In Liberia, a country where malaria transmission occurs throughout the year, the Ministry of Health prioritizes the provision of insecticide-treated bed nets (ITNs) to pregnant women during the course of their pregnancy. ITNs provide effective protection against malaria and have been shown to reduce malaria illness and death in high-burden settings. These protective benefits are especially important for pregnant women, not only because they are at greater risk of malaria infection and symptomatic malaria disease than non-pregnant adults, but because malaria in pregnancy contributes to maternal and newborn morbidity and mortality.
Despite the Ministry of Health’s commitment, access to and use of ITNs has been relatively low, with only a little over half of pregnant women receiving ITNs during their antenatal care in 2018. Reasons for this low access and use include low awareness of the benefits of ITNs and of the need to sleep under one every night.
Through the Strategic Technical Assistance for Improved Health Systems Performance and Health Outcomes (STAIP) project, funded by the U.S. Agency for International Development, Jhpiego has been supporting the Ministry of Health to ensure improved access to ITNs for pregnant women. The project does this by providing job aids that remind health workers to offer bed nets to pregnant women and to clearly communicate the benefits of ITNs, the importance of using them every night and how to care for them. It also provides health care workers with in-service training, supportive supervision and continual coaching and mentoring on the national guidelines for malaria in pregnancy.
As a result, pregnant women like 24-year old Hawa Johnson, mother of four, are receiving ITNs when they go for their first antenatal care visit. Johnson visited Dagweh Clinic in Bomi County in the northwestern part of Liberia, one of the 400 health facilities supported by Jhpiego in Liberia.
“I visited the clinic,” she said, “and they gave me a check-up, and told me I was pregnant, so they gave me a mosquito net for me to sleep under to prevent myself and my unborn child from getting malaria…. I do not have malaria. I sleep sound at night. I do not have any sickness in my body… I have not had malaria because I always sleep under the net, every night. To take care of the mosquito net, I wash it with bathing soap once a month, hang it up, and when it dries, I hang it back up above my bed before I sleep under it.”
Efforts such as these are having an effect, one woman at a time. In just three years, the STAIP project’s interventions have contributed to an increase in the percentage of pregnant women who received ITNs during their antenatal care in Liberia from 57% in 2018 to 74% in 2021. Fortunately, women like Johnson are getting the protection that the Ministry of Health intended.
