Since 2002, Jhpiego has implemented innovative and strategic health practices for pregnant women, including focused antenatal care (ANC) and community-directed interventions (CDIs), to improve efforts to control malaria in pregnancy (MIP). Beginning in 2002, in collaboration with the World Health Organization, Jhpiego introduced the implementation of focused ANC services with MIP. Given that over 90 percent of pregnant women attend ANC at least once during pregnancy and often twice, ANC is an opportune platform to deliver a broad range of comprehensive health services during pregnancy, including malaria control. For malaria these services include: a full treatment dose of an antimalarial for intermittent preventive treatment in pregnancy (IPTp) during routine ANC, promotion and use of an insecticide-treated bed net (ITN) and effective diagnosis and treatment for women with malaria.
Between 2002 and 2004, Jhpiego provided technical support to the Ministries of Health in Kenya and Burkina Faso to introduce and expand focused ANC with MIP. In Kenya, a baseline and a follow-up survey, conducted by the U.S. Centers for Disease Control and Prevention in 2002 and 2005, respectively, showed that IPTp increased significantly from 7 percent to 38 percent. In Burkina Faso, between baseline (2001) and follow-up (2004), results revealed significant improvements in health outcomes. Women attending four or more ANC visits increased from 21 percent to 44 percent, IPTp increased from 0 to 75 percent and owning an ITN increased from 22 percent to 46 percent. Also, substantial health impacts in the form of significantly reduced malaria (22 percent to 15 percent) and low birth weight (13 percent to 11 percent) were documented. These efforts also catalyzed the introduction and expansion of focused ANC services with MIP in multiple African countries.
For example, in 2008, supported by the ExxonMobil Foundation, Jhpiego piloted a CDI approach in Akwa Ibom State, Nigeria, to improve MIP services for pregnant women. (CDIs foster partnerships between communities and facilities, where communities “direct” the planning and implementation of health services in coordination and collaboration with health facilities.) This approach led to increases in IPTp use and ITN ownership and maintained ANC coverage among pregnant women. During the baseline and follow-up surveys conducted in 2008 and 2010 respectively, the number of pregnant women who slept under an ITN increased from 19 percent to 36 percent. In the facilities supported by the CDI project, 65 percent of women received IPTp during ANC compared to 20 percent of women in the control sites from the same region.This single project led to the adoption and expansion of the CDI approach across Nigeria for MIP and malaria services for young children.
At the global level, Jhpiego is a recognized leader in MIP. Jhpiego has extended its ability to make an impact on malaria globally by participating in strategic partnerships. Since 2003, Jhpiego has actively participated in the Roll Back Malaria MIP Working Group—as co-chair for seven years, secretariat for four years and technical representative throughout. Through this collaboration, Jhpiego has contributed to efforts that have reprioritized MIP as a core component of maternal, neonatal and child health programming in countries where malaria is prevalent. Jhpiego’s work in MIP has led to increased use of IPTp, increased ownership and use of ITNs and improved care for pregnant women with malaria in more than 20 countries across sub-Saharan Africa.
 2010 Multiple Indicator Cluster Survey (MICS)