Nineteen-year-old Diolista João is a mother of four living in the Maririmo community in Meconta District, Mozambique. During her first three pregnancies, João only visited the health facility for an initial antenatal care (ANC) consultation to get a prenatal booklet and mosquito net, and then gave birth at home. All three children were low birthweight and she experienced hemorrhaging after the births.
In December 2019, during her fourth pregnancy, João received a visit from a lay community counselor (LCC) with the Transforming Intermittent Preventive Treatment for Optimal Pregnancy (TIPTOP) project, who encouraged her to go to the health facility for regular ANC services. The LCC registered her using a mapping tool to record her location for follow-up visits and gave her a referral to the nearest health facility. João started ANC visits and received her first dose of intermittent preventive treatment of malaria in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) at the facility. She then received the second and third doses from the TIPTOP community health worker (CHW) in her area.
The TIPTOP project uses an innovative, community-based approach that aims to dramatically increase the number of pregnant women in malaria-affected countries in sub-Saharan Africa receiving antimalarial preventive therapy. In Mozambique, TIPTOP is being implemented in three districts: Nhamatanda (Sofala Province), Meconta and Murrupula (both in Nampula Province).
In TIPTOP’s community-based delivery system, CHWs deliver SP to eligible pregnant women in their communities, while LCCs counsel pregnant women to visit the health facility to receive comprehensive ANC services.
Because the number of CHWs available to implement community IPTp in Mozambique is limited, the Ministry of Health supports having LCCs do the health promotion, including making home visits and bringing pregnant women to the local CHW for counseling and, if eligible, SP. TIPTOP trained LCCs to promote ANC and IPTp, and they play a vital role in sensitizing pregnant women to the approach and ensuring they are willing to meet their respective CHW. LCCs have a strong connection to their communities. They are selected by the community leader, so consider it a privilege to conduct door-to-door community mobilization/visits and referrals to CHWs.
After several follow-up visits from the LCC who counseled her about the importance of regular ANC consultations, João received comprehensive ANC care and delivered her baby at a health facility for the first time. Her baby boy, Fabião Miguel, weighed a healthy 3,200 grams at birth at the Nacavala health facility, and João had no complications during or after the birth. João remembers, “In December, the TIPTOP LCC came to my house, introduced himself, and asked me if I was in good health. When I told him I was just pregnant, he asked me if I had started the prenatal consultation and I explained to him that I had not because the pregnancy was in an early stage.”
The LCC advised me to go to the nearest health facility for an ANC visit and explained the benefits of starting the antenatal visits early. He gave me a referral form to present at the Nacavala facility where I started the antenatal consultations and took my first dose of SP.”Diolista João
Thanks to the contributions and hard work of TIPTOP CHWs and LCCs, routine monitoring data show IPTp3 coverage continuing to improve. The implementation of community IPTp and the strong referral system by LCCs and CHWs to ANC are affording pregnant women more opportunities to receive malaria protection and comprehensive ANC care.
André Lamina is the former monitoring and evaluation assistant in Meconta District, Mozambique.
Photo: André Lamina