregnancy Abuja declaration: Goal is for 60% of women in Africa to be sleeping under insecticide-treated nets (ITNs) and getting intermittent preventive treatment (IPT) by 2005 Prevention and Control of Malaria during Pregnancy 5 Malaria Prevention and Treatment during Pregnancy Focused antenatal care (ANC) with health education about malaria Use of insecticide-treated nets (ITNs) Intermittent preventive treatment (IPT) Case management of women with symptoms and signs of malaria Prevention and Control of Malaria during Pregnancy Chapter I: Focused Antenatal Care Prevention and Control of Malaria during Pregnancy 7 Focused Antenatal Care: Chapter Objectives Describe four main components of focused antenatal care (ANC) Discuss frequency and timing of ANC visits Describe essential elements of a birth plan that includes complication readiness Describe interpersonal skills for effective ANC Describe components of record keeping for ANC Prevention and Control of Malaria during Pregnancy 8 Focused Antenatal Care An approach to ANC that emphasizes: Evidence-based, goal-directed actions Individualized, woman-centered care Quality vs. quantity of visits Care by skilled providers Prevention and Control of Malaria during Pregnancy 9 Goal of Focused Antenatal Care To promote maternal and newborn health and survival through: Early detection and treatment of problems and complications Prevention of complications and disease Birth preparedness and complication readiness Health promotion Prevention and Control of Malaria during Pregnancy 10 Traditional Antenatal Care Emphasizes: Ritualistic, “routine” care vs. evidence-based, goal-directed actions Frequent visits Does not emphasize individual client needs Prevention and Control of Malaria during Pregnancy 11 No Longer Recommended Numerous, routine visits Burden to women and healthcare system Routine measurements and examinations: Maternal height and weight Ankle edema Fetal position before 36 weeks Care based on risk assessment Prevention and Control of Malaria during Pregnancy 12 Risk Approach Not an effective ANC strategy because: Complications cannot be predicted—all pregnant women are at risk for developing complications Risk factors are usually not direct cause of complications Many “low risk” women develop complications Have false sense of security Do not know how to recognize/respond to problems Most “high risk” women give birth without complications Inefficient use of scarce resources Prevention and Control of Malaria during Pregnancy 13 Focused Antenatal Care Services Evidence-based, goal-directed actions: Address most prevalent health issues affecting women and newborns Adjusted for specific populations/regions Appropriate to gestational age Based on firm rationale Prevention and Control of Malaria during Pregnancy 14 Focused Antenatal Care Services (cont’d.) Individualized, woman-centered care based on each woman’s: Specific needs and concerns Circumstances History, physical examination, testing Available resources Prevention and Control of Malaria during Pregnancy 15 Focused Antenatal Care Services (cont’d.) Quality vs. quantity of ANC visits: WHO multi-center study Number of visits reduced without affecting outcome for mother or baby Recommendations Content and quality vs. number of visits Goal-oriented care Minimum of four visits Prevention and Control of Malaria during Pregnancy 16 First visit: By 16 weeks or when woman first thinks she is pregnant Second visit: At 24–28 weeks or at least once in second trimester Third visit: At 32 weeks Fourth visit: At 36 weeks Other visits: If complication occurs, followup or referral is needed, woman wants to see provider, or provider changes frequency based on findings (history, exam, testing) or local policy Scheduling and Timing of ANC Visits Prevention and Control of Malaria during Pregnancy 17 Focused Antenatal Care Services (cont’d.) Care by a skilled provider who: Has formal training and experience Has knowledge, skills, and qualifications to deliver safe, effective maternal and newborn healthcare Practices in home, hospital, health center May be a midwife, nurse, doctor, clinical officer, etc. Prevention and Control of Malaria during Pregnancy 18 Early Detection and Treatment Malaria—history and physical exam Fever and accompanying signs/symptoms Region Complicated vs. uncomplicated cases Severe anemia—physical exam, testing Pre-eclampsia/eclampsia—measurement of blood pressure HIV—voluntary counseling and testing Sexually transmitted infections, including syphilis— testing Prevention and Control of Malaria during Pregnancy 19 Prevention: Key Preventive Measures Malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Tetanus toxoid, iron/folate supplements Country/region-specific interventions as appropriate Vitamin A supplements Iodine supplements Presumptive treatment for hookworm Prevention and Control of Malaria during Pregnancy 20 Birth Preparedness and Complication Readiness: Objectives Develop birth plan—exact plan for normal birth and possible complications: Arrangements made in advance by woman and family (with help of skilled provider) Usually not a written document Reviewed/revised at every visit Minimize disorganization at time of birth or in an emergency Ensure timely and appropriate care Prevention and Control of Malaria during Pregnancy 21 Essential Elements of a Birth Plan Facility or Place of Birth: Home or health facility for birth, appropriate facility for emergencies Skilled Provider: To attend birth Provider/Facility Contact Information Transportation: Reliable, accessible, especially for odd hours Funds: Personal savings, emergency funds Decision-Making: Who will make decisions, especially in an emergency Prevention and Control of Malaria during Pregnancy 22 Essential Elements of a Birth Plan (cont’d.) Family and Community Support: Care for family in woman’s absence and birth companion during labor Blood Donor: In case of emergency Needed Items: For clean and safe birth and for newborn care Danger Signs/Signs of Advanced Labor Prevention and Control of Malaria during Pregnancy 23 Danger Signs of Pregnancy Vaginal bleeding Difficulty breathing Fever Severe abdominal pain Severe headache/blurred vision Convulsions/loss of consciousness Labor pains before 37 weeks Prevention and Control of Malaria during Pregnancy 24 Health Education: Objectives Inform and educate the woman with health messages and counseling appropriate to: Individual needs, concerns, circumstances Gestational age Most prevalent health issues Support the woman in making decisions and solving actual or anticipated problems Involve partner and family in supporting/adopting healthy practices Prevention and Control of Malaria during Pregnancy 25 Health Education: Topics Addressed Prevention of malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Other methods Other important issues to be discussed include: Nutrition Care for common discomforts Use of potentially harmful substances Hygiene Rest and activity Prevention and Control of Malaria during Pregnancy 26 Health Education: Topics Addressed (cont’d.) Sexual relations and safer sex Early and exclusive breastfeeding Prevention of tetanus and anemia Voluntary counseling and testing for HIV Prevention of other endemic diseases/deficiencies Prevention and Control of Malaria during Pregnancy 27 Interpersonal Skills Speak in a quiet, gentle tone of voice Listen to woman/family and respond appropriately Encourage them to ask questions and express concerns Allow them to demonstrate understanding of information provided Explain all procedures/actions and obtain permission before proceeding Show respect for cultural beliefs and social norms Be empathetic and nonjudgmental Avoid distractions while conducting the visit Prevention and Control of Malaria during Pregnancy 28 Record Keeping First ANC Visit History Physical examination Testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs Date of next ANC visit Subsequent ANC Visits Interim history Targeted physical examination, testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs (and relevant information on how client obtained and used ITN) Date of next ANC visit Record all information on the ANC chart and clinic card: Prevention and Control of Malaria during Pregnancy Chapter II: Malaria Transmission Prevention and Control of Malaria during Pregnancy 30 Malaria Transmission: Chapter Objectives Define malaria and how it is transmitted Describe extent of malaria in Africa Identify groups at highest risk of malaria infection List effects of malaria on pregnant women and their unborn babies Describe effects of malaria on pregnant women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 31 Malaria Transmission Caused by Plasmodium parasites Spread by female Anopheles mosquitoes infected with parasites Anopheles mosquitoes usually active at night Infected mosquito bites a person Malaria parasites reproduce in human blood Mosquito bites infected person, and goes on to bite and infect another person Prevention and Control of Malaria during Pregnancy 32 Populations Most Affected by Malaria Children under 5 years of age Pregnant women Unborn babies Immigrants from low-transmission areas HIV-infected persons Prevention and Control of Malaria during Pregnancy 33 Effects of Malaria on Pregnant Women All pregnant women in malaria-endemic areas are at risk Parasites attack and destroy red blood cells Malaria causes up to 15% of anemia in pregnancy Can cause severe anemia In Africa, anemia due to malaria causes up to 10,000 maternal deaths per year Prevention and Control of Malaria during Pregnancy 34 Effects on Unborn Babies Parasites hide in placenta Interferes with transfer of oxygen and nutrients to the baby, increasing risk of: Spontaneous abortion Preterm birth Low birthweight—single greatest risk factor for death during first month of life Stillbirth Prevention and Control of Malaria during Pregnancy 35 Effects on Communities Causes missed work and wages Results in frequent school absences Uses scarce resources Causes preventable deaths: increases maternal, newborn, and infant mortality rates Prevention and Control of Malaria during Pregnancy 36 HIV/AIDS and Malaria during Pregnancy HIV/AIDS reduces a woman’s resistance to malaria Intermittent preventive treatment (IPT) given 3 times during pregnancy is effective for women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 37 Summary of Health Education Points Malaria transmitted through mosquito bites Pregnant women and children are most at risk Pregnant women infected with malaria may have no symptoms Women with HIV/AIDS are at higher risk Malaria can lead to severe anemia, spontaneous abortion, low-birthweight babies Malaria is preventable Prevention and Control of Malaria during Pregnancy Chapter III: Preventing Malaria Prevention and Control of Malaria during Pregnancy 39 Preventing Malaria: Chapter Objectives List the elements of counseling women about the use of insecticide-treated nets (ITNs) and intermittent preventive treatment (IPT) during pregnancy Describe the use of sulfadoxine-pyrimethamine (SP) for IPT during pregnancy Prevention and Control of Malaria during Pregnancy 40 Insecticide-Treated Nets Kill or repel mosquitoes Prevent physical contact with mosquitoes Kill or repel other insects: Lice Ticks Bedbugs Cockroaches Prevention and Control of Malaria during Pregnancy 41 Insecticide-Treated Nets (cont’d.) Untreated Nets Provide some protection against malaria Do not kill or repel mosquitoes that touch net Do not reduce number of mosquitoes Do not kill other insects like lice, roaches, and bedbugs Are safe for pregnant women, young children, and infants Insecticide-Treated Nets Provide a high level of protection against malaria Kills or repels mosquitoes that touch the net Reduce number of mosquitoes in/outside net Kills other insects such as lice, roaches, and bedbugs Are safe for pregnant women, young children, and infants Prevention and Control of Malaria during Pregnancy 42 Benefits of Insecticide-Treated Nets Prevent mosquito bites Protect against malaria, resulting in less: Anemia Prematurity and low birthweight Risk of maternal and newborn death Help people sleep better Promote growth and development of fetus and newborn Prevention and Control of Malaria during Pregnancy 43 Benefits of Insecticide-Treated Nets: Community Cost less than treating malaria Reduce number of sick children and adults (helping children grow to be healthy and helping working adults remain productive) Reduce number of deaths Prevention and Control of Malaria during Pregnancy 44 Where to Find Insecticide-Treated Nets General merchandise shops Drug shops/pharmacies Markets Public and private health facilities Community health workers NGOs, community-based organizations Prevention and Control of Malaria during Pregnancy 45 How to Use Insecticide-Treated Nets Hang above bed or sleeping mat Tuck under mattress or mat Use every night, all year long Use for everyone, if possible, but give priority to pregnant women, infants, and children Prevention and Control of Malaria during Pregnancy 46 Caring for Insecticide-Treated Nets Handle gently to avoid tears Tie net up during day to avoid damage Regularly inspect for holes, repair if found Nets need to be re-treated regularly to stay effective Keep away from smoke, fire, direct sunlight Prevention and Control of Malaria during Pregnancy 47 Intermittent Preventive Treatment Based on the assumption that every pregnant woman living in an area of high malaria transmission has malaria parasites in her blood or placenta, whether or not she has symptoms of malaria Prevention and Control of Malaria during Pregnancy 48 Intermittent Preventive Treatment Although a pregnant woman with malaria may have no symptoms, malaria can still affect her and her unborn child Prevention and Control of Malaria during Pregnancy 49 Intermittent Preventive Treatment: WHO Recommendation All pregnant women should receive at least two doses of IPT after quickening, during routinely scheduled ANC visits (WHO recommends a schedule of four visits, three after quickening) Presently, the most effective drug for IPT is sulfadoxine-pyrimethamine (SP) Women should receive at least two doses of IPT with SP at ANC visits after quickening, but no more frequently than monthly Prevention and Control of Malaria during Pregnancy 50 Intermittent Preventive Treatment: Dose and Timing A single dose is three tablets of sulfadoxine 500 mg + pyrimethamine 25 mg Healthcare provider should dispense dose and directly observe client taking dose Prevention and Control of Malaria during Pregnancy 51 Instructions for Giving Intermittent Preventive Treatment Ensure woman is at least 16 weeks pregnant and that quickening has occurred Inquire about use of SP in last 4 weeks Inquire about allergies to SP or other sulfa drugs (especially severe rashes) Explain what you will do; address the woman’s questions Provide cup and clean water Prevention and Control of Malaria during Pregnancy 52 Instructions for Giving Intermittent Preventive Treatment (cont’d.) Directly observe woman swallow three tablets of SP Record SP dose on ANC and clinic card Advise the woman when to return: For her next scheduled visit If she has signs of malaria If she has other danger signs Reinforce the importance of using ITNs Prevention and Control of Malaria during Pregnancy 53 Intermittent Preventive Treatment: Contraindications to Using SP Do NOT give during first trimester: Be sure quickening has occurred and woman is at least 16 weeks pregnant Do NOT give to women with reported allergy to SP or other sulfa drugs: Ask about sulfa drug allergies before giving SP Do NOT give to women taking co-trimoxazole, or other sulfa-containing drugs: Ask about use of these medicines before giving SP Do not give SP more frequently than monthly: Be sure at least 1 month has passed since the last dose of SP Prevention and Control of Malaria during Pregnancy 54 Chemoprophylaxis with Chloroquine: For Women Allergic to Sulfa Drugs* Dose Chloroquine 150 mg Timing 1 4 tablets First ANC visit after 16 weeks 2 4 tablets Second day after first dose 3 2 tablets Third day after first dose Weekly 2 tablets Every week during pregnancy *If chloroquine resistance rates in the country are high, chemoprophylaxis with chloroquine is not recommended. Prevention and Control of Malaria during Pregnancy 55 Summary of Health Education Points Pregnant women should sleep under ITNs every night By preventing malaria, IPT reduces the incidence of maternal anemia, spontaneous abortion, preterm birth, stillbirth, and low birthweight IPT should be administered to pregnant women at regularly scheduled ANC visits after quickening, but not more often than monthly Prevention and Control of Malaria during Pregnancy Chapter IV: Detection and Treatment Prevention and Control of Malaria during Pregnancy 57 Malaria Detection and Treatment: Chapter Objectives Identify causes of fever during pregnancy List the signs and symptoms of uncomplicated and complicated malaria Describe the treatment for uncomplicated malaria during pregnancy Explain the steps to appropriately refer a pregnant woman who has complicated malaria Prevention and Control of Malaria during Pregnancy 58 Detecting Malaria Symptoms Fever Chills Headaches Muscle/joint pains Lab exam of blood from a finger prick Prevention and Control of Malaria during Pregnancy 59 Fever during Pregnancy Temperature of 38° C or higher May be caused by malaria, but also by: Bladder or kidney infection Pneumonia Typhoid Uterine infection Careful history and physical required to rule out other causes Prevention and Control of Malaria during Pregnancy 60 Fever during Pregnancy (cont’d.) Ask about or examine for: Type, duration, degree of fever Signs of other infections: Chest pain/difficulty breathing Foul-smelling watery vaginal discharge Tender/painful uterus or abdomen Frequency/urgency/pain in urinating Signs of complicated malaria or other danger signs Prevention and Control of Malaria during Pregnancy 61 Types of Malaria Uncomplicated Most common Complicated Life threatening, can affect brain Pregnant women more likely to get complicated malaria than non-pregnant women Prevention and Control of Malaria during Pregnancy 62 Recognizing Malaria in Pregnant Women Uncomplicated Malaria Fever Shivering/chills/rigors Headaches Muscle/joint pains Nausea/vomiting False labor pains Complicated Malaria Signs of uncomplicated malaria PLUS one or more of the following: Dizziness Breathlessness/difficulty breathing Sleepy/drowsy Confusion/coma Sometimes fits, jaundice, severe dehydration Prevention and Control of Malaria during Pregnancy 63 Recognizing Malaria in Pregnant Women (cont’d.) Refer the woman immediately if you suspect anything other than uncomplicated malaria Prevention and Control of Malaria during Pregnancy 64 Case Management Determine whether malaria is uncomplicated or complicated Uncomplicated: Manage according to national protocol Complicated: Refer immediately to higher level of care; consider giving first dose of anti-malarial if available and healthcare provider is familiar with its use Prevention and Control of Malaria during Pregnancy 65 Case Management: Drugs First-line drug therapy is indicated for uncomplicated malaria Second-line drug therapy is indicated for uncomplicated malaria that has failed to respond to first-line drug In almost all countries, quinine is the drug of choice for complicated malaria Prevention and Control of Malaria during Pregnancy 66 Managing Uncomplicated Malaria Provide first-line anti-malarial drugs Follow country guidelines Manage fever Analgesics, tepid sponging Diagnose and treat anemia Provide fluids Prevention and Control of Malaria during Pregnancy 67 Treating Uncomplicated Malaria Observe client taking anti-malarial drugs Advise client to: Complete course of drugs Return if no improvement in 48 hours Consume iron-rich foods Use ITNs and other preventive measures Prevention and Control of Malaria during Pregnancy 68 SP: Contraindications Before 16 weeks of pregnancy SP dose in last 4 weeks Allergies to sulfa drugs (e.g., co-trimoxazole) Currently taking other sulfa drugs Substitute other drug before giving SP Prevention and Control of Malaria during Pregnancy 69 Treatment Problems Vomiting within 30 minutes Repeat dose of SP Itching Warm or cool baths Use lotions/skin creams Give Piriton™ or Phenergan® Stomach upset/irritation Take chloroquine with food or sugar Reduce intake of caffeine and greasy foods Prevention and Control of Malaria during Pregnancy 70 Treatment Followup Arrange followup within 48 hours Advise to return if condition worsens Review danger signs Reinforce use of ITNs
Slide 71 - Prevention and Control of Malaria during Pregnancy A Workshop for Healthcare Providers Prevention and Control of Malaria during Pregnancy 2 Facts about Malaria 300 million cases each year worldwide 9 of 10 cases occur in Africa A person in Africa dies of malaria every 10 seconds Women and young children are most at risk Affects five times as many people as AIDS, leprosy, measles, and tuberculosis combined Prevention and Control of Malaria during Pregnancy 3 Facts about Malaria and Pregnancy 30 million African women are pregnant yearly Malaria is more frequent and complicated during pregnancy In malaria-endemic areas, malaria during pregnancy may account for: Up to 15% of maternal anemia 5–14% of low birthweight 30% of “preventable” low birthweight Prevention and Control of Malaria during Pregnancy 4 Roll Back Malaria Worldwide partnership Governments, private groups, research organizations, civil society, media Aim to reduce malaria by half by 2010 Free advocacy resources and tools: http://www.rbm.who.int Priority: Prevent poor outcomes caused by malaria in pregnancy Abuja declaration: Goal is for 60% of women in Africa to be sleeping under insecticide-treated nets (ITNs) and getting intermittent preventive treatment (IPT) by 2005 Prevention and Control of Malaria during Pregnancy 5 Malaria Prevention and Treatment during Pregnancy Focused antenatal care (ANC) with health education about malaria Use of insecticide-treated nets (ITNs) Intermittent preventive treatment (IPT) Case management of women with symptoms and signs of malaria Prevention and Control of Malaria during Pregnancy Chapter I: Focused Antenatal Care Prevention and Control of Malaria during Pregnancy 7 Focused Antenatal Care: Chapter Objectives Describe four main components of focused antenatal care (ANC) Discuss frequency and timing of ANC visits Describe essential elements of a birth plan that includes complication readiness Describe interpersonal skills for effective ANC Describe components of record keeping for ANC Prevention and Control of Malaria during Pregnancy 8 Focused Antenatal Care An approach to ANC that emphasizes: Evidence-based, goal-directed actions Individualized, woman-centered care Quality vs. quantity of visits Care by skilled providers Prevention and Control of Malaria during Pregnancy 9 Goal of Focused Antenatal Care To promote maternal and newborn health and survival through: Early detection and treatment of problems and complications Prevention of complications and disease Birth preparedness and complication readiness Health promotion Prevention and Control of Malaria during Pregnancy 10 Traditional Antenatal Care Emphasizes: Ritualistic, “routine” care vs. evidence-based, goal-directed actions Frequent visits Does not emphasize individual client needs Prevention and Control of Malaria during Pregnancy 11 No Longer Recommended Numerous, routine visits Burden to women and healthcare system Routine measurements and examinations: Maternal height and weight Ankle edema Fetal position before 36 weeks Care based on risk assessment Prevention and Control of Malaria during Pregnancy 12 Risk Approach Not an effective ANC strategy because: Complications cannot be predicted—all pregnant women are at risk for developing complications Risk factors are usually not direct cause of complications Many “low risk” women develop complications Have false sense of security Do not know how to recognize/respond to problems Most “high risk” women give birth without complications Inefficient use of scarce resources Prevention and Control of Malaria during Pregnancy 13 Focused Antenatal Care Services Evidence-based, goal-directed actions: Address most prevalent health issues affecting women and newborns Adjusted for specific populations/regions Appropriate to gestational age Based on firm rationale Prevention and Control of Malaria during Pregnancy 14 Focused Antenatal Care Services (cont’d.) Individualized, woman-centered care based on each woman’s: Specific needs and concerns Circumstances History, physical examination, testing Available resources Prevention and Control of Malaria during Pregnancy 15 Focused Antenatal Care Services (cont’d.) Quality vs. quantity of ANC visits: WHO multi-center study Number of visits reduced without affecting outcome for mother or baby Recommendations Content and quality vs. number of visits Goal-oriented care Minimum of four visits Prevention and Control of Malaria during Pregnancy 16 First visit: By 16 weeks or when woman first thinks she is pregnant Second visit: At 24–28 weeks or at least once in second trimester Third visit: At 32 weeks Fourth visit: At 36 weeks Other visits: If complication occurs, followup or referral is needed, woman wants to see provider, or provider changes frequency based on findings (history, exam, testing) or local policy Scheduling and Timing of ANC Visits Prevention and Control of Malaria during Pregnancy 17 Focused Antenatal Care Services (cont’d.) Care by a skilled provider who: Has formal training and experience Has knowledge, skills, and qualifications to deliver safe, effective maternal and newborn healthcare Practices in home, hospital, health center May be a midwife, nurse, doctor, clinical officer, etc. Prevention and Control of Malaria during Pregnancy 18 Early Detection and Treatment Malaria—history and physical exam Fever and accompanying signs/symptoms Region Complicated vs. uncomplicated cases Severe anemia—physical exam, testing Pre-eclampsia/eclampsia—measurement of blood pressure HIV—voluntary counseling and testing Sexually transmitted infections, including syphilis— testing Prevention and Control of Malaria during Pregnancy 19 Prevention: Key Preventive Measures Malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Tetanus toxoid, iron/folate supplements Country/region-specific interventions as appropriate Vitamin A supplements Iodine supplements Presumptive treatment for hookworm Prevention and Control of Malaria during Pregnancy 20 Birth Preparedness and Complication Readiness: Objectives Develop birth plan—exact plan for normal birth and possible complications: Arrangements made in advance by woman and family (with help of skilled provider) Usually not a written document Reviewed/revised at every visit Minimize disorganization at time of birth or in an emergency Ensure timely and appropriate care Prevention and Control of Malaria during Pregnancy 21 Essential Elements of a Birth Plan Facility or Place of Birth: Home or health facility for birth, appropriate facility for emergencies Skilled Provider: To attend birth Provider/Facility Contact Information Transportation: Reliable, accessible, especially for odd hours Funds: Personal savings, emergency funds Decision-Making: Who will make decisions, especially in an emergency Prevention and Control of Malaria during Pregnancy 22 Essential Elements of a Birth Plan (cont’d.) Family and Community Support: Care for family in woman’s absence and birth companion during labor Blood Donor: In case of emergency Needed Items: For clean and safe birth and for newborn care Danger Signs/Signs of Advanced Labor Prevention and Control of Malaria during Pregnancy 23 Danger Signs of Pregnancy Vaginal bleeding Difficulty breathing Fever Severe abdominal pain Severe headache/blurred vision Convulsions/loss of consciousness Labor pains before 37 weeks Prevention and Control of Malaria during Pregnancy 24 Health Education: Objectives Inform and educate the woman with health messages and counseling appropriate to: Individual needs, concerns, circumstances Gestational age Most prevalent health issues Support the woman in making decisions and solving actual or anticipated problems Involve partner and family in supporting/adopting healthy practices Prevention and Control of Malaria during Pregnancy 25 Health Education: Topics Addressed Prevention of malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Other methods Other important issues to be discussed include: Nutrition Care for common discomforts Use of potentially harmful substances Hygiene Rest and activity Prevention and Control of Malaria during Pregnancy 26 Health Education: Topics Addressed (cont’d.) Sexual relations and safer sex Early and exclusive breastfeeding Prevention of tetanus and anemia Voluntary counseling and testing for HIV Prevention of other endemic diseases/deficiencies Prevention and Control of Malaria during Pregnancy 27 Interpersonal Skills Speak in a quiet, gentle tone of voice Listen to woman/family and respond appropriately Encourage them to ask questions and express concerns Allow them to demonstrate understanding of information provided Explain all procedures/actions and obtain permission before proceeding Show respect for cultural beliefs and social norms Be empathetic and nonjudgmental Avoid distractions while conducting the visit Prevention and Control of Malaria during Pregnancy 28 Record Keeping First ANC Visit History Physical examination Testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs Date of next ANC visit Subsequent ANC Visits Interim history Targeted physical examination, testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs (and relevant information on how client obtained and used ITN) Date of next ANC visit Record all information on the ANC chart and clinic card: Prevention and Control of Malaria during Pregnancy Chapter II: Malaria Transmission Prevention and Control of Malaria during Pregnancy 30 Malaria Transmission: Chapter Objectives Define malaria and how it is transmitted Describe extent of malaria in Africa Identify groups at highest risk of malaria infection List effects of malaria on pregnant women and their unborn babies Describe effects of malaria on pregnant women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 31 Malaria Transmission Caused by Plasmodium parasites Spread by female Anopheles mosquitoes infected with parasites Anopheles mosquitoes usually active at night Infected mosquito bites a person Malaria parasites reproduce in human blood Mosquito bites infected person, and goes on to bite and infect another person Prevention and Control of Malaria during Pregnancy 32 Populations Most Affected by Malaria Children under 5 years of age Pregnant women Unborn babies Immigrants from low-transmission areas HIV-infected persons Prevention and Control of Malaria during Pregnancy 33 Effects of Malaria on Pregnant Women All pregnant women in malaria-endemic areas are at risk Parasites attack and destroy red blood cells Malaria causes up to 15% of anemia in pregnancy Can cause severe anemia In Africa, anemia due to malaria causes up to 10,000 maternal deaths per year Prevention and Control of Malaria during Pregnancy 34 Effects on Unborn Babies Parasites hide in placenta Interferes with transfer of oxygen and nutrients to the baby, increasing risk of: Spontaneous abortion Preterm birth Low birthweight—single greatest risk factor for death during first month of life Stillbirth Prevention and Control of Malaria during Pregnancy 35 Effects on Communities Causes missed work and wages Results in frequent school absences Uses scarce resources Causes preventable deaths: increases maternal, newborn, and infant mortality rates Prevention and Control of Malaria during Pregnancy 36 HIV/AIDS and Malaria during Pregnancy HIV/AIDS reduces a woman’s resistance to malaria Intermittent preventive treatment (IPT) given 3 times during pregnancy is effective for women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 37 Summary of Health Education Points Malaria transmitted through mosquito bites Pregnant women and children are most at risk Pregnant women infected with malaria may have no symptoms Women with HIV/AIDS are at higher risk Malaria can lead to severe anemia, spontaneous abortion, low-birthweight babies Malaria is preventable Prevention and Control of Malaria during Pregnancy Chapter III: Preventing Malaria Prevention and Control of Malaria during Pregnancy 39 Preventing Malaria: Chapter Objectives List the elements of counseling women about the use of insecticide-treated nets (ITNs) and intermittent preventive treatment (IPT) during pregnancy Describe the use of sulfadoxine-pyrimethamine (SP) for IPT during pregnancy Prevention and Control of Malaria during Pregnancy 40 Insecticide-Treated Nets Kill or repel mosquitoes Prevent physical contact with mosquitoes Kill or repel other insects: Lice Ticks Bedbugs Cockroaches Prevention and Control of Malaria during Pregnancy 41 Insecticide-Treated Nets (cont’d.) Untreated Nets Provide some protection against malaria Do not kill or repel mosquitoes that touch net Do not reduce number of mosquitoes Do not kill other insects like lice, roaches, and bedbugs Are safe for pregnant women, young children, and infants Insecticide-Treated Nets Provide a high level of protection against malaria Kills or repels mosquitoes that touch the net Reduce number of mosquitoes in/outside net Kills other insects such as lice, roaches, and bedbugs Are safe for pregnant women, young children, and infants Prevention and Control of Malaria during Pregnancy 42 Benefits of Insecticide-Treated Nets Prevent mosquito bites Protect against malaria, resulting in less: Anemia Prematurity and low birthweight Risk of maternal and newborn death Help people sleep better Promote growth and development of fetus and newborn Prevention and Control of Malaria during Pregnancy 43 Benefits of Insecticide-Treated Nets: Community Cost less than treating malaria Reduce number of sick children and adults (helping children grow to be healthy and helping working adults remain productive) Reduce number of deaths Prevention and Control of Malaria during Pregnancy 44 Where to Find Insecticide-Treated Nets General merchandise shops Drug shops/pharmacies Markets Public and private health facilities Community health workers NGOs, community-based organizations Prevention and Control of Malaria during Pregnancy 45 How to Use Insecticide-Treated Nets Hang above bed or sleeping mat Tuck under mattress or mat Use every night, all year long Use for everyone, if possible, but give priority to pregnant women, infants, and children Prevention and Control of Malaria during Pregnancy 46 Caring for Insecticide-Treated Nets Handle gently to avoid tears Tie net up during day to avoid damage Regularly inspect for holes, repair if found Nets need to be re-treated regularly to stay effective Keep away from smoke, fire, direct sunlight Prevention and Control of Malaria during Pregnancy 47 Intermittent Preventive Treatment Based on the assumption that every pregnant woman living in an area of high malaria transmission has malaria parasites in her blood or placenta, whether or not she has symptoms of malaria Prevention and Control of Malaria during Pregnancy 48 Intermittent Preventive Treatment Although a pregnant woman with malaria may have no symptoms, malaria can still affect her and her unborn child Prevention and Control of Malaria during Pregnancy 49 Intermittent Preventive Treatment: WHO Recommendation All pregnant women should receive at least two doses of IPT after quickening, during routinely scheduled ANC visits (WHO recommends a schedule of four visits, three after quickening) Presently, the most effective drug for IPT is sulfadoxine-pyrimethamine (SP) Women should receive at least two doses of IPT with SP at ANC visits after quickening, but no more frequently than monthly Prevention and Control of Malaria during Pregnancy 50 Intermittent Preventive Treatment: Dose and Timing A single dose is three tablets of sulfadoxine 500 mg + pyrimethamine 25 mg Healthcare provider should dispense dose and directly observe client taking dose Prevention and Control of Malaria during Pregnancy 51 Instructions for Giving Intermittent Preventive Treatment Ensure woman is at least 16 weeks pregnant and that quickening has occurred Inquire about use of SP in last 4 weeks Inquire about allergies to SP or other sulfa drugs (especially severe rashes) Explain what you will do; address the woman’s questions Provide cup and clean water Prevention and Control of Malaria during Pregnancy 52 Instructions for Giving Intermittent Preventive Treatment (cont’d.) Directly observe woman swallow three tablets of SP Record SP dose on ANC and clinic card Advise the woman when to return: For her next scheduled visit If she has signs of malaria If she has other danger signs Reinforce the importance of using ITNs Prevention and Control of Malaria during Pregnancy 53 Intermittent Preventive Treatment: Contraindications to Using SP Do NOT give during first trimester: Be sure quickening has occurred and woman is at least 16 weeks pregnant Do NOT give to women with reported allergy to SP or other sulfa drugs: Ask about sulfa drug allergies before giving SP Do NOT give to women taking co-trimoxazole, or other sulfa-containing drugs: Ask about use of these medicines before giving SP Do not give SP more frequently than monthly: Be sure at least 1 month has passed since the last dose of SP Prevention and Control of Malaria during Pregnancy 54 Chemoprophylaxis with Chloroquine: For Women Allergic to Sulfa Drugs* Dose Chloroquine 150 mg Timing 1 4 tablets First ANC visit after 16 weeks 2 4 tablets Second day after first dose 3 2 tablets Third day after first dose Weekly 2 tablets Every week during pregnancy *If chloroquine resistance rates in the country are high, chemoprophylaxis with chloroquine is not recommended. Prevention and Control of Malaria during Pregnancy 55 Summary of Health Education Points Pregnant women should sleep under ITNs every night By preventing malaria, IPT reduces the incidence of maternal anemia, spontaneous abortion, preterm birth, stillbirth, and low birthweight IPT should be administered to pregnant women at regularly scheduled ANC visits after quickening, but not more often than monthly Prevention and Control of Malaria during Pregnancy Chapter IV: Detection and Treatment Prevention and Control of Malaria during Pregnancy 57 Malaria Detection and Treatment: Chapter Objectives Identify causes of fever during pregnancy List the signs and symptoms of uncomplicated and complicated malaria Describe the treatment for uncomplicated malaria during pregnancy Explain the steps to appropriately refer a pregnant woman who has complicated malaria Prevention and Control of Malaria during Pregnancy 58 Detecting Malaria Symptoms Fever Chills Headaches Muscle/joint pains Lab exam of blood from a finger prick Prevention and Control of Malaria during Pregnancy 59 Fever during Pregnancy Temperature of 38° C or higher May be caused by malaria, but also by: Bladder or kidney infection Pneumonia Typhoid Uterine infection Careful history and physical required to rule out other causes Prevention and Control of Malaria during Pregnancy 60 Fever during Pregnancy (cont’d.) Ask about or examine for: Type, duration, degree of fever Signs of other infections: Chest pain/difficulty breathing Foul-smelling watery vaginal discharge Tender/painful uterus or abdomen Frequency/urgency/pain in urinating Signs of complicated malaria or other danger signs Prevention and Control of Malaria during Pregnancy 61 Types of Malaria Uncomplicated Most common Complicated Life threatening, can affect brain Pregnant women more likely to get complicated malaria than non-pregnant women Prevention and Control of Malaria during Pregnancy 62 Recognizing Malaria in Pregnant Women Uncomplicated Malaria Fever Shivering/chills/rigors Headaches Muscle/joint pains Nausea/vomiting False labor pains Complicated Malaria Signs of uncomplicated malaria PLUS one or more of the following: Dizziness Breathlessness/difficulty breathing Sleepy/drowsy Confusion/coma Sometimes fits, jaundice, severe dehydration Prevention and Control of Malaria during Pregnancy 63 Recognizing Malaria in Pregnant Women (cont’d.) Refer the woman immediately if you suspect anything other than uncomplicated malaria Prevention and Control of Malaria during Pregnancy 64 Case Management Determine whether malaria is uncomplicated or complicated Uncomplicated: Manage according to national protocol Complicated: Refer immediately to higher level of care; consider giving first dose of anti-malarial if available and healthcare provider is familiar with its use Prevention and Control of Malaria during Pregnancy 65 Case Management: Drugs First-line drug therapy is indicated for uncomplicated malaria Second-line drug therapy is indicated for uncomplicated malaria that has failed to respond to first-line drug In almost all countries, quinine is the drug of choice for complicated malaria Prevention and Control of Malaria during Pregnancy 66 Managing Uncomplicated Malaria Provide first-line anti-malarial drugs Follow country guidelines Manage fever Analgesics, tepid sponging Diagnose and treat anemia Provide fluids Prevention and Control of Malaria during Pregnancy 67 Treating Uncomplicated Malaria Observe client taking anti-malarial drugs Advise client to: Complete course of drugs Return if no improvement in 48 hours Consume iron-rich foods Use ITNs and other preventive measures Prevention and Control of Malaria during Pregnancy 68 SP: Contraindications Before 16 weeks of pregnancy SP dose in last 4 weeks Allergies to sulfa drugs (e.g., co-trimoxazole) Currently taking other sulfa drugs Substitute other drug before giving SP Prevention and Control of Malaria during Pregnancy 69 Treatment Problems Vomiting within 30 minutes Repeat dose of SP Itching Warm or cool baths Use lotions/skin creams Give Piriton™ or Phenergan® Stomach upset/irritation Take chloroquine with food or sugar Reduce intake of caffeine and greasy foods Prevention and Control of Malaria during Pregnancy 70 Treatment Followup Arrange followup within 48 hours Advise to return if condition worsens Review danger signs Reinforce use of ITNs Prevention and Control of Malaria during Pregnancy 71 Second-Line Drug Most clients will respond to malaria treatment and begin to feel better within 48 hours However, if the client’s condition does not improve or worsens, give second-line treatment for uncomplicated malaria
Slide 72 - Prevention and Control of Malaria during Pregnancy A Workshop for Healthcare Providers Prevention and Control of Malaria during Pregnancy 2 Facts about Malaria 300 million cases each year worldwide 9 of 10 cases occur in Africa A person in Africa dies of malaria every 10 seconds Women and young children are most at risk Affects five times as many people as AIDS, leprosy, measles, and tuberculosis combined Prevention and Control of Malaria during Pregnancy 3 Facts about Malaria and Pregnancy 30 million African women are pregnant yearly Malaria is more frequent and complicated during pregnancy In malaria-endemic areas, malaria during pregnancy may account for: Up to 15% of maternal anemia 5–14% of low birthweight 30% of “preventable” low birthweight Prevention and Control of Malaria during Pregnancy 4 Roll Back Malaria Worldwide partnership Governments, private groups, research organizations, civil society, media Aim to reduce malaria by half by 2010 Free advocacy resources and tools: http://www.rbm.who.int Priority: Prevent poor outcomes caused by malaria in pregnancy Abuja declaration: Goal is for 60% of women in Africa to be sleeping under insecticide-treated nets (ITNs) and getting intermittent preventive treatment (IPT) by 2005 Prevention and Control of Malaria during Pregnancy 5 Malaria Prevention and Treatment during Pregnancy Focused antenatal care (ANC) with health education about malaria Use of insecticide-treated nets (ITNs) Intermittent preventive treatment (IPT) Case management of women with symptoms and signs of malaria Prevention and Control of Malaria during Pregnancy Chapter I: Focused Antenatal Care Prevention and Control of Malaria during Pregnancy 7 Focused Antenatal Care: Chapter Objectives Describe four main components of focused antenatal care (ANC) Discuss frequency and timing of ANC visits Describe essential elements of a birth plan that includes complication readiness Describe interpersonal skills for effective ANC Describe components of record keeping for ANC Prevention and Control of Malaria during Pregnancy 8 Focused Antenatal Care An approach to ANC that emphasizes: Evidence-based, goal-directed actions Individualized, woman-centered care Quality vs. quantity of visits Care by skilled providers Prevention and Control of Malaria during Pregnancy 9 Goal of Focused Antenatal Care To promote maternal and newborn health and survival through: Early detection and treatment of problems and complications Prevention of complications and disease Birth preparedness and complication readiness Health promotion Prevention and Control of Malaria during Pregnancy 10 Traditional Antenatal Care Emphasizes: Ritualistic, “routine” care vs. evidence-based, goal-directed actions Frequent visits Does not emphasize individual client needs Prevention and Control of Malaria during Pregnancy 11 No Longer Recommended Numerous, routine visits Burden to women and healthcare system Routine measurements and examinations: Maternal height and weight Ankle edema Fetal position before 36 weeks Care based on risk assessment Prevention and Control of Malaria during Pregnancy 12 Risk Approach Not an effective ANC strategy because: Complications cannot be predicted—all pregnant women are at risk for developing complications Risk factors are usually not direct cause of complications Many “low risk” women develop complications Have false sense of security Do not know how to recognize/respond to problems Most “high risk” women give birth without complications Inefficient use of scarce resources Prevention and Control of Malaria during Pregnancy 13 Focused Antenatal Care Services Evidence-based, goal-directed actions: Address most prevalent health issues affecting women and newborns Adjusted for specific populations/regions Appropriate to gestational age Based on firm rationale Prevention and Control of Malaria during Pregnancy 14 Focused Antenatal Care Services (cont’d.) Individualized, woman-centered care based on each woman’s: Specific needs and concerns Circumstances History, physical examination, testing Available resources Prevention and Control of Malaria during Pregnancy 15 Focused Antenatal Care Services (cont’d.) Quality vs. quantity of ANC visits: WHO multi-center study Number of visits reduced without affecting outcome for mother or baby Recommendations Content and quality vs. number of visits Goal-oriented care Minimum of four visits Prevention and Control of Malaria during Pregnancy 16 First visit: By 16 weeks or when woman first thinks she is pregnant Second visit: At 24–28 weeks or at least once in second trimester Third visit: At 32 weeks Fourth visit: At 36 weeks Other visits: If complication occurs, followup or referral is needed, woman wants to see provider, or provider changes frequency based on findings (history, exam, testing) or local policy Scheduling and Timing of ANC Visits Prevention and Control of Malaria during Pregnancy 17 Focused Antenatal Care Services (cont’d.) Care by a skilled provider who: Has formal training and experience Has knowledge, skills, and qualifications to deliver safe, effective maternal and newborn healthcare Practices in home, hospital, health center May be a midwife, nurse, doctor, clinical officer, etc. Prevention and Control of Malaria during Pregnancy 18 Early Detection and Treatment Malaria—history and physical exam Fever and accompanying signs/symptoms Region Complicated vs. uncomplicated cases Severe anemia—physical exam, testing Pre-eclampsia/eclampsia—measurement of blood pressure HIV—voluntary counseling and testing Sexually transmitted infections, including syphilis— testing Prevention and Control of Malaria during Pregnancy 19 Prevention: Key Preventive Measures Malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Tetanus toxoid, iron/folate supplements Country/region-specific interventions as appropriate Vitamin A supplements Iodine supplements Presumptive treatment for hookworm Prevention and Control of Malaria during Pregnancy 20 Birth Preparedness and Complication Readiness: Objectives Develop birth plan—exact plan for normal birth and possible complications: Arrangements made in advance by woman and family (with help of skilled provider) Usually not a written document Reviewed/revised at every visit Minimize disorganization at time of birth or in an emergency Ensure timely and appropriate care Prevention and Control of Malaria during Pregnancy 21 Essential Elements of a Birth Plan Facility or Place of Birth: Home or health facility for birth, appropriate facility for emergencies Skilled Provider: To attend birth Provider/Facility Contact Information Transportation: Reliable, accessible, especially for odd hours Funds: Personal savings, emergency funds Decision-Making: Who will make decisions, especially in an emergency Prevention and Control of Malaria during Pregnancy 22 Essential Elements of a Birth Plan (cont’d.) Family and Community Support: Care for family in woman’s absence and birth companion during labor Blood Donor: In case of emergency Needed Items: For clean and safe birth and for newborn care Danger Signs/Signs of Advanced Labor Prevention and Control of Malaria during Pregnancy 23 Danger Signs of Pregnancy Vaginal bleeding Difficulty breathing Fever Severe abdominal pain Severe headache/blurred vision Convulsions/loss of consciousness Labor pains before 37 weeks Prevention and Control of Malaria during Pregnancy 24 Health Education: Objectives Inform and educate the woman with health messages and counseling appropriate to: Individual needs, concerns, circumstances Gestational age Most prevalent health issues Support the woman in making decisions and solving actual or anticipated problems Involve partner and family in supporting/adopting healthy practices Prevention and Control of Malaria during Pregnancy 25 Health Education: Topics Addressed Prevention of malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Other methods Other important issues to be discussed include: Nutrition Care for common discomforts Use of potentially harmful substances Hygiene Rest and activity Prevention and Control of Malaria during Pregnancy 26 Health Education: Topics Addressed (cont’d.) Sexual relations and safer sex Early and exclusive breastfeeding Prevention of tetanus and anemia Voluntary counseling and testing for HIV Prevention of other endemic diseases/deficiencies Prevention and Control of Malaria during Pregnancy 27 Interpersonal Skills Speak in a quiet, gentle tone of voice Listen to woman/family and respond appropriately Encourage them to ask questions and express concerns Allow them to demonstrate understanding of information provided Explain all procedures/actions and obtain permission before proceeding Show respect for cultural beliefs and social norms Be empathetic and nonjudgmental Avoid distractions while conducting the visit Prevention and Control of Malaria during Pregnancy 28 Record Keeping First ANC Visit History Physical examination Testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs Date of next ANC visit Subsequent ANC Visits Interim history Targeted physical examination, testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs (and relevant information on how client obtained and used ITN) Date of next ANC visit Record all information on the ANC chart and clinic card: Prevention and Control of Malaria during Pregnancy Chapter II: Malaria Transmission Prevention and Control of Malaria during Pregnancy 30 Malaria Transmission: Chapter Objectives Define malaria and how it is transmitted Describe extent of malaria in Africa Identify groups at highest risk of malaria infection List effects of malaria on pregnant women and their unborn babies Describe effects of malaria on pregnant women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 31 Malaria Transmission Caused by Plasmodium parasites Spread by female Anopheles mosquitoes infected with parasites Anopheles mosquitoes usually active at night Infected mosquito bites a person Malaria parasites reproduce in human blood Mosquito bites infected person, and goes on to bite and infect another person Prevention and Control of Malaria during Pregnancy 32 Populations Most Affected by Malaria Children under 5 years of age Pregnant women Unborn babies Immigrants from low-transmission areas HIV-infected persons Prevention and Control of Malaria during Pregnancy 33 Effects of Malaria on Pregnant Women All pregnant women in malaria-endemic areas are at risk Parasites attack and destroy red blood cells Malaria causes up to 15% of anemia in pregnancy Can cause severe anemia In Africa, anemia due to malaria causes up to 10,000 maternal deaths per year Prevention and Control of Malaria during Pregnancy 34 Effects on Unborn Babies Parasites hide in placenta Interferes with transfer of oxygen and nutrients to the baby, increasing risk of: Spontaneous abortion Preterm birth Low birthweight—single greatest risk factor for death during first month of life Stillbirth Prevention and Control of Malaria during Pregnancy 35 Effects on Communities Causes missed work and wages Results in frequent school absences Uses scarce resources Causes preventable deaths: increases maternal, newborn, and infant mortality rates Prevention and Control of Malaria during Pregnancy 36 HIV/AIDS and Malaria during Pregnancy HIV/AIDS reduces a woman’s resistance to malaria Intermittent preventive treatment (IPT) given 3 times during pregnancy is effective for women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 37 Summary of Health Education Points Malaria transmitted through mosquito bites Pregnant women and children are most at risk Pregnant women infected with malaria may have no symptoms Women with HIV/AIDS are at higher risk Malaria can lead to severe anemia, spontaneous abortion, low-birthweight babies Malaria is preventable Prevention and Control of Malaria during Pregnancy Chapter III: Preventing Malaria Prevention and Control of Malaria during Pregnancy 39 Preventing Malaria: Chapter Objectives List the elements of counseling women about the use of insecticide-treated nets (ITNs) and intermittent preventive treatment (IPT) during pregnancy Describe the use of sulfadoxine-pyrimethamine (SP) for IPT during pregnancy Prevention and Control of Malaria during Pregnancy 40 Insecticide-Treated Nets Kill or repel mosquitoes Prevent physical contact with mosquitoes Kill or repel other insects: Lice Ticks Bedbugs Cockroaches Prevention and Control of Malaria during Pregnancy 41 Insecticide-Treated Nets (cont’d.) Untreated Nets Provide some protection against malaria Do not kill or repel mosquitoes that touch net Do not reduce number of mosquitoes Do not kill other insects like lice, roaches, and bedbugs Are safe for pregnant women, young children, and infants Insecticide-Treated Nets Provide a high level of protection against malaria Kills or repels mosquitoes that touch the net Reduce number of mosquitoes in/outside net Kills other insects such as lice, roaches, and bedbugs Are safe for pregnant women, young children, and infants Prevention and Control of Malaria during Pregnancy 42 Benefits of Insecticide-Treated Nets Prevent mosquito bites Protect against malaria, resulting in less: Anemia Prematurity and low birthweight Risk of maternal and newborn death Help people sleep better Promote growth and development of fetus and newborn Prevention and Control of Malaria during Pregnancy 43 Benefits of Insecticide-Treated Nets: Community Cost less than treating malaria Reduce number of sick children and adults (helping children grow to be healthy and helping working adults remain productive) Reduce number of deaths Prevention and Control of Malaria during Pregnancy 44 Where to Find Insecticide-Treated Nets General merchandise shops Drug shops/pharmacies Markets Public and private health facilities Community health workers NGOs, community-based organizations Prevention and Control of Malaria during Pregnancy 45 How to Use Insecticide-Treated Nets Hang above bed or sleeping mat Tuck under mattress or mat Use every night, all year long Use for everyone, if possible, but give priority to pregnant women, infants, and children Prevention and Control of Malaria during Pregnancy 46 Caring for Insecticide-Treated Nets Handle gently to avoid tears Tie net up during day to avoid damage Regularly inspect for holes, repair if found Nets need to be re-treated regularly to stay effective Keep away from smoke, fire, direct sunlight Prevention and Control of Malaria during Pregnancy 47 Intermittent Preventive Treatment Based on the assumption that every pregnant woman living in an area of high malaria transmission has malaria parasites in her blood or placenta, whether or not she has symptoms of malaria Prevention and Control of Malaria during Pregnancy 48 Intermittent Preventive Treatment Although a pregnant woman with malaria may have no symptoms, malaria can still affect her and her unborn child Prevention and Control of Malaria during Pregnancy 49 Intermittent Preventive Treatment: WHO Recommendation All pregnant women should receive at least two doses of IPT after quickening, during routinely scheduled ANC visits (WHO recommends a schedule of four visits, three after quickening) Presently, the most effective drug for IPT is sulfadoxine-pyrimethamine (SP) Women should receive at least two doses of IPT with SP at ANC visits after quickening, but no more frequently than monthly Prevention and Control of Malaria during Pregnancy 50 Intermittent Preventive Treatment: Dose and Timing A single dose is three tablets of sulfadoxine 500 mg + pyrimethamine 25 mg Healthcare provider should dispense dose and directly observe client taking dose Prevention and Control of Malaria during Pregnancy 51 Instructions for Giving Intermittent Preventive Treatment Ensure woman is at least 16 weeks pregnant and that quickening has occurred Inquire about use of SP in last 4 weeks Inquire about allergies to SP or other sulfa drugs (especially severe rashes) Explain what you will do; address the woman’s questions Provide cup and clean water Prevention and Control of Malaria during Pregnancy 52 Instructions for Giving Intermittent Preventive Treatment (cont’d.) Directly observe woman swallow three tablets of SP Record SP dose on ANC and clinic card Advise the woman when to return: For her next scheduled visit If she has signs of malaria If she has other danger signs Reinforce the importance of using ITNs Prevention and Control of Malaria during Pregnancy 53 Intermittent Preventive Treatment: Contraindications to Using SP Do NOT give during first trimester: Be sure quickening has occurred and woman is at least 16 weeks pregnant Do NOT give to women with reported allergy to SP or other sulfa drugs: Ask about sulfa drug allergies before giving SP Do NOT give to women taking co-trimoxazole, or other sulfa-containing drugs: Ask about use of these medicines before giving SP Do not give SP more frequently than monthly: Be sure at least 1 month has passed since the last dose of SP Prevention and Control of Malaria during Pregnancy 54 Chemoprophylaxis with Chloroquine: For Women Allergic to Sulfa Drugs* Dose Chloroquine 150 mg Timing 1 4 tablets First ANC visit after 16 weeks 2 4 tablets Second day after first dose 3 2 tablets Third day after first dose Weekly 2 tablets Every week during pregnancy *If chloroquine resistance rates in the country are high, chemoprophylaxis with chloroquine is not recommended. Prevention and Control of Malaria during Pregnancy 55 Summary of Health Education Points Pregnant women should sleep under ITNs every night By preventing malaria, IPT reduces the incidence of maternal anemia, spontaneous abortion, preterm birth, stillbirth, and low birthweight IPT should be administered to pregnant women at regularly scheduled ANC visits after quickening, but not more often than monthly Prevention and Control of Malaria during Pregnancy Chapter IV: Detection and Treatment Prevention and Control of Malaria during Pregnancy 57 Malaria Detection and Treatment: Chapter Objectives Identify causes of fever during pregnancy List the signs and symptoms of uncomplicated and complicated malaria Describe the treatment for uncomplicated malaria during pregnancy Explain the steps to appropriately refer a pregnant woman who has complicated malaria Prevention and Control of Malaria during Pregnancy 58 Detecting Malaria Symptoms Fever Chills Headaches Muscle/joint pains Lab exam of blood from a finger prick Prevention and Control of Malaria during Pregnancy 59 Fever during Pregnancy Temperature of 38° C or higher May be caused by malaria, but also by: Bladder or kidney infection Pneumonia Typhoid Uterine infection Careful history and physical required to rule out other causes Prevention and Control of Malaria during Pregnancy 60 Fever during Pregnancy (cont’d.) Ask about or examine for: Type, duration, degree of fever Signs of other infections: Chest pain/difficulty breathing Foul-smelling watery vaginal discharge Tender/painful uterus or abdomen Frequency/urgency/pain in urinating Signs of complicated malaria or other danger signs Prevention and Control of Malaria during Pregnancy 61 Types of Malaria Uncomplicated Most common Complicated Life threatening, can affect brain Pregnant women more likely to get complicated malaria than non-pregnant women Prevention and Control of Malaria during Pregnancy 62 Recognizing Malaria in Pregnant Women Uncomplicated Malaria Fever Shivering/chills/rigors Headaches Muscle/joint pains Nausea/vomiting False labor pains Complicated Malaria Signs of uncomplicated malaria PLUS one or more of the following: Dizziness Breathlessness/difficulty breathing Sleepy/drowsy Confusion/coma Sometimes fits, jaundice, severe dehydration Prevention and Control of Malaria during Pregnancy 63 Recognizing Malaria in Pregnant Women (cont’d.) Refer the woman immediately if you suspect anything other than uncomplicated malaria Prevention and Control of Malaria during Pregnancy 64 Case Management Determine whether malaria is uncomplicated or complicated Uncomplicated: Manage according to national protocol Complicated: Refer immediately to higher level of care; consider giving first dose of anti-malarial if available and healthcare provider is familiar with its use Prevention and Control of Malaria during Pregnancy 65 Case Management: Drugs First-line drug therapy is indicated for uncomplicated malaria Second-line drug therapy is indicated for uncomplicated malaria that has failed to respond to first-line drug In almost all countries, quinine is the drug of choice for complicated malaria Prevention and Control of Malaria during Pregnancy 66 Managing Uncomplicated Malaria Provide first-line anti-malarial drugs Follow country guidelines Manage fever Analgesics, tepid sponging Diagnose and treat anemia Provide fluids Prevention and Control of Malaria during Pregnancy 67 Treating Uncomplicated Malaria Observe client taking anti-malarial drugs Advise client to: Complete course of drugs Return if no improvement in 48 hours Consume iron-rich foods Use ITNs and other preventive measures Prevention and Control of Malaria during Pregnancy 68 SP: Contraindications Before 16 weeks of pregnancy SP dose in last 4 weeks Allergies to sulfa drugs (e.g., co-trimoxazole) Currently taking other sulfa drugs Substitute other drug before giving SP Prevention and Control of Malaria during Pregnancy 69 Treatment Problems Vomiting within 30 minutes Repeat dose of SP Itching Warm or cool baths Use lotions/skin creams Give Piriton™ or Phenergan® Stomach upset/irritation Take chloroquine with food or sugar Reduce intake of caffeine and greasy foods Prevention and Control of Malaria during Pregnancy 70 Treatment Followup Arrange followup within 48 hours Advise to return if condition worsens Review danger signs Reinforce use of ITNs Prevention and Control of Malaria during Pregnancy 71 Second-Line Drug Most clients will respond to malaria treatment and begin to feel better within 48 hours However, if the client’s condition does not improve or worsens, give second-line treatment for uncomplicated malaria Prevention and Control of Malaria during Pregnancy 72 Second-Line Drug (cont’d.) If the woman’s condition does not improve or worsens within 48 hours of starting treatment with a second-line drug, and/or other symptoms appear, REFER IMMEDIATELY If signs of complicated malaria are present, REFER IMMEDIATELY
Slide 73 - Prevention and Control of Malaria during Pregnancy A Workshop for Healthcare Providers Prevention and Control of Malaria during Pregnancy 2 Facts about Malaria 300 million cases each year worldwide 9 of 10 cases occur in Africa A person in Africa dies of malaria every 10 seconds Women and young children are most at risk Affects five times as many people as AIDS, leprosy, measles, and tuberculosis combined Prevention and Control of Malaria during Pregnancy 3 Facts about Malaria and Pregnancy 30 million African women are pregnant yearly Malaria is more frequent and complicated during pregnancy In malaria-endemic areas, malaria during pregnancy may account for: Up to 15% of maternal anemia 5–14% of low birthweight 30% of “preventable” low birthweight Prevention and Control of Malaria during Pregnancy 4 Roll Back Malaria Worldwide partnership Governments, private groups, research organizations, civil society, media Aim to reduce malaria by half by 2010 Free advocacy resources and tools: http://www.rbm.who.int Priority: Prevent poor outcomes caused by malaria in pregnancy Abuja declaration: Goal is for 60% of women in Africa to be sleeping under insecticide-treated nets (ITNs) and getting intermittent preventive treatment (IPT) by 2005 Prevention and Control of Malaria during Pregnancy 5 Malaria Prevention and Treatment during Pregnancy Focused antenatal care (ANC) with health education about malaria Use of insecticide-treated nets (ITNs) Intermittent preventive treatment (IPT) Case management of women with symptoms and signs of malaria Prevention and Control of Malaria during Pregnancy Chapter I: Focused Antenatal Care Prevention and Control of Malaria during Pregnancy 7 Focused Antenatal Care: Chapter Objectives Describe four main components of focused antenatal care (ANC) Discuss frequency and timing of ANC visits Describe essential elements of a birth plan that includes complication readiness Describe interpersonal skills for effective ANC Describe components of record keeping for ANC Prevention and Control of Malaria during Pregnancy 8 Focused Antenatal Care An approach to ANC that emphasizes: Evidence-based, goal-directed actions Individualized, woman-centered care Quality vs. quantity of visits Care by skilled providers Prevention and Control of Malaria during Pregnancy 9 Goal of Focused Antenatal Care To promote maternal and newborn health and survival through: Early detection and treatment of problems and complications Prevention of complications and disease Birth preparedness and complication readiness Health promotion Prevention and Control of Malaria during Pregnancy 10 Traditional Antenatal Care Emphasizes: Ritualistic, “routine” care vs. evidence-based, goal-directed actions Frequent visits Does not emphasize individual client needs Prevention and Control of Malaria during Pregnancy 11 No Longer Recommended Numerous, routine visits Burden to women and healthcare system Routine measurements and examinations: Maternal height and weight Ankle edema Fetal position before 36 weeks Care based on risk assessment Prevention and Control of Malaria during Pregnancy 12 Risk Approach Not an effective ANC strategy because: Complications cannot be predicted—all pregnant women are at risk for developing complications Risk factors are usually not direct cause of complications Many “low risk” women develop complications Have false sense of security Do not know how to recognize/respond to problems Most “high risk” women give birth without complications Inefficient use of scarce resources Prevention and Control of Malaria during Pregnancy 13 Focused Antenatal Care Services Evidence-based, goal-directed actions: Address most prevalent health issues affecting women and newborns Adjusted for specific populations/regions Appropriate to gestational age Based on firm rationale Prevention and Control of Malaria during Pregnancy 14 Focused Antenatal Care Services (cont’d.) Individualized, woman-centered care based on each woman’s: Specific needs and concerns Circumstances History, physical examination, testing Available resources Prevention and Control of Malaria during Pregnancy 15 Focused Antenatal Care Services (cont’d.) Quality vs. quantity of ANC visits: WHO multi-center study Number of visits reduced without affecting outcome for mother or baby Recommendations Content and quality vs. number of visits Goal-oriented care Minimum of four visits Prevention and Control of Malaria during Pregnancy 16 First visit: By 16 weeks or when woman first thinks she is pregnant Second visit: At 24–28 weeks or at least once in second trimester Third visit: At 32 weeks Fourth visit: At 36 weeks Other visits: If complication occurs, followup or referral is needed, woman wants to see provider, or provider changes frequency based on findings (history, exam, testing) or local policy Scheduling and Timing of ANC Visits Prevention and Control of Malaria during Pregnancy 17 Focused Antenatal Care Services (cont’d.) Care by a skilled provider who: Has formal training and experience Has knowledge, skills, and qualifications to deliver safe, effective maternal and newborn healthcare Practices in home, hospital, health center May be a midwife, nurse, doctor, clinical officer, etc. Prevention and Control of Malaria during Pregnancy 18 Early Detection and Treatment Malaria—history and physical exam Fever and accompanying signs/symptoms Region Complicated vs. uncomplicated cases Severe anemia—physical exam, testing Pre-eclampsia/eclampsia—measurement of blood pressure HIV—voluntary counseling and testing Sexually transmitted infections, including syphilis— testing Prevention and Control of Malaria during Pregnancy 19 Prevention: Key Preventive Measures Malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Tetanus toxoid, iron/folate supplements Country/region-specific interventions as appropriate Vitamin A supplements Iodine supplements Presumptive treatment for hookworm Prevention and Control of Malaria during Pregnancy 20 Birth Preparedness and Complication Readiness: Objectives Develop birth plan—exact plan for normal birth and possible complications: Arrangements made in advance by woman and family (with help of skilled provider) Usually not a written document Reviewed/revised at every visit Minimize disorganization at time of birth or in an emergency Ensure timely and appropriate care Prevention and Control of Malaria during Pregnancy 21 Essential Elements of a Birth Plan Facility or Place of Birth: Home or health facility for birth, appropriate facility for emergencies Skilled Provider: To attend birth Provider/Facility Contact Information Transportation: Reliable, accessible, especially for odd hours Funds: Personal savings, emergency funds Decision-Making: Who will make decisions, especially in an emergency Prevention and Control of Malaria during Pregnancy 22 Essential Elements of a Birth Plan (cont’d.) Family and Community Support: Care for family in woman’s absence and birth companion during labor Blood Donor: In case of emergency Needed Items: For clean and safe birth and for newborn care Danger Signs/Signs of Advanced Labor Prevention and Control of Malaria during Pregnancy 23 Danger Signs of Pregnancy Vaginal bleeding Difficulty breathing Fever Severe abdominal pain Severe headache/blurred vision Convulsions/loss of consciousness Labor pains before 37 weeks Prevention and Control of Malaria during Pregnancy 24 Health Education: Objectives Inform and educate the woman with health messages and counseling appropriate to: Individual needs, concerns, circumstances Gestational age Most prevalent health issues Support the woman in making decisions and solving actual or anticipated problems Involve partner and family in supporting/adopting healthy practices Prevention and Control of Malaria during Pregnancy 25 Health Education: Topics Addressed Prevention of malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Other methods Other important issues to be discussed include: Nutrition Care for common discomforts Use of potentially harmful substances Hygiene Rest and activity Prevention and Control of Malaria during Pregnancy 26 Health Education: Topics Addressed (cont’d.) Sexual relations and safer sex Early and exclusive breastfeeding Prevention of tetanus and anemia Voluntary counseling and testing for HIV Prevention of other endemic diseases/deficiencies Prevention and Control of Malaria during Pregnancy 27 Interpersonal Skills Speak in a quiet, gentle tone of voice Listen to woman/family and respond appropriately Encourage them to ask questions and express concerns Allow them to demonstrate understanding of information provided Explain all procedures/actions and obtain permission before proceeding Show respect for cultural beliefs and social norms Be empathetic and nonjudgmental Avoid distractions while conducting the visit Prevention and Control of Malaria during Pregnancy 28 Record Keeping First ANC Visit History Physical examination Testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs Date of next ANC visit Subsequent ANC Visits Interim history Targeted physical examination, testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs (and relevant information on how client obtained and used ITN) Date of next ANC visit Record all information on the ANC chart and clinic card: Prevention and Control of Malaria during Pregnancy Chapter II: Malaria Transmission Prevention and Control of Malaria during Pregnancy 30 Malaria Transmission: Chapter Objectives Define malaria and how it is transmitted Describe extent of malaria in Africa Identify groups at highest risk of malaria infection List effects of malaria on pregnant women and their unborn babies Describe effects of malaria on pregnant women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 31 Malaria Transmission Caused by Plasmodium parasites Spread by female Anopheles mosquitoes infected with parasites Anopheles mosquitoes usually active at night Infected mosquito bites a person Malaria parasites reproduce in human blood Mosquito bites infected person, and goes on to bite and infect another person Prevention and Control of Malaria during Pregnancy 32 Populations Most Affected by Malaria Children under 5 years of age Pregnant women Unborn babies Immigrants from low-transmission areas HIV-infected persons Prevention and Control of Malaria during Pregnancy 33 Effects of Malaria on Pregnant Women All pregnant women in malaria-endemic areas are at risk Parasites attack and destroy red blood cells Malaria causes up to 15% of anemia in pregnancy Can cause severe anemia In Africa, anemia due to malaria causes up to 10,000 maternal deaths per year Prevention and Control of Malaria during Pregnancy 34 Effects on Unborn Babies Parasites hide in placenta Interferes with transfer of oxygen and nutrients to the baby, increasing risk of: Spontaneous abortion Preterm birth Low birthweight—single greatest risk factor for death during first month of life Stillbirth Prevention and Control of Malaria during Pregnancy 35 Effects on Communities Causes missed work and wages Results in frequent school absences Uses scarce resources Causes preventable deaths: increases maternal, newborn, and infant mortality rates Prevention and Control of Malaria during Pregnancy 36 HIV/AIDS and Malaria during Pregnancy HIV/AIDS reduces a woman’s resistance to malaria Intermittent preventive treatment (IPT) given 3 times during pregnancy is effective for women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 37 Summary of Health Education Points Malaria transmitted through mosquito bites Pregnant women and children are most at risk Pregnant women infected with malaria may have no symptoms Women with HIV/AIDS are at higher risk Malaria can lead to severe anemia, spontaneous abortion, low-birthweight babies Malaria is preventable Prevention and Control of Malaria during Pregnancy Chapter III: Preventing Malaria Prevention and Control of Malaria during Pregnancy 39 Preventing Malaria: Chapter Objectives List the elements of counseling women about the use of insecticide-treated nets (ITNs) and intermittent preventive treatment (IPT) during pregnancy Describe the use of sulfadoxine-pyrimethamine (SP) for IPT during pregnancy Prevention and Control of Malaria during Pregnancy 40 Insecticide-Treated Nets Kill or repel mosquitoes Prevent physical contact with mosquitoes Kill or repel other insects: Lice Ticks Bedbugs Cockroaches Prevention and Control of Malaria during Pregnancy 41 Insecticide-Treated Nets (cont’d.) Untreated Nets Provide some protection against malaria Do not kill or repel mosquitoes that touch net Do not reduce number of mosquitoes Do not kill other insects like lice, roaches, and bedbugs Are safe for pregnant women, young children, and infants Insecticide-Treated Nets Provide a high level of protection against malaria Kills or repels mosquitoes that touch the net Reduce number of mosquitoes in/outside net Kills other insects such as lice, roaches, and bedbugs Are safe for pregnant women, young children, and infants Prevention and Control of Malaria during Pregnancy 42 Benefits of Insecticide-Treated Nets Prevent mosquito bites Protect against malaria, resulting in less: Anemia Prematurity and low birthweight Risk of maternal and newborn death Help people sleep better Promote growth and development of fetus and newborn Prevention and Control of Malaria during Pregnancy 43 Benefits of Insecticide-Treated Nets: Community Cost less than treating malaria Reduce number of sick children and adults (helping children grow to be healthy and helping working adults remain productive) Reduce number of deaths Prevention and Control of Malaria during Pregnancy 44 Where to Find Insecticide-Treated Nets General merchandise shops Drug shops/pharmacies Markets Public and private health facilities Community health workers NGOs, community-based organizations Prevention and Control of Malaria during Pregnancy 45 How to Use Insecticide-Treated Nets Hang above bed or sleeping mat Tuck under mattress or mat Use every night, all year long Use for everyone, if possible, but give priority to pregnant women, infants, and children Prevention and Control of Malaria during Pregnancy 46 Caring for Insecticide-Treated Nets Handle gently to avoid tears Tie net up during day to avoid damage Regularly inspect for holes, repair if found Nets need to be re-treated regularly to stay effective Keep away from smoke, fire, direct sunlight Prevention and Control of Malaria during Pregnancy 47 Intermittent Preventive Treatment Based on the assumption that every pregnant woman living in an area of high malaria transmission has malaria parasites in her blood or placenta, whether or not she has symptoms of malaria Prevention and Control of Malaria during Pregnancy 48 Intermittent Preventive Treatment Although a pregnant woman with malaria may have no symptoms, malaria can still affect her and her unborn child Prevention and Control of Malaria during Pregnancy 49 Intermittent Preventive Treatment: WHO Recommendation All pregnant women should receive at least two doses of IPT after quickening, during routinely scheduled ANC visits (WHO recommends a schedule of four visits, three after quickening) Presently, the most effective drug for IPT is sulfadoxine-pyrimethamine (SP) Women should receive at least two doses of IPT with SP at ANC visits after quickening, but no more frequently than monthly Prevention and Control of Malaria during Pregnancy 50 Intermittent Preventive Treatment: Dose and Timing A single dose is three tablets of sulfadoxine 500 mg + pyrimethamine 25 mg Healthcare provider should dispense dose and directly observe client taking dose Prevention and Control of Malaria during Pregnancy 51 Instructions for Giving Intermittent Preventive Treatment Ensure woman is at least 16 weeks pregnant and that quickening has occurred Inquire about use of SP in last 4 weeks Inquire about allergies to SP or other sulfa drugs (especially severe rashes) Explain what you will do; address the woman’s questions Provide cup and clean water Prevention and Control of Malaria during Pregnancy 52 Instructions for Giving Intermittent Preventive Treatment (cont’d.) Directly observe woman swallow three tablets of SP Record SP dose on ANC and clinic card Advise the woman when to return: For her next scheduled visit If she has signs of malaria If she has other danger signs Reinforce the importance of using ITNs Prevention and Control of Malaria during Pregnancy 53 Intermittent Preventive Treatment: Contraindications to Using SP Do NOT give during first trimester: Be sure quickening has occurred and woman is at least 16 weeks pregnant Do NOT give to women with reported allergy to SP or other sulfa drugs: Ask about sulfa drug allergies before giving SP Do NOT give to women taking co-trimoxazole, or other sulfa-containing drugs: Ask about use of these medicines before giving SP Do not give SP more frequently than monthly: Be sure at least 1 month has passed since the last dose of SP Prevention and Control of Malaria during Pregnancy 54 Chemoprophylaxis with Chloroquine: For Women Allergic to Sulfa Drugs* Dose Chloroquine 150 mg Timing 1 4 tablets First ANC visit after 16 weeks 2 4 tablets Second day after first dose 3 2 tablets Third day after first dose Weekly 2 tablets Every week during pregnancy *If chloroquine resistance rates in the country are high, chemoprophylaxis with chloroquine is not recommended. Prevention and Control of Malaria during Pregnancy 55 Summary of Health Education Points Pregnant women should sleep under ITNs every night By preventing malaria, IPT reduces the incidence of maternal anemia, spontaneous abortion, preterm birth, stillbirth, and low birthweight IPT should be administered to pregnant women at regularly scheduled ANC visits after quickening, but not more often than monthly Prevention and Control of Malaria during Pregnancy Chapter IV: Detection and Treatment Prevention and Control of Malaria during Pregnancy 57 Malaria Detection and Treatment: Chapter Objectives Identify causes of fever during pregnancy List the signs and symptoms of uncomplicated and complicated malaria Describe the treatment for uncomplicated malaria during pregnancy Explain the steps to appropriately refer a pregnant woman who has complicated malaria Prevention and Control of Malaria during Pregnancy 58 Detecting Malaria Symptoms Fever Chills Headaches Muscle/joint pains Lab exam of blood from a finger prick Prevention and Control of Malaria during Pregnancy 59 Fever during Pregnancy Temperature of 38° C or higher May be caused by malaria, but also by: Bladder or kidney infection Pneumonia Typhoid Uterine infection Careful history and physical required to rule out other causes Prevention and Control of Malaria during Pregnancy 60 Fever during Pregnancy (cont’d.) Ask about or examine for: Type, duration, degree of fever Signs of other infections: Chest pain/difficulty breathing Foul-smelling watery vaginal discharge Tender/painful uterus or abdomen Frequency/urgency/pain in urinating Signs of complicated malaria or other danger signs Prevention and Control of Malaria during Pregnancy 61 Types of Malaria Uncomplicated Most common Complicated Life threatening, can affect brain Pregnant women more likely to get complicated malaria than non-pregnant women Prevention and Control of Malaria during Pregnancy 62 Recognizing Malaria in Pregnant Women Uncomplicated Malaria Fever Shivering/chills/rigors Headaches Muscle/joint pains Nausea/vomiting False labor pains Complicated Malaria Signs of uncomplicated malaria PLUS one or more of the following: Dizziness Breathlessness/difficulty breathing Sleepy/drowsy Confusion/coma Sometimes fits, jaundice, severe dehydration Prevention and Control of Malaria during Pregnancy 63 Recognizing Malaria in Pregnant Women (cont’d.) Refer the woman immediately if you suspect anything other than uncomplicated malaria Prevention and Control of Malaria during Pregnancy 64 Case Management Determine whether malaria is uncomplicated or complicated Uncomplicated: Manage according to national protocol Complicated: Refer immediately to higher level of care; consider giving first dose of anti-malarial if available and healthcare provider is familiar with its use Prevention and Control of Malaria during Pregnancy 65 Case Management: Drugs First-line drug therapy is indicated for uncomplicated malaria Second-line drug therapy is indicated for uncomplicated malaria that has failed to respond to first-line drug In almost all countries, quinine is the drug of choice for complicated malaria Prevention and Control of Malaria during Pregnancy 66 Managing Uncomplicated Malaria Provide first-line anti-malarial drugs Follow country guidelines Manage fever Analgesics, tepid sponging Diagnose and treat anemia Provide fluids Prevention and Control of Malaria during Pregnancy 67 Treating Uncomplicated Malaria Observe client taking anti-malarial drugs Advise client to: Complete course of drugs Return if no improvement in 48 hours Consume iron-rich foods Use ITNs and other preventive measures Prevention and Control of Malaria during Pregnancy 68 SP: Contraindications Before 16 weeks of pregnancy SP dose in last 4 weeks Allergies to sulfa drugs (e.g., co-trimoxazole) Currently taking other sulfa drugs Substitute other drug before giving SP Prevention and Control of Malaria during Pregnancy 69 Treatment Problems Vomiting within 30 minutes Repeat dose of SP Itching Warm or cool baths Use lotions/skin creams Give Piriton™ or Phenergan® Stomach upset/irritation Take chloroquine with food or sugar Reduce intake of caffeine and greasy foods Prevention and Control of Malaria during Pregnancy 70 Treatment Followup Arrange followup within 48 hours Advise to return if condition worsens Review danger signs Reinforce use of ITNs Prevention and Control of Malaria during Pregnancy 71 Second-Line Drug Most clients will respond to malaria treatment and begin to feel better within 48 hours However, if the client’s condition does not improve or worsens, give second-line treatment for uncomplicated malaria Prevention and Control of Malaria during Pregnancy 72 Second-Line Drug (cont’d.) If the woman’s condition does not improve or worsens within 48 hours of starting treatment with a second-line drug, and/or other symptoms appear, REFER IMMEDIATELY If signs of complicated malaria are present, REFER IMMEDIATELY Prevention and Control of Malaria during Pregnancy 73 Referral Preparation Explain situation to the client/family Help arrange transport to other facility if possible Write referral note Treat any urgent conditions and stabilize
Slide 74 - Prevention and Control of Malaria during Pregnancy A Workshop for Healthcare Providers Prevention and Control of Malaria during Pregnancy 2 Facts about Malaria 300 million cases each year worldwide 9 of 10 cases occur in Africa A person in Africa dies of malaria every 10 seconds Women and young children are most at risk Affects five times as many people as AIDS, leprosy, measles, and tuberculosis combined Prevention and Control of Malaria during Pregnancy 3 Facts about Malaria and Pregnancy 30 million African women are pregnant yearly Malaria is more frequent and complicated during pregnancy In malaria-endemic areas, malaria during pregnancy may account for: Up to 15% of maternal anemia 5–14% of low birthweight 30% of “preventable” low birthweight Prevention and Control of Malaria during Pregnancy 4 Roll Back Malaria Worldwide partnership Governments, private groups, research organizations, civil society, media Aim to reduce malaria by half by 2010 Free advocacy resources and tools: http://www.rbm.who.int Priority: Prevent poor outcomes caused by malaria in pregnancy Abuja declaration: Goal is for 60% of women in Africa to be sleeping under insecticide-treated nets (ITNs) and getting intermittent preventive treatment (IPT) by 2005 Prevention and Control of Malaria during Pregnancy 5 Malaria Prevention and Treatment during Pregnancy Focused antenatal care (ANC) with health education about malaria Use of insecticide-treated nets (ITNs) Intermittent preventive treatment (IPT) Case management of women with symptoms and signs of malaria Prevention and Control of Malaria during Pregnancy Chapter I: Focused Antenatal Care Prevention and Control of Malaria during Pregnancy 7 Focused Antenatal Care: Chapter Objectives Describe four main components of focused antenatal care (ANC) Discuss frequency and timing of ANC visits Describe essential elements of a birth plan that includes complication readiness Describe interpersonal skills for effective ANC Describe components of record keeping for ANC Prevention and Control of Malaria during Pregnancy 8 Focused Antenatal Care An approach to ANC that emphasizes: Evidence-based, goal-directed actions Individualized, woman-centered care Quality vs. quantity of visits Care by skilled providers Prevention and Control of Malaria during Pregnancy 9 Goal of Focused Antenatal Care To promote maternal and newborn health and survival through: Early detection and treatment of problems and complications Prevention of complications and disease Birth preparedness and complication readiness Health promotion Prevention and Control of Malaria during Pregnancy 10 Traditional Antenatal Care Emphasizes: Ritualistic, “routine” care vs. evidence-based, goal-directed actions Frequent visits Does not emphasize individual client needs Prevention and Control of Malaria during Pregnancy 11 No Longer Recommended Numerous, routine visits Burden to women and healthcare system Routine measurements and examinations: Maternal height and weight Ankle edema Fetal position before 36 weeks Care based on risk assessment Prevention and Control of Malaria during Pregnancy 12 Risk Approach Not an effective ANC strategy because: Complications cannot be predicted—all pregnant women are at risk for developing complications Risk factors are usually not direct cause of complications Many “low risk” women develop complications Have false sense of security Do not know how to recognize/respond to problems Most “high risk” women give birth without complications Inefficient use of scarce resources Prevention and Control of Malaria during Pregnancy 13 Focused Antenatal Care Services Evidence-based, goal-directed actions: Address most prevalent health issues affecting women and newborns Adjusted for specific populations/regions Appropriate to gestational age Based on firm rationale Prevention and Control of Malaria during Pregnancy 14 Focused Antenatal Care Services (cont’d.) Individualized, woman-centered care based on each woman’s: Specific needs and concerns Circumstances History, physical examination, testing Available resources Prevention and Control of Malaria during Pregnancy 15 Focused Antenatal Care Services (cont’d.) Quality vs. quantity of ANC visits: WHO multi-center study Number of visits reduced without affecting outcome for mother or baby Recommendations Content and quality vs. number of visits Goal-oriented care Minimum of four visits Prevention and Control of Malaria during Pregnancy 16 First visit: By 16 weeks or when woman first thinks she is pregnant Second visit: At 24–28 weeks or at least once in second trimester Third visit: At 32 weeks Fourth visit: At 36 weeks Other visits: If complication occurs, followup or referral is needed, woman wants to see provider, or provider changes frequency based on findings (history, exam, testing) or local policy Scheduling and Timing of ANC Visits Prevention and Control of Malaria during Pregnancy 17 Focused Antenatal Care Services (cont’d.) Care by a skilled provider who: Has formal training and experience Has knowledge, skills, and qualifications to deliver safe, effective maternal and newborn healthcare Practices in home, hospital, health center May be a midwife, nurse, doctor, clinical officer, etc. Prevention and Control of Malaria during Pregnancy 18 Early Detection and Treatment Malaria—history and physical exam Fever and accompanying signs/symptoms Region Complicated vs. uncomplicated cases Severe anemia—physical exam, testing Pre-eclampsia/eclampsia—measurement of blood pressure HIV—voluntary counseling and testing Sexually transmitted infections, including syphilis— testing Prevention and Control of Malaria during Pregnancy 19 Prevention: Key Preventive Measures Malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Tetanus toxoid, iron/folate supplements Country/region-specific interventions as appropriate Vitamin A supplements Iodine supplements Presumptive treatment for hookworm Prevention and Control of Malaria during Pregnancy 20 Birth Preparedness and Complication Readiness: Objectives Develop birth plan—exact plan for normal birth and possible complications: Arrangements made in advance by woman and family (with help of skilled provider) Usually not a written document Reviewed/revised at every visit Minimize disorganization at time of birth or in an emergency Ensure timely and appropriate care Prevention and Control of Malaria during Pregnancy 21 Essential Elements of a Birth Plan Facility or Place of Birth: Home or health facility for birth, appropriate facility for emergencies Skilled Provider: To attend birth Provider/Facility Contact Information Transportation: Reliable, accessible, especially for odd hours Funds: Personal savings, emergency funds Decision-Making: Who will make decisions, especially in an emergency Prevention and Control of Malaria during Pregnancy 22 Essential Elements of a Birth Plan (cont’d.) Family and Community Support: Care for family in woman’s absence and birth companion during labor Blood Donor: In case of emergency Needed Items: For clean and safe birth and for newborn care Danger Signs/Signs of Advanced Labor Prevention and Control of Malaria during Pregnancy 23 Danger Signs of Pregnancy Vaginal bleeding Difficulty breathing Fever Severe abdominal pain Severe headache/blurred vision Convulsions/loss of consciousness Labor pains before 37 weeks Prevention and Control of Malaria during Pregnancy 24 Health Education: Objectives Inform and educate the woman with health messages and counseling appropriate to: Individual needs, concerns, circumstances Gestational age Most prevalent health issues Support the woman in making decisions and solving actual or anticipated problems Involve partner and family in supporting/adopting healthy practices Prevention and Control of Malaria during Pregnancy 25 Health Education: Topics Addressed Prevention of malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Other methods Other important issues to be discussed include: Nutrition Care for common discomforts Use of potentially harmful substances Hygiene Rest and activity Prevention and Control of Malaria during Pregnancy 26 Health Education: Topics Addressed (cont’d.) Sexual relations and safer sex Early and exclusive breastfeeding Prevention of tetanus and anemia Voluntary counseling and testing for HIV Prevention of other endemic diseases/deficiencies Prevention and Control of Malaria during Pregnancy 27 Interpersonal Skills Speak in a quiet, gentle tone of voice Listen to woman/family and respond appropriately Encourage them to ask questions and express concerns Allow them to demonstrate understanding of information provided Explain all procedures/actions and obtain permission before proceeding Show respect for cultural beliefs and social norms Be empathetic and nonjudgmental Avoid distractions while conducting the visit Prevention and Control of Malaria during Pregnancy 28 Record Keeping First ANC Visit History Physical examination Testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs Date of next ANC visit Subsequent ANC Visits Interim history Targeted physical examination, testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs (and relevant information on how client obtained and used ITN) Date of next ANC visit Record all information on the ANC chart and clinic card: Prevention and Control of Malaria during Pregnancy Chapter II: Malaria Transmission Prevention and Control of Malaria during Pregnancy 30 Malaria Transmission: Chapter Objectives Define malaria and how it is transmitted Describe extent of malaria in Africa Identify groups at highest risk of malaria infection List effects of malaria on pregnant women and their unborn babies Describe effects of malaria on pregnant women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 31 Malaria Transmission Caused by Plasmodium parasites Spread by female Anopheles mosquitoes infected with parasites Anopheles mosquitoes usually active at night Infected mosquito bites a person Malaria parasites reproduce in human blood Mosquito bites infected person, and goes on to bite and infect another person Prevention and Control of Malaria during Pregnancy 32 Populations Most Affected by Malaria Children under 5 years of age Pregnant women Unborn babies Immigrants from low-transmission areas HIV-infected persons Prevention and Control of Malaria during Pregnancy 33 Effects of Malaria on Pregnant Women All pregnant women in malaria-endemic areas are at risk Parasites attack and destroy red blood cells Malaria causes up to 15% of anemia in pregnancy Can cause severe anemia In Africa, anemia due to malaria causes up to 10,000 maternal deaths per year Prevention and Control of Malaria during Pregnancy 34 Effects on Unborn Babies Parasites hide in placenta Interferes with transfer of oxygen and nutrients to the baby, increasing risk of: Spontaneous abortion Preterm birth Low birthweight—single greatest risk factor for death during first month of life Stillbirth Prevention and Control of Malaria during Pregnancy 35 Effects on Communities Causes missed work and wages Results in frequent school absences Uses scarce resources Causes preventable deaths: increases maternal, newborn, and infant mortality rates Prevention and Control of Malaria during Pregnancy 36 HIV/AIDS and Malaria during Pregnancy HIV/AIDS reduces a woman’s resistance to malaria Intermittent preventive treatment (IPT) given 3 times during pregnancy is effective for women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 37 Summary of Health Education Points Malaria transmitted through mosquito bites Pregnant women and children are most at risk Pregnant women infected with malaria may have no symptoms Women with HIV/AIDS are at higher risk Malaria can lead to severe anemia, spontaneous abortion, low-birthweight babies Malaria is preventable Prevention and Control of Malaria during Pregnancy Chapter III: Preventing Malaria Prevention and Control of Malaria during Pregnancy 39 Preventing Malaria: Chapter Objectives List the elements of counseling women about the use of insecticide-treated nets (ITNs) and intermittent preventive treatment (IPT) during pregnancy Describe the use of sulfadoxine-pyrimethamine (SP) for IPT during pregnancy Prevention and Control of Malaria during Pregnancy 40 Insecticide-Treated Nets Kill or repel mosquitoes Prevent physical contact with mosquitoes Kill or repel other insects: Lice Ticks Bedbugs Cockroaches Prevention and Control of Malaria during Pregnancy 41 Insecticide-Treated Nets (cont’d.) Untreated Nets Provide some protection against malaria Do not kill or repel mosquitoes that touch net Do not reduce number of mosquitoes Do not kill other insects like lice, roaches, and bedbugs Are safe for pregnant women, young children, and infants Insecticide-Treated Nets Provide a high level of protection against malaria Kills or repels mosquitoes that touch the net Reduce number of mosquitoes in/outside net Kills other insects such as lice, roaches, and bedbugs Are safe for pregnant women, young children, and infants Prevention and Control of Malaria during Pregnancy 42 Benefits of Insecticide-Treated Nets Prevent mosquito bites Protect against malaria, resulting in less: Anemia Prematurity and low birthweight Risk of maternal and newborn death Help people sleep better Promote growth and development of fetus and newborn Prevention and Control of Malaria during Pregnancy 43 Benefits of Insecticide-Treated Nets: Community Cost less than treating malaria Reduce number of sick children and adults (helping children grow to be healthy and helping working adults remain productive) Reduce number of deaths Prevention and Control of Malaria during Pregnancy 44 Where to Find Insecticide-Treated Nets General merchandise shops Drug shops/pharmacies Markets Public and private health facilities Community health workers NGOs, community-based organizations Prevention and Control of Malaria during Pregnancy 45 How to Use Insecticide-Treated Nets Hang above bed or sleeping mat Tuck under mattress or mat Use every night, all year long Use for everyone, if possible, but give priority to pregnant women, infants, and children Prevention and Control of Malaria during Pregnancy 46 Caring for Insecticide-Treated Nets Handle gently to avoid tears Tie net up during day to avoid damage Regularly inspect for holes, repair if found Nets need to be re-treated regularly to stay effective Keep away from smoke, fire, direct sunlight Prevention and Control of Malaria during Pregnancy 47 Intermittent Preventive Treatment Based on the assumption that every pregnant woman living in an area of high malaria transmission has malaria parasites in her blood or placenta, whether or not she has symptoms of malaria Prevention and Control of Malaria during Pregnancy 48 Intermittent Preventive Treatment Although a pregnant woman with malaria may have no symptoms, malaria can still affect her and her unborn child Prevention and Control of Malaria during Pregnancy 49 Intermittent Preventive Treatment: WHO Recommendation All pregnant women should receive at least two doses of IPT after quickening, during routinely scheduled ANC visits (WHO recommends a schedule of four visits, three after quickening) Presently, the most effective drug for IPT is sulfadoxine-pyrimethamine (SP) Women should receive at least two doses of IPT with SP at ANC visits after quickening, but no more frequently than monthly Prevention and Control of Malaria during Pregnancy 50 Intermittent Preventive Treatment: Dose and Timing A single dose is three tablets of sulfadoxine 500 mg + pyrimethamine 25 mg Healthcare provider should dispense dose and directly observe client taking dose Prevention and Control of Malaria during Pregnancy 51 Instructions for Giving Intermittent Preventive Treatment Ensure woman is at least 16 weeks pregnant and that quickening has occurred Inquire about use of SP in last 4 weeks Inquire about allergies to SP or other sulfa drugs (especially severe rashes) Explain what you will do; address the woman’s questions Provide cup and clean water Prevention and Control of Malaria during Pregnancy 52 Instructions for Giving Intermittent Preventive Treatment (cont’d.) Directly observe woman swallow three tablets of SP Record SP dose on ANC and clinic card Advise the woman when to return: For her next scheduled visit If she has signs of malaria If she has other danger signs Reinforce the importance of using ITNs Prevention and Control of Malaria during Pregnancy 53 Intermittent Preventive Treatment: Contraindications to Using SP Do NOT give during first trimester: Be sure quickening has occurred and woman is at least 16 weeks pregnant Do NOT give to women with reported allergy to SP or other sulfa drugs: Ask about sulfa drug allergies before giving SP Do NOT give to women taking co-trimoxazole, or other sulfa-containing drugs: Ask about use of these medicines before giving SP Do not give SP more frequently than monthly: Be sure at least 1 month has passed since the last dose of SP Prevention and Control of Malaria during Pregnancy 54 Chemoprophylaxis with Chloroquine: For Women Allergic to Sulfa Drugs* Dose Chloroquine 150 mg Timing 1 4 tablets First ANC visit after 16 weeks 2 4 tablets Second day after first dose 3 2 tablets Third day after first dose Weekly 2 tablets Every week during pregnancy *If chloroquine resistance rates in the country are high, chemoprophylaxis with chloroquine is not recommended. Prevention and Control of Malaria during Pregnancy 55 Summary of Health Education Points Pregnant women should sleep under ITNs every night By preventing malaria, IPT reduces the incidence of maternal anemia, spontaneous abortion, preterm birth, stillbirth, and low birthweight IPT should be administered to pregnant women at regularly scheduled ANC visits after quickening, but not more often than monthly Prevention and Control of Malaria during Pregnancy Chapter IV: Detection and Treatment Prevention and Control of Malaria during Pregnancy 57 Malaria Detection and Treatment: Chapter Objectives Identify causes of fever during pregnancy List the signs and symptoms of uncomplicated and complicated malaria Describe the treatment for uncomplicated malaria during pregnancy Explain the steps to appropriately refer a pregnant woman who has complicated malaria Prevention and Control of Malaria during Pregnancy 58 Detecting Malaria Symptoms Fever Chills Headaches Muscle/joint pains Lab exam of blood from a finger prick Prevention and Control of Malaria during Pregnancy 59 Fever during Pregnancy Temperature of 38° C or higher May be caused by malaria, but also by: Bladder or kidney infection Pneumonia Typhoid Uterine infection Careful history and physical required to rule out other causes Prevention and Control of Malaria during Pregnancy 60 Fever during Pregnancy (cont’d.) Ask about or examine for: Type, duration, degree of fever Signs of other infections: Chest pain/difficulty breathing Foul-smelling watery vaginal discharge Tender/painful uterus or abdomen Frequency/urgency/pain in urinating Signs of complicated malaria or other danger signs Prevention and Control of Malaria during Pregnancy 61 Types of Malaria Uncomplicated Most common Complicated Life threatening, can affect brain Pregnant women more likely to get complicated malaria than non-pregnant women Prevention and Control of Malaria during Pregnancy 62 Recognizing Malaria in Pregnant Women Uncomplicated Malaria Fever Shivering/chills/rigors Headaches Muscle/joint pains Nausea/vomiting False labor pains Complicated Malaria Signs of uncomplicated malaria PLUS one or more of the following: Dizziness Breathlessness/difficulty breathing Sleepy/drowsy Confusion/coma Sometimes fits, jaundice, severe dehydration Prevention and Control of Malaria during Pregnancy 63 Recognizing Malaria in Pregnant Women (cont’d.) Refer the woman immediately if you suspect anything other than uncomplicated malaria Prevention and Control of Malaria during Pregnancy 64 Case Management Determine whether malaria is uncomplicated or complicated Uncomplicated: Manage according to national protocol Complicated: Refer immediately to higher level of care; consider giving first dose of anti-malarial if available and healthcare provider is familiar with its use Prevention and Control of Malaria during Pregnancy 65 Case Management: Drugs First-line drug therapy is indicated for uncomplicated malaria Second-line drug therapy is indicated for uncomplicated malaria that has failed to respond to first-line drug In almost all countries, quinine is the drug of choice for complicated malaria Prevention and Control of Malaria during Pregnancy 66 Managing Uncomplicated Malaria Provide first-line anti-malarial drugs Follow country guidelines Manage fever Analgesics, tepid sponging Diagnose and treat anemia Provide fluids Prevention and Control of Malaria during Pregnancy 67 Treating Uncomplicated Malaria Observe client taking anti-malarial drugs Advise client to: Complete course of drugs Return if no improvement in 48 hours Consume iron-rich foods Use ITNs and other preventive measures Prevention and Control of Malaria during Pregnancy 68 SP: Contraindications Before 16 weeks of pregnancy SP dose in last 4 weeks Allergies to sulfa drugs (e.g., co-trimoxazole) Currently taking other sulfa drugs Substitute other drug before giving SP Prevention and Control of Malaria during Pregnancy 69 Treatment Problems Vomiting within 30 minutes Repeat dose of SP Itching Warm or cool baths Use lotions/skin creams Give Piriton™ or Phenergan® Stomach upset/irritation Take chloroquine with food or sugar Reduce intake of caffeine and greasy foods Prevention and Control of Malaria during Pregnancy 70 Treatment Followup Arrange followup within 48 hours Advise to return if condition worsens Review danger signs Reinforce use of ITNs Prevention and Control of Malaria during Pregnancy 71 Second-Line Drug Most clients will respond to malaria treatment and begin to feel better within 48 hours However, if the client’s condition does not improve or worsens, give second-line treatment for uncomplicated malaria Prevention and Control of Malaria during Pregnancy 72 Second-Line Drug (cont’d.) If the woman’s condition does not improve or worsens within 48 hours of starting treatment with a second-line drug, and/or other symptoms appear, REFER IMMEDIATELY If signs of complicated malaria are present, REFER IMMEDIATELY Prevention and Control of Malaria during Pregnancy 73 Referral Preparation Explain situation to the client/family Help arrange transport to other facility if possible Write referral note Treat any urgent conditions and stabilize Prevention and Control of Malaria during Pregnancy 74 Referral Note Brief history of client’s condition Details of any treatment provided Reason for referral Significant findings from history, physical exam, or lab Any important details of current pregnancy Copy of client’s ANC record, if possible Referring provider contact information
Slide 75 - Prevention and Control of Malaria during Pregnancy A Workshop for Healthcare Providers Prevention and Control of Malaria during Pregnancy 2 Facts about Malaria 300 million cases each year worldwide 9 of 10 cases occur in Africa A person in Africa dies of malaria every 10 seconds Women and young children are most at risk Affects five times as many people as AIDS, leprosy, measles, and tuberculosis combined Prevention and Control of Malaria during Pregnancy 3 Facts about Malaria and Pregnancy 30 million African women are pregnant yearly Malaria is more frequent and complicated during pregnancy In malaria-endemic areas, malaria during pregnancy may account for: Up to 15% of maternal anemia 5–14% of low birthweight 30% of “preventable” low birthweight Prevention and Control of Malaria during Pregnancy 4 Roll Back Malaria Worldwide partnership Governments, private groups, research organizations, civil society, media Aim to reduce malaria by half by 2010 Free advocacy resources and tools: http://www.rbm.who.int Priority: Prevent poor outcomes caused by malaria in pregnancy Abuja declaration: Goal is for 60% of women in Africa to be sleeping under insecticide-treated nets (ITNs) and getting intermittent preventive treatment (IPT) by 2005 Prevention and Control of Malaria during Pregnancy 5 Malaria Prevention and Treatment during Pregnancy Focused antenatal care (ANC) with health education about malaria Use of insecticide-treated nets (ITNs) Intermittent preventive treatment (IPT) Case management of women with symptoms and signs of malaria Prevention and Control of Malaria during Pregnancy Chapter I: Focused Antenatal Care Prevention and Control of Malaria during Pregnancy 7 Focused Antenatal Care: Chapter Objectives Describe four main components of focused antenatal care (ANC) Discuss frequency and timing of ANC visits Describe essential elements of a birth plan that includes complication readiness Describe interpersonal skills for effective ANC Describe components of record keeping for ANC Prevention and Control of Malaria during Pregnancy 8 Focused Antenatal Care An approach to ANC that emphasizes: Evidence-based, goal-directed actions Individualized, woman-centered care Quality vs. quantity of visits Care by skilled providers Prevention and Control of Malaria during Pregnancy 9 Goal of Focused Antenatal Care To promote maternal and newborn health and survival through: Early detection and treatment of problems and complications Prevention of complications and disease Birth preparedness and complication readiness Health promotion Prevention and Control of Malaria during Pregnancy 10 Traditional Antenatal Care Emphasizes: Ritualistic, “routine” care vs. evidence-based, goal-directed actions Frequent visits Does not emphasize individual client needs Prevention and Control of Malaria during Pregnancy 11 No Longer Recommended Numerous, routine visits Burden to women and healthcare system Routine measurements and examinations: Maternal height and weight Ankle edema Fetal position before 36 weeks Care based on risk assessment Prevention and Control of Malaria during Pregnancy 12 Risk Approach Not an effective ANC strategy because: Complications cannot be predicted—all pregnant women are at risk for developing complications Risk factors are usually not direct cause of complications Many “low risk” women develop complications Have false sense of security Do not know how to recognize/respond to problems Most “high risk” women give birth without complications Inefficient use of scarce resources Prevention and Control of Malaria during Pregnancy 13 Focused Antenatal Care Services Evidence-based, goal-directed actions: Address most prevalent health issues affecting women and newborns Adjusted for specific populations/regions Appropriate to gestational age Based on firm rationale Prevention and Control of Malaria during Pregnancy 14 Focused Antenatal Care Services (cont’d.) Individualized, woman-centered care based on each woman’s: Specific needs and concerns Circumstances History, physical examination, testing Available resources Prevention and Control of Malaria during Pregnancy 15 Focused Antenatal Care Services (cont’d.) Quality vs. quantity of ANC visits: WHO multi-center study Number of visits reduced without affecting outcome for mother or baby Recommendations Content and quality vs. number of visits Goal-oriented care Minimum of four visits Prevention and Control of Malaria during Pregnancy 16 First visit: By 16 weeks or when woman first thinks she is pregnant Second visit: At 24–28 weeks or at least once in second trimester Third visit: At 32 weeks Fourth visit: At 36 weeks Other visits: If complication occurs, followup or referral is needed, woman wants to see provider, or provider changes frequency based on findings (history, exam, testing) or local policy Scheduling and Timing of ANC Visits Prevention and Control of Malaria during Pregnancy 17 Focused Antenatal Care Services (cont’d.) Care by a skilled provider who: Has formal training and experience Has knowledge, skills, and qualifications to deliver safe, effective maternal and newborn healthcare Practices in home, hospital, health center May be a midwife, nurse, doctor, clinical officer, etc. Prevention and Control of Malaria during Pregnancy 18 Early Detection and Treatment Malaria—history and physical exam Fever and accompanying signs/symptoms Region Complicated vs. uncomplicated cases Severe anemia—physical exam, testing Pre-eclampsia/eclampsia—measurement of blood pressure HIV—voluntary counseling and testing Sexually transmitted infections, including syphilis— testing Prevention and Control of Malaria during Pregnancy 19 Prevention: Key Preventive Measures Malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Tetanus toxoid, iron/folate supplements Country/region-specific interventions as appropriate Vitamin A supplements Iodine supplements Presumptive treatment for hookworm Prevention and Control of Malaria during Pregnancy 20 Birth Preparedness and Complication Readiness: Objectives Develop birth plan—exact plan for normal birth and possible complications: Arrangements made in advance by woman and family (with help of skilled provider) Usually not a written document Reviewed/revised at every visit Minimize disorganization at time of birth or in an emergency Ensure timely and appropriate care Prevention and Control of Malaria during Pregnancy 21 Essential Elements of a Birth Plan Facility or Place of Birth: Home or health facility for birth, appropriate facility for emergencies Skilled Provider: To attend birth Provider/Facility Contact Information Transportation: Reliable, accessible, especially for odd hours Funds: Personal savings, emergency funds Decision-Making: Who will make decisions, especially in an emergency Prevention and Control of Malaria during Pregnancy 22 Essential Elements of a Birth Plan (cont’d.) Family and Community Support: Care for family in woman’s absence and birth companion during labor Blood Donor: In case of emergency Needed Items: For clean and safe birth and for newborn care Danger Signs/Signs of Advanced Labor Prevention and Control of Malaria during Pregnancy 23 Danger Signs of Pregnancy Vaginal bleeding Difficulty breathing Fever Severe abdominal pain Severe headache/blurred vision Convulsions/loss of consciousness Labor pains before 37 weeks Prevention and Control of Malaria during Pregnancy 24 Health Education: Objectives Inform and educate the woman with health messages and counseling appropriate to: Individual needs, concerns, circumstances Gestational age Most prevalent health issues Support the woman in making decisions and solving actual or anticipated problems Involve partner and family in supporting/adopting healthy practices Prevention and Control of Malaria during Pregnancy 25 Health Education: Topics Addressed Prevention of malaria: Intermittent preventive treatment (IPT) Use of insecticide-treated nets (ITNs) Other methods Other important issues to be discussed include: Nutrition Care for common discomforts Use of potentially harmful substances Hygiene Rest and activity Prevention and Control of Malaria during Pregnancy 26 Health Education: Topics Addressed (cont’d.) Sexual relations and safer sex Early and exclusive breastfeeding Prevention of tetanus and anemia Voluntary counseling and testing for HIV Prevention of other endemic diseases/deficiencies Prevention and Control of Malaria during Pregnancy 27 Interpersonal Skills Speak in a quiet, gentle tone of voice Listen to woman/family and respond appropriately Encourage them to ask questions and express concerns Allow them to demonstrate understanding of information provided Explain all procedures/actions and obtain permission before proceeding Show respect for cultural beliefs and social norms Be empathetic and nonjudgmental Avoid distractions while conducting the visit Prevention and Control of Malaria during Pregnancy 28 Record Keeping First ANC Visit History Physical examination Testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs Date of next ANC visit Subsequent ANC Visits Interim history Targeted physical examination, testing Care provision, including provision of IPT for malaria, if appropriate Counseling, including birth plan and use of ITNs (and relevant information on how client obtained and used ITN) Date of next ANC visit Record all information on the ANC chart and clinic card: Prevention and Control of Malaria during Pregnancy Chapter II: Malaria Transmission Prevention and Control of Malaria during Pregnancy 30 Malaria Transmission: Chapter Objectives Define malaria and how it is transmitted Describe extent of malaria in Africa Identify groups at highest risk of malaria infection List effects of malaria on pregnant women and their unborn babies Describe effects of malaria on pregnant women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 31 Malaria Transmission Caused by Plasmodium parasites Spread by female Anopheles mosquitoes infected with parasites Anopheles mosquitoes usually active at night Infected mosquito bites a person Malaria parasites reproduce in human blood Mosquito bites infected person, and goes on to bite and infect another person Prevention and Control of Malaria during Pregnancy 32 Populations Most Affected by Malaria Children under 5 years of age Pregnant women Unborn babies Immigrants from low-transmission areas HIV-infected persons Prevention and Control of Malaria during Pregnancy 33 Effects of Malaria on Pregnant Women All pregnant women in malaria-endemic areas are at risk Parasites attack and destroy red blood cells Malaria causes up to 15% of anemia in pregnancy Can cause severe anemia In Africa, anemia due to malaria causes up to 10,000 maternal deaths per year Prevention and Control of Malaria during Pregnancy 34 Effects on Unborn Babies Parasites hide in placenta Interferes with transfer of oxygen and nutrients to the baby, increasing risk of: Spontaneous abortion Preterm birth Low birthweight—single greatest risk factor for death during first month of life Stillbirth Prevention and Control of Malaria during Pregnancy 35 Effects on Communities Causes missed work and wages Results in frequent school absences Uses scarce resources Causes preventable deaths: increases maternal, newborn, and infant mortality rates Prevention and Control of Malaria during Pregnancy 36 HIV/AIDS and Malaria during Pregnancy HIV/AIDS reduces a woman’s resistance to malaria Intermittent preventive treatment (IPT) given 3 times during pregnancy is effective for women with HIV/AIDS Prevention and Control of Malaria during Pregnancy 37 Summary of Health Education Points Malaria transmitted through mosquito bites Pregnant women and children are most at risk Pregnant women infected with malaria may have no symptoms Women with HIV/AIDS are at higher risk Malaria can lead to severe anemia, spontaneous abortion, low-birthweight babies Malaria is preventable Prevention and Control of Malaria during Pregnancy Chapter III: Preventing Malaria Prevention and Control of Malaria during Pregnancy 39 Preventing Malaria: Chapter Objectives List the elements of counseling women about the use of insecticide-treated nets (ITNs) and intermittent preventive treatment (IPT) during pregnancy Describe the use of sulfadoxine-pyrimethamine (SP) for IPT during pregnancy Prevention and Control of Malaria during Pregnancy 40 Insecticide-Treated Nets Kill or repel mosquitoes Prevent physical contact with mosquitoes Kill or repel other insects: Lice Ticks Bedbugs Cockroaches Prevention and Control of Malaria during Pregnancy 41 Insecticide-Treated Nets (cont’d.) Untreated Nets Provide some protection against malaria Do not kill or repel mosquitoes that touch net Do not reduce number of mosquitoes Do not kill other insects like lice, roaches, and bedbugs Are safe for pregnant women, young children, and infants Insecticide-Treated Nets Provide a high level of protection against malaria Kills or repels mosquitoes that touch the net Reduce number of mosquitoes in/outside net Kills other insects such as lice, roaches, and bedbugs Are safe for pregnant women, young children, and infants Prevention and Control of Malaria during Pregnancy 42 Benefits of Insecticide-Treated Nets Prevent mosquito bites Protect against malaria, resulting in less: Anemia Prematurity and low birthweight Risk of maternal and newborn death Help people sleep better Promote growth and development of fetus and newborn Prevention and Control of Malaria during Pregnancy 43 Benefits of Insecticide-Treated Nets: Community Cost less than treating malaria Reduce number of sick children and adults (helping children grow to be healthy and helping working adults remain productive) Reduce number of deaths Prevention and Control of Malaria during Pregnancy 44 Where to Find Insecticide-Treated Nets General merchandise shops Drug shops/pharmacies Markets Public and private health facilities Community health workers NGOs, community-based organizations Prevention and Control of Malaria during Pregnancy 45 How to Use Insecticide-Treated Nets Hang above bed or sleeping mat Tuck under mattress or mat Use every night, all year long Use for everyone, if possible, but give priority to pregnant women, infants, and children Prevention and Control of Malaria during Pregnancy 46 Caring for Insecticide-Treated Nets Handle gently to avoid tears Tie net up during day to avoid damage Regularly inspect for holes, repair if found Nets need to be re-treated regularly to stay effective Keep away from smoke, fire, direct sunlight Prevention and Control of Malaria during Pregnancy 47 Intermittent Preventive Treatment Based on the assumption that every pregnant woman living in an area of high malaria transmission has malaria parasites in her blood or placenta, whether or not she has symptoms of malaria Prevention and Control of Malaria during Pregnancy 48 Intermittent Preventive Treatment Although a pregnant woman with malaria may have no symptoms, malaria can still affect her and her unborn child Prevention and Control of Malaria during Pregnancy 49 Intermittent Preventive Treatment: WHO Recommendation All pregnant women should receive at least two doses of IPT after quickening, during routinely scheduled ANC visits (WHO recommends a schedule of four visits, three after quickening) Presently, the most effective drug for IPT is sulfadoxine-pyrimethamine (SP) Women should receive at least two doses of IPT with SP at ANC visits after quickening, but no more frequently than monthly Prevention and Control of Malaria during Pregnancy 50 Intermittent Preventive Treatment: Dose and Timing A single dose is three tablets of sulfadoxine 500 mg + pyrimethamine 25 mg Healthcare provider should dispense dose and directly observe client taking dose Prevention and Control of Malaria during Pregnancy 51 Instructions for Giving Intermittent Preventive Treatment Ensure woman is at least 16 weeks pregnant and that quickening has occurred Inquire about use of SP in last 4 weeks Inquire about allergies to SP or other sulfa drugs (especially severe rashes) Explain what you will do; address the woman’s questions Provide cup and clean water Prevention and Control of Malaria during Pregnancy 52 Instructions for Giving Intermittent Preventive Treatment (cont’d.) Directly observe woman swallow three tablets of SP Record SP dose on ANC and clinic card Advise the woman when to return: For her next scheduled visit If she has signs of malaria If she has other danger signs Reinforce the importance of using ITNs Prevention and Control of Malaria during Pregnancy 53 Intermittent Preventive Treatment: Contraindications to Using SP Do NOT give during first trimester: Be sure quickening has occurred and woman is at least 16 weeks pregnant Do NOT give to women with reported allergy to SP or other sulfa drugs: Ask about sulfa drug allergies before giving SP Do NOT give to women taking co-trimoxazole, or other sulfa-containing drugs: Ask about use of these medicines before giving SP Do not give SP more frequently than monthly: Be sure at least 1 month has passed since the last dose of SP Prevention and Control of Malaria during Pregnancy 54 Chemoprophylaxis with Chloroquine: For Women Allergic to Sulfa Drugs* Dose Chloroquine 150 mg Timing 1 4 tablets First ANC visit after 16 weeks 2 4 tablets Second day after first dose 3 2 tablets Third day after first dose Weekly 2 tablets Every week during pregnancy *If chloroquine resistance rates in the country are high, chemoprophylaxis with chloroquine is not recommended. Prevention and Control of Malaria during Pregnancy 55 Summary of Health Education Points Pregnant women should sleep under ITNs every night By preventing malaria, IPT reduces the incidence of maternal anemia, spontaneous abortion, preterm birth, stillbirth, and low birthweight IPT should be administered to pregnant women at regularly scheduled ANC visits after quickening, but not more often than monthly Prevention and Control of Malaria during Pregnancy Chapter IV: Detection and Treatment Prevention and Control of Malaria during Pregnancy 57 Malaria Detection and Treatment: Chapter Objectives Identify causes of fever during pregnancy List the signs and symptoms of uncomplicated and complicated malaria Describe the treatment for uncomplicated malaria during pregnancy Explain the steps to appropriately refer a pregnant woman who has complicated malaria Prevention and Control of Malaria during Pregnancy 58 Detecting Malaria Symptoms Fever Chills Headaches Muscle/joint pains Lab exam of blood from a finger prick Prevention and Control of Malaria during Pregnancy 59 Fever during Pregnancy Temperature of 38° C or higher May be caused by malaria, but also by: Bladder or kidney infection Pneumonia Typhoid Uterine infection Careful history and physical required to rule out other causes Prevention and Control of Malaria during Pregnancy 60 Fever during Pregnancy (cont’d.) Ask about or examine for: Type, duration, degree of fever Signs of other infections: Chest pain/difficulty breathing Foul-smelling watery vaginal discharge Tender/painful uterus or abdomen Frequency/urgency/pain in urinating Signs of complicated malaria or other danger signs Prevention and Control of Malaria during Pregnancy 61 Types of Malaria Uncomplicated Most common Complicated Life threatening, can affect brain Pregnant women more likely to get complicated malaria than non-pregnant women Prevention and Control of Malaria during Pregnancy 62 Recognizing Malaria in Pregnant Women Uncomplicated Malaria Fever Shivering/chills/rigors Headaches Muscle/joint pains Nausea/vomiting False labor pains Complicated Malaria Signs of uncomplicated malaria PLUS one or more of the following: Dizziness Breathlessness/difficulty breathing Sleepy/drowsy Confusion/coma Sometimes fits, jaundice, severe dehydration Prevention and Control of Malaria during Pregnancy 63 Recognizing Malaria in Pregnant Women (cont’d.) Refer the woman immediately if you suspect anything other than uncomplicated malaria Prevention and Control of Malaria during Pregnancy 64 Case Management Determine whether malaria is uncomplicated or complicated Uncomplicated: Manage according to national protocol Complicated: Refer immediately to higher level of care; consider giving first dose of anti-malarial if available and healthcare provider is familiar with its use Prevention and Control of Malaria during Pregnancy 65 Case Management: Drugs First-line drug therapy is indicated for uncomplicated malaria Second-line drug therapy is indicated for uncomplicated malaria that has failed to respond to first-line drug In almost all countries, quinine is the drug of choice for complicated malaria Prevention and Control of Malaria during Pregnancy 66 Managing Uncomplicated Malaria Provide first-line anti-malarial drugs Follow country guidelines Manage fever Analgesics, tepid sponging Diagnose and treat anemia Provide fluids Prevention and Control of Malaria during Pregnancy 67 Treating Uncomplicated Malaria Observe client taking anti-malarial drugs Advise client to: Complete course of drugs Return if no improvement in 48 hours Consume iron-rich foods Use ITNs and other preventive measures Prevention and Control of Malaria during Pregnancy 68 SP: Contraindications Before 16 weeks of pregnancy SP dose in last 4 weeks Allergies to sulfa drugs (e.g., co-trimoxazole) Currently taking other sulfa drugs Substitute other drug before giving SP Prevention and Control of Malaria during Pregnancy 69 Treatment Problems Vomiting within 30 minutes Repeat dose of SP Itching Warm or cool baths Use lotions/skin creams Give Piriton™ or Phenergan® Stomach upset/irritation Take chloroquine with food or sugar Reduce intake of caffeine and greasy foods Prevention and Control of Malaria during Pregnancy 70 Treatment Followup Arrange followup within 48 hours Advise to return if condition worsens Review danger signs Reinforce use of ITNs Prevention and Control of Malaria during Pregnancy 71 Second-Line Drug Most clients will respond to malaria treatment and begin to feel better within 48 hours However, if the client’s condition does not improve or worsens, give second-line treatment for uncomplicated malaria Prevention and Control of Malaria during Pregnancy 72 Second-Line Drug (cont’d.) If the woman’s condition does not improve or worsens within 48 hours of starting treatment with a second-line drug, and/or other symptoms appear, REFER IMMEDIATELY If signs of complicated malaria are present, REFER IMMEDIATELY Prevention and Control of Malaria during Pregnancy 73 Referral Preparation Explain situation to the client/family Help arrange transport to other facility if possible Write referral note Treat any urgent conditions and stabilize Prevention and Control of Malaria during Pregnancy 74 Referral Note Brief history of client’s condition Details of any treatment provided Reason for referral Significant findings from history, physical exam, or lab Any important details of current pregnancy Copy of client’s ANC record, if possible Referring provider contact information Prevention and Control of Malaria during Pregnancy 75 Summary of Health Education Points Uncomplicated malaria can be easily treated if recognized early, but it is very important to finish the course of treatment to be effective Because complicated malaria requires specialized management, women with complicated malaria should be referred immediately to avoid complications and death