It was a sunny morning at Chipuputa in Mtwara region – a quiet street tucked in South-eastern Tanzania. Almost all the house fronts were filled with trees. Soon as I arrived at the street I saw children in a jolly mood playing outside their houses.
As I stood outside one of the many small houses, Asha Wemba, 37, a mother of five children appeared. She embraced a broad smile while holding her one month old baby boy. She was covered in a blue khanga and her baby in blue clothes and a red baby blanket to protect him from the cold.
Her smile hides the ordeal she went through during her last pregnancy. Asha only visited a health facility in third trimester. Feeling headache and fatigue prompted her to visit Ufukoni dispensary, where she was diagnosed with Malaria but alas she was already eight months pregnant.
She says, upon her arrival at the hospital she was educated on the importance of pregnant women making prompt visits to the hospital soon after finding out they are pregnant. She realised how late it was for her and the health dangers she was most likely to face if the malaria was not treated.
“I will educate other women around me on the importance of going to the hospital soon as they know they are pregnant. I am happy the information I received from the hospital helped me understand why it’s important to go to the clinic soon after a woman knows she is pregnant,” says Wemba.
Thanks to community health worker Esther Mpinyi, who benefited through training by USAID ‘Boresha Afya’ project, Wemba was educated on the importance of attending antenatal clinic.
According to statistics from Regional Medical Offices of Lindi and Mtwara, three years ago the two regions recorded not less than 60 per cent of pregnant women who used to get up to one to two doses of Intermittent preventive treatment in pregnancy (IPTp) . Cases which are similar to Wemba’s were many. Thanks to the USAID Boresha Afya program which has boosted the use of IPTp by over 80 per cent in the two regions respectively.
The program, which aims at addressing health service gaps among 43 Councils in Njombe, Iringa, Morogoro, Lindi, Mtwara and Ruvuma has reduced cases which are similar to Wemba’s as the community is well involved through community awareness programs.
Mtwara Regional Medical Officer, Dr Silvia Mamkwe, says malaria in pregnancy has been found to contribute to maternal deaths. She says early visits to an antenatal clinic enables women to get four doses of Intermittent Preventive Treatment in pregnancy, anti-malarial tablets.
Dr Mamkwe further says that early antenatal clinic visits allow women to get four doses of IPTp’s and prevent maternal and fatal anaemia, low birth weight and placental parasitaemia. Information available from Mtwara RMO shows that, funds from USAID Boresha Afya program has helped the region to conduct quarterly reports which shows out of 9,000 women who delivered in the last quarter, more than 700 women delivered either from home or on their way to the hospital.
As a way of educating the community on the importance of attending antenatal clinics at an early stage, Dr Faustine Rwebogora – the Mtwara Regional Malaria Adviser for USAID Boresha Afya project, says several efforts are being taken, including training health workers on how to handle pregnant women in connection to malaria.
Such efforts to cut down Malaria in pregnant women are wide-spread. The aim is to ensure that women are in the right health status throughout the pregnancy period. In Lindi, such efforts have resulted in a positive outcome as more than 80 per cent of pregnant women are using Sulfadoxine-Pyrimethamine (SP) tablets.
According to the Lindi Regional Medical Officer Dr John Sijaona, from training health workers on the right approach of giving the tablets, to raising awareness among the community on the importance of using the tablets for pregnant women, women are now getting at least to two to three doses of Sulfadoxine-Pyrimethamine (SP) after each trimester.
He says, the tablets are given to prevent pregnant women and their unborn babies against Malaria with the aim of reducing maternal deaths in the country.
“In the past five years, Boresha Afya program has helped Lindi to reduce Malaria prevalence from 17 per cent in 2016 to 12per cent this year,” says Sijaona
Adding to that, he said the program has empowered them [women] to start a programme that shows medication availability in all 247 health centres in Lindi. As a result the health centres never run out of medical stock and women can easily access both medication and treated bed nets.
Dr Living Colman, a gynaecologist based in Dar es Salaam, says pregnant women should be given malaria medication after each trimester to prevent them contracting malaria. He further says women are given the medication at the hospital as a way of monitoring usage.
Lindi Coordinator for Mother and Child Health Care, Zainab Mathradas, says despite facing social barriers when giving pregnant women services, they have managed to involve the entire community on the importance of using SP through outreach programs that happen once a month and pregnant women who cannot reach health facilities are also covered.
“Lack of skilled health personnel in the regions was also a challenge, but the program has helped train health workers on the right ways to deal with a pregnant woman as well as documenting everything after administering the medication,” says Mathradas.
The doctor acknowledged the role played by men in the fight against malaria, advising more involvement from them.
The program is implemented by Deloitte Consulting Limited in various regions: Iringa, Njombe, Morogoro, Lindi, Mtwara and Ruvuma.
On visiting the Lindi Town Health Center, I met Mwanaisha Ally, 39, a mother of four children. She is holding her two-month baby as she waits for a routine check-up. She is among other women who have benefited from the awareness programs on the importance of using IPTp.
“I managed to get four doses of SP when I was pregnant. I am happy that I never got malarial or any other disease during my pregnancy. I advise other women to visit antenatal clinics soon as they know they are pregnant,” says Mwanaisha.
Adding to that she says, through information from health and community workers women are now accessing information through village and street meetings on the importance of using the IPTp. The information reaches the community through community gatherings and door to door visits.
Software to track medication availability at the health centres, training CWH
Bosco Chilongola, a Malaria Coordinator in Lindi Municipal, says three years prior to the commencement of the project, they had no access to far-flung villages, making it impossible for some women to make it to the health centres, as a result they missed the IPTp.
Currently the program has helped them to deliver IPTp in areas which are more than 20 kilometres from the centre through outreach programs. In addition, there is a software that tracks the amount of medication in stock. This helps them know when exactly to take another batch of medication, for how many women and vaccination for children.
“Some areas like Mnali, Ng’apa etc, are not easily accessible. Outreach programs have helped us to meet women and children from these areas. If there is new registration of pregnant women we always get informed before we go there to disperse medication,” says Cholongola.
Commenting on the software, Taiwan Seleman the Regional Health Secretary says apart from training health workers they have introduced a software which allows all medical centres to see how much medication is in stock and it helps them know when it’s the right time for them to supply other medication.
He says, each health centre has been provided with an iPad for them to upload data on medication availability. The information fed on the iPad is very useful in providing insight on where there is shortage and where there is adequate stock.
Dr Godlove Mkumbo, the Project adviser for malaria in Lindi, commenting on the CHWs, says the project has benefited about 260 CHWs in the region by building capacity to health workers to enable them to spread positive information to the citizens on the accessibility of health services.
The survey by the National Bureau of Statistics (NBS) indicates that malaria prevalence rate dropped from 14.4 per cent in 2015 to 7.3 per cent in 2017. According to information from World Health Organization (WHO), Malaria infection during pregnancy is a significant public health problem with substantial risks for the pregnant woman, her fetus, and the newborn child. Malaria-associated maternal illness and low birth weight is mostly the result of Plasmodium falciparum infection and occurs predominantly in Africa.
The symptoms and complications of malaria in pregnancy vary according to malaria transmission intensity in the given geographical area, and the individual’s level of acquired immunity.