Malaria and children: Progress in intervention coverage - Unicef

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Recent successful
malaria interventions
in sub- Saharan Africa
Malawi strengthens
malaria control, including
coverage of intermittent
preventive treatment
for pregnant women
In 2003 the Government of
Malawi initiated one of the largest
insecticide-treated net distribution
programmes in Africa,
targeting pregnant women and
children under age five. 1 Efforts to
expand insecticide-treated net use
have been tremendously successful,
increasing the number of children
sleeping under insecticide-treated
nets sevenfold between 2000 and
2006 (figure 1).
After the 2000 Malawi Demographic
and Health Survey revealed
unexpectedly low levels of coverage
of intermittent preventive
treatment for pregnant women, a
study determined that a key reason
was confusion among ante natal
clinic staff about the timing of the
administration of the two doses
Figure 1 Insecticide-treated net
use in Malawi is up
sevenfold since 2000
of sulfadoxine-pyrimethamine,
which led to lower prescribing rates.
Guidelines were then simplified and
communicated to health staff, and
Malawi now has one of the highest
coverage rates of intermittent
preventive treatment for pregnant
women among malaria-endemic
countries (figure 2). 2
Togo’s dramatic success
in scaling up insecticidetreated
net use
Togo made history in December
2004 by conducting the first-ever
national insecticide-treated net
distribution campaign integrated
with other key child survival interventions
including deworming and
measles immunization. Around
900,000 insecticide-treated nets
were distributed free of charge
during the integrated child health
campaign. 3 As a result, Togo’s dramatic
gains in insecticide-treated
net use—including a nineteenfold
increase in share of children sleeping
under insecticide-treated nets,
from 2000 to 2006 (figure 3)—are
among the largest in sub- Saharan
Africa. Other countries, including
Angola, Democratic Republic of
Congo, Ghana, Kenya, Madagascar,
Rwanda, Sierra Leone, Uganda
and Zambia have also successfully
implemented large-scale insecticidetreated
net distributions integrated
with other child health campaigns.
Education and communication
were key elements of the Togo campaign.
Before the campaign Red
Cross volunteers conducted doorto-door
and community mobilization,
and after the campaign they
visited households to advise families
on the proper use of insecticidetreated
nets and to provide more
vaccinations and additional free
nets. An emphasis on behaviour
change communication is likely one
factor that led to the campaign’s
success.
Togo’s approach to distributing
nets free of charge to end-users
likely also contributed to the equitable
distribution of nets among
Figure 2 Progress in intermittent preventive treatment for
pregnant women in Malawi has been good since 2000
2000 3
2004
15
2006
23
0 10 20 30
Percentage of
children under
age five sleeping
under insecticidetreated
nets,
Malawi, 2000,
2004 and 2006
Source:
Malawi 2000
and 2004
Demographic and
Health Surveys
and 2006 Multiple
Indicator Cluster
Survey.
2000
29
2006
45
0 10 20 30 40 50
Percentage of pregnant women ages 15–49
receiving intermittent preventive treatment,
Malawi, 2000 and 2006
Note: Data on intermittent preventive
treatment from the 2000 Demographic
and Health Survey refer to treatment
with at least two doses of sulfadoxinepyrimethamine
or Fansidar but do not
specify that treatment was received
through antenatal care visits.
Source: Malawi 2000 Demographic and
Health Survey and 2006 Multiple Indicator
Cluster Survey.