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[Washington, D.C.], MCSP, 2018 Mar. 6 p.In 2016, the World Health Organization (WHO) published Recommendations on Antenatal Care for a Positive Pregnancy Experience (WHO 2016), which outlines a new set of evidence-based global guidelines on recommended content and scheduling for antenatal care (ANC). These recommendations are the first set of ANC guidelines created under WHO’s current approved process for development of clinical guidelines. This FAQ addresses commonly asked questions about the implementation of IPTp programs in the context of the 2016 ANC recommendations, as well as reminders about technical considerations for intermittent preventive treatment of malaria in pregnancy programs.
Baltimore, Maryland, Jhpiego, 2018. 92 p. (USAID Award No. HRN-A-00-98-00043-00; USAID Leader with Associates Cooperative Agreement No.GHS-A-00-04-00002-00)The Malaria in Pregnancy reference manual and clinical learning materials are intended for skilled providers who provide antenatal care, including midwives, nurses, clinical officers, and medical assistants. The clinical learning materials can be used to conduct a 2-day workshop designed to provide learners with the knowledge and skills needed to prevent, recognize, and treat malaria in pregnancy as they provide focused antenatal care services.
Geneva, Switzerland, WHO, 2017. 196 p.The World malaria report, published annually, provides a comprehensive update on global and regional malaria data and trends. The latest report, released on 29 November 2017, tracks investments in malaria programmes and research as well as progress across all intervention areas: prevention, diagnosis, treatment and surveillance. It also includes dedicated chapters on malaria elimination and on key threats in the fight against malaria. The report is based on information received from national malaria control programmes and other partners in endemic countries; most of the data presented is from 2016.
Implementing malaria in pregnancy programs in the context of World Health Organization recommendations on antenatal care for a positive pregnancy experience.
[Washington, D.C.], MCSP, 2017 Apr. 6 p.This technical brief highlights recommendations for the prevention and treatment of malaria in pregnancy (MiP) in the context of the World Health Organization (WHO) Recommendations on Antenatal Care for a Positive Pregnancy Experience, published in 2016. Also available in French and Portuguese.
The relative roles of ANC and EPI in the continuous distribution of LLINs: a qualitative study in four countries.
Health Policy and Planning. 2017 May 1; 32(4):467-475.Background: The continuous distribution of long-lasting insecticidal nets (LLINs) for malaria prevention, through the antenatal care (ANC) and the Expanded Programme on Immunizations (EPI), is recommended by the WHO to improve and maintain LLIN coverage. Despite these recommendations, little is known about the relative strengths and weaknesses of the ANC and EPI-based LLIN distribution. This study aimed to explore and compare the roles of the ANC and EPI for LLIN distribution in four African countries. Methods: In a qualitative evaluation of continuous distribution through the ANC and EPI, semi-structured, individual and group interviews were conducted in Kenya, Malawi, Mali, and Rwanda. Respondents included national, sub-national, and facility-level health staff, and were selected to capture a range of roles related to malaria, ANC and EPI programmes. Policies, guidelines, and data collection tools were reviewed as a means of triangulation to assess the structure of LLIN distribution, and the methods of data collection and reporting for malaria, ANC and EPI programmes. Results: In the four countries visited, distribution of LLINs was more effectively integrated through ANC than through EPI because of a) stronger linkages and involvement between malaria and reproductive health programmes, as compared to malaria and EPI, and b) more complete programme monitoring for ANC-based distribution, compared to EPI-based distribution. Conclusions: Opportunities for improving the distribution of LLINs through these channels exist, especially in the case of EPI. For both ANC and EPI, integrated distribution of LLINs has the potential to act as an incentive, improving the already strong coverage of both these essential services. The collection and reporting of data on LLINs distributed through the ANC and EPI can provide insight into the performance of LLIN distribution within these programmes. Greater attention to data collection and use, by both the global malaria community, and the integrated programmes, can improve this distribution channel strength and effectiveness.
Geneva, Switzerland, WHO, 2016. 186 p.The World Health Organization’s (WHO) World Malaria Report 2016 reveals that children and pregnant women in sub-Saharan Africa have greater access to effective malaria control. Across the region, a steep increase in diagnostic testing for children and preventive treatment for pregnant women has been reported over the last five years. Among all populations at risk of malaria, the use of insecticide-treated nets has expanded rapidly. But in many countries in the region, substantial gaps in programme coverage remain. Funding shortfalls and fragile health systems are undermining overall progress, jeopardizing the attainment of global targets.
Report of the Director General of the World Health Organization. Implementation of General Assembly resolution 66/289 on consolidating gains and accelerating efforts to control and eliminate malaria in developing countries, particularly in Africa, by 2015.
[New York, New York], United Nations, General Assembly, 2013 Apr 5.  p. (A/67/825)The present report is submitted in response to General Assembly resolution 66/289. It provides a review of progress in the implementation of that resolution, focusing on the adoption and scaling-up of interventions recommended by the World Health Organization in 99 countries with ongoing malaria transmission and key challenges impeding progress, including a shortfall in financing for malaria control globally. It provides an assessment of progress towards the 2015 global malaria targets, including Millennium Development Goal 6, targets set through the African Union and the World Health Assembly and goals set through the Global Malaria Action Plan of the Roll Back Malaria Partnership. It elaborates on the challenges limiting the full achievement of the targets and provides recommendations to ensure that progress is accelerated up to and beyond 2015.
WHO policy brief for the implementation of intermittent preventive treatment of malaria in pregnancy using sulfadoxine-pyrimethamine (IPTp-SP).
[Geneva, Switzerland], WHO, 2013 Apr 11.  p.Malaria infection during pregnancy is a major public health problem, with substantial risks for the mother, her fetus and the newborn. In areas with moderate to high transmission of Plasmodium falciparum, the World Health Organization (WHO) recommends a package of interventions for controlling malaria and its effects during pregnancy, which includes the promotion and use of insecticide-treated nets (ITNs), the administration during pregnancy of intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP), and appropriate case management through prompt and effective treatment of malaria in pregnant women . During the last few years, WHO has observed a slowing of efforts to scale-up IPTp-SP in a number of countries in Africa. Although there may be several reasons for this, an important factor is confusion among health workers about sulfadoxine-pyrimethamine administration for intermittent preventive treatment in pregnancy. At a recent WHO evidence review, a meta-analysis of 7 trials evaluating IPTp-SP was undertaken. It showed that 3 or more doses of IPTp-SP were associated with higher mean birth weight and fewer low birth weight (LBW) births than 2 doses of IPTp-SP. The estimated relative risk reduction for LBW was 20% (95% CI 6-31). This effect was consistent across a wide range of SP resistance levels. The 3+ dose group also was found to have less placental malaria. There were no differences in serious adverse events between the two groups . Based on this evidence review, in October 2012, WHO updated the recommendations on IPTp-SP as outlined in this document, and urges national health authorities to disseminate this update widely and ensure its correct application. IPTp-SP is an integral part of WHO’s three-pronged approach to the prevention and treatment of malaria in pregnancy, which also includes the use of insecticide-treated nets and prompt and effective case management. (Excerpts)
Geneva, Switzerland, WHO, 2013.  p. (WHO/HTM/NTD/WHOPES/2013.3)Guidelines for testing long-lasting insecticidal nets (LNs) were first published by WHO in 2005. The revised guidelines were reviewed by a WHOPES informal consultation on innovative public health pesticide products, held at WHO headquarters on 22-26 October 2012. Industry was invited to attend the first 2 days of the meeting to exchange information and provide their views, after which their comments were further reviewed by a group of WHO-appointed experts, who finalized the guidelines by consensus. The purpose of this document is to provide specific, standardized procedures and guidelines for testing LNs for personal protection and malaria vector control. It is intended to harmonize testing procedures in order to generate data for registration and labelling of such products by national authorities and provide a framework for industry in developing novel LN products. This document replaces the previous guidelines, published by WHOPES in 2005. (Excerpts)
Lancet. 2007 Sep 22; 370(9592):1007.This week, The Lancet publishes two papers of critical interest to child survival. Unfortunately, both have stirred concerns about misuse of data by UN agencies. Here, we review the allegations and try to draw lessons about the place of independent scientific inquiry in the arena of global health policymaking. Greg Fegan and colleagues report the success of an expanded insecticide-treated bednet programme in Kenya. The full paper reveals the strengths and limitations of the study, and provides important estimates of uncertainty. No such statistical caution was expressed in the WHO statement about these data, released on Aug 16. Indeed, WHO claimed that this finding "ends the debate about how to deliver long-lasting insecticidal nets". Yet communications between the Kenyan research team and WHO suggest an ill-considered rush by WHO against the advice of wiser scientific minds. (excerpt)
Lancet Infectious Diseases. 2007 Feb; 7(2):79.Malaria in pregnancy can have devastating consequences for the mother and the unborn child. This month's issue contains seven state of the art reviews on malaria in pregnancy, and a final paper describing a rational research strategy that could lead to substantial improvements in maternal and child health in malaria endemic settings. Supported by a Gates Foundation grant, the authors provide up-to-date knowledge of a wide range of issues that include, epidemiology and burden of disease, pathogenesis and immunity, case management, prevention, treatment, policy implementation and programme delivery, and economic impact. Clearly, effective interventions to prevent malaria in pregnancy have been woefully slow to translate into policy and practice, and there are many remaining gaps where research is urgently needed. Although the severity of malaria in pregnancy has been known for decades, the burden of malaria in pregnancy is not visible since most pregnant women are unaware of being infected. Historically reproductive health programmes, which at a country level are responsible for caring for women during pregnancy, did not see malaria control as part of their remit and the malaria programmes were reluctant to share their interventions. (excerpt)
Mera. 2006 Jan; (21):3-4.The Global Fund is a unique global public-private partnership dedicated to attracting and disbursing additional resources to prevent and treat HIV/AIDS, tuberculosis and malaria. This partnership between governments, civil society, the private sector and affected communities represents a new approach to international health financing. The Fund works in close collaboration with other bilateral and multilateral organisations to supplement existing efforts dealing with the three diseases. Apart from a high standard of technical quality, the Global Fund attaches no conditions to any of its grants. It is not an implementing agency, instead relying on local ownership and planning to ensure that new resources are directed to programmes on the frontline of this global effort to reach those most in need. Its performance-based approach to grant-making is designed to ensure that funds are used efficiently and create real change for people and communities. (excerpt)
Malaria and HIV / AIDS interactions and implications: conclusions of a technical consultation convened by WHO, 23-25 June, 2004.
Geneva, Switzerland, WHO, 2004.  p. (WHO/HIV/2004.08)Malaria and HIV are among the two most important global health problems of our time. Together, they cause more than four million deaths per year. Malaria accounts for more than a million deaths each year, of which about 90% occur in tropical Africa, where malaria is the leading cause of mortality in children below five years. Aside from young children, pregnant women are among the most affected by the disease. Constituting 10% of the overall disease burden, malaria places a substantial strain on health services and costs Africa about USD 12 billion in lost production each year. Sub-Saharan Africa is also home to more than 29 million people living with HIV/AIDS. In 2003 in Africa, AIDS claimed the lives of an estimated 2.4 million people and over 600 000 children were newly infected with the virus. HIV/AIDS increasingly accounts for a large proportion of mortality among children under five years in heavily affected countries. By taking its greatest toll on its young and most productive generation, HIV/AIDS hinders sustainable development in Africa. (excerpt)
Mass use of insecticide-treated bednets in malaria endemic poor countries: public health concerns and remedies.
Journal of Public Health Policy. 2004; 25(1):9-22.Over the last two decades, morbidity and mortality from malaria have increased in sub-Saharan Africa due to civil unrest, resistance to available drugs, human migration, population displacements, deteriorating health systems, and the HIV/AIDS epidemic which consumes much of the resources for disease prevention. In response to this growing challenge, international development agencies, spearheaded by the World Health Organization (WHO), founded the Roll Back Malaria (RBM) initiative, a global partnership for prevention and control of malaria. The primary goal of RBM is to achieve a 50% reduction in the global malaria burden by 2010, and the period 2001-2010 has been tagged the "United Nations Decade to Roll Back Malaria". RBM has adopted use of insecticide-treated mosquito nets as a major tool for the achievement of its malaria control objectives. Treatment of mosquito nets with insecticide was probably introduced for the first time during World War II, when nearly half a million American servicemen were stricken with malaria. Wider use of insecticide treated nets began in the 1980s following the development in the early 1970s of photostable synthetic pyrethroids which are fast-acting, effective in small quantities, relatively stable, adhere to fabric, and relatively safe to humans. Based on a series of field studies of the effect of insecticide-treated nets (ITNs) on malaria morbidity and mortality in sub-Saharan Africa, promotion of use of ITNs has emerged as a key intervention for malaria control. RBM's target is to have 60% of the world's population at risk of malaria sleeping under ITNs by 2005 (I). Realization of this goal could see tens of millions of doses of pesticides for net impregnation entering thousands of homes in malaria endemic poor countries annually. Thus, strategies to ensure a fuller understanding of their health risk and to minimize actual and potential adverse effects on human health are urgently needed. (excerpt)
Vector-control synergies, between "roll back malaria" and the Global Programme to Eliminate Lymphatic Filariasis, in the African region.
Annals of Tropical Medicine and Parasitology. 2002; 96 Suppl 2:S129-S132.The perspectives and opportunities for controlling the mosquito vectors of Wuchereria bancrofti in tropical Africa are summarized and discussed. The countries covered by the World Health Organization’s African Region have about one third of the world’s burden of lymphatic filariasis (LF) as well as large shares of the planet’s malaria and of many other vector-borne diseases. African LF is entirely caused by nocturnally periodic W. bancrofti, a filarial nematode that is transmitted in urban East Africa by Culex quinquefasciatus, and in rural areas across tropical Africa by the same anopheline species that transmit the Plasmodium spp. causing human malaria. The standard practices for controlling the vectors of malarial parasites — house-spraying with residual insecticides and the use of bednets (preferably pre-treated with insecticide) for personal and community protection — can be simultaneously effective against both LF and malaria. Although mass drug administrations remain the mainstay of the current strategy for LF elimination, the vector-control activities of the ‘Roll Back Malaria’ campaign can be expected to reduce the transmission of W. bancrofti in co-endemic areas. The relevant issues of programme management and integrated vector control are briefly reviewed. (author's)
Lancet. 2004 Apr 3; 363(9415):1160.Amir Attaran and colleagues highlight a very serious public-health issue. Provision of ineffective drugs for a life-threatening disease is indefensible. There is no doubt that chloroquine is now ineffective for the treatment of falciparum malaria in nearly all tropical countries, and that its usual successor, sulfadoxine-pyrimethamine, is falling fast to resistance. As a result, malaria mortality in eastern and southern Africa, where hundreds of thousands of children die each year from the infection, has doubled in the past decade. We have failed to roll back malaria, and we in the developed world bear the responsibility for this humanitarian disaster. Malaria is not an insoluble problem. We already have the tools (insecticides, bednets, highly effective drugs) to reduce substantially the terrible death toll. But we are not providing them to the people who need them desperately, but who cannot pay for them. Only a tiny fraction of the millions with malaria today receive highly effective treatments. The donors must take some responsibility for this failure. Given the choice between receiving donor support for ineffective chloroquine or sulfadoxine-pyrimethamine and receiving nothing, most countries have naturally opted for the former. It is not easy to protest, particularly when the main donors, and the representatives of international organisations, both claim these drugs are still “programmatically effective”. (excerpt)
Use of intermittent presumptive treatment and insecticide treated bed nets by pregnant women in four Kenyan districts.
Tropical Medicine and International Health. 2004 Feb; 9(2):255-261.The roll back malaria (RBM) movement promotes the use of insecticide-treated bednets (ITNs) and intermittent presumptive treatment (IPT) of malaria infection as preventive measures against the adverse effects of malaria among pregnant women in Africa. To determine the use of these preventive measures we undertook a community-based survey of recently pregnant women randomly selected from communities in four districts of Kenya in December 2001. Of the 1814 women surveyed, only 5% had slept under an ITN. More than half of the 13% of women using a bednet (treated or untreated) had bought their nets from shops or markets. Women from rural areas used bednets less than urban women (11% vs. 27%; P < 0.001), and 41% of the bednets used by rural women had been obtained free of charge from a research project in Bondo or a nationwide UNICEF donation through antenatal clinics (ANCs). Despite 96% of ANC providers being aware of IPT with sulphadoxine–pyrimethamine (SP), only 5% of women interviewed had received two or more doses of SP as a presumptive treatment. The coverage of pregnant women with at least one dose of IPT with SP was 14%, though a similar percentage also had received at least a single dose as a curative treatment. The coverage of nationally recommended strategies to prevent malaria during pregnancy during 2001 was low across the diverse malaria ecology of Kenya. Rapid expansion of access to these services is required to meet international and national targets by the year 2005. The scaling up of malaria prevention programmes through ANC services should be possible with 74% of women visiting ANCs at least twice in all four districts. Issues of commodity supply and service costs to clients will be the greatest impediments to reaching RBM targets. (author's)
Lancet. 2003 Nov; 362(9395):1549-1550.In 2001, UNICEF procured 70 000 bednets and insecticide treatments to be distributed free to pregnant women attending antenatal clinics in 35 (of 69) districts in Kenya. 1 year later, we interviewed 294 pregnant women who had received a free net. 267 (91%) nets had remained in the target homesteads, and only one of the nets had been sold. In a district with high malarial transmission, 93 (84%) of 111 women who had not previously been sleeping under a bednet had used the net while pregnant, and 97 (91%) of the 107 surviving babies were also protected; in another district, which had low transmission, 73 (58%) of 126 women used the nets during pregnancy and 91 (80%) of 114 infants were protected by the nets. These data suggest that bednets given free to pregnant women are used by recipients and their newborn children, and should be regarded as an important delivery system in increasing access to and use of insecticidetreated bednets in vulnerable groups. (author's)
Insect wars in eastern province. Nangarhar people hope malaria mosquitoes will be an early casualty of peace.
London, England, Institute for War and Peace Reporting [IWPR], 2003 Jun 9. 3 p. (Afghan Recovery Report No. 63)The new campaign, funded by the World Health Organization, the UN Development Programme, and Nangarhar’s own health department, is intended to teach people how to protect themselves from bites by using sprays and mosquito nets. It will also attack the insects themselves, clearing stagnant waters, spraying pools where they lay their eggs, and introducing “mosquito-fish”, a species which eats the larvae. (excerpt)
Comparative performances, under laboratory conditions, of seven pyrethroid insecticides used for impregnation of mosquito nets. [Performances comparées, dans des conditions de laboratoire, de sept insecticides à base de pyréthroïde utilisés pour l'imprégnation des moustiquaires]
Bulletin of the World Health Organization. 2003 May; 81(5):324-333.Objective: To compare the efficacy of seven pyrethroid insecticides for impregnation of mosquito nets, six currently recommended by WHO and one candidate (bifenthrin), under laboratory conditions. Methods: Tests were conducted using pyrethroid-susceptible and pyrethroid-resistant strains of Anopheles gambiae and Culex quinquefasciatus. Knock-down effect, irritancy and mortality were measured using standard WHO cone tests. Mortality and bloodfeeding inhibition were also measured using a baited tunnel device. Findings: For susceptible A. gambiae, alpha-cypermethrin had the fastest knock-down effect. For resistant A. gambiae, the knockdown effect was slightly slower with alpha-cypermethrin and much reduced following exposure to the other insecticides, particularly bifenthrin and permethrin. For susceptible C. quinquefasciatus, the knock-down effect was significantly slower than in A. gambiae, particularly with bifenthrin, and no knock-down effect was observed with any of the pyrethroids against the resistant strain. Bifenthrin was significantly less irritant than the other pyrethroids to susceptible and resistant A. gambiaebut there was no clear ranking of pyrethroid irritancy against C. quinquefasciatus. In tunnels, all insecticides were less toxic against C. quinquefasciatusthan against A. gambiaefor susceptible strains. For resistant strains, mortality was significant with all the pyrethroids with A. gambiaebut not with C. quinquefasciatus. Inhibition of blood-feeding was also high for susceptible strains of both species and for resistant A. gambiaebut lower for resistant C. quinquefasciatus; bifenthrin had the greatest impact. Conclusions: Efficacy for impregnation of mosquito nets against A. gambiae was greatest with alpha-cypermethrin. Bifenthrin is likely to have a significant comparative advantage over other pyrethroids in areas with pyrethroid resistance because of its much stronger impact on the nuisance mosquito, C. quinquefasciatus, despite its slower knock-down effect and irritancy. Selection of pyrethroids for mosquito vector control and personal protection should take into account the different effects of these insecticides, the status of pyrethroid resistance in the target area, and the importance of nuisance mosquitoes, such as C. quinquefasciatus. (author's)
Population Today. 2000 Feb-Mar; 28: p..In sub-Saharan Africa, insecticide-treated materials (ITMs)--primarily mosquito nets or bed nets--have protected pregnant women and reduced mortality among infants and children. According to the WHO, the use of treated bed nets can reduce rates of severe malaria by an average of 45% and decrease childhood mortality rates between 25% and 35%. Since the nets and insecticide have proven so effective that access to them furthers public health, the WHO, UN Children's Fund, and the US Agency for International Development (USAID) have committed in the distribution of ITMs. The international donors have also supported the public sector and nongovernmental organizations in selling health products and services at affordable prices and motivating people to use them. However, Will Shaw, director of international public health with the Academy for Educational Development (AED), pointed out several limitations of donor-funded ITM programs. Hence, under a cooperative agreement with USAID, AED will work with the S.C. Johnson company and other international and local partners on the Africa NetMark regional project, promoting the commercial distribution of ITMs.
[Unpublished] 2001 Dec 4 p.While the use of effective drugs and protective bed nets is reducing the toll of malaria in several African countries, continuing and expanded efforts are needed to protect the health of pregnant women and children. In 1998, the WHO, the UN Development Program, the UN Children's Fund, and the World Bank established the Roll Back Malaria partnership that aims to cut the global incidence of malaria in half. Its goals include malaria treatment for pregnant women, insecticide- treated bed nets, vector control, early diagnosis, prompt treatment, and prevention and response to epidemics. Furthermore, the Abuja Declaration, signed by African leaders in 1998, calls for government to take actions to prevent and treat malaria among pregnant women and children under 5 years old. Finally, continuing efforts are needed to reduce the toll of malaria on maternal and child health through specific actions taken by policymakers and program managers.