Community-based scheduled screening and treatment .. (COSMIC)
Community-based scheduled screening and treatment of malaria in pregnancy for improved maternal and infant health: a cluster-randomized trial
Start date: Sep 1, 2012,
End date: May 31, 2017
Pregnant women are very susceptible to malaria infection and Malaria in Pregnancy (MiP) is a major cause of maternal anaemia and low birth weight (LBW) that leads to infant mortality, poor growth and development. In low transmission areas, malaria can become severe, resulting in maternal and foetal death. In sub-Saharan Africa (SSA) MiP is responsible for 8–14% of LBW, 3–8% of infant deaths, higher risk of post-partum haemorrhage and >10,000 maternal deaths/year. Prevention like, bed nets and intermittent preventive treatment with sulphadoxine-pyrimethamine (IPTp/SP), is cheap and cost-effective, but coverage achieved by these interventions is low. Therefore, we propose Community Health Workers (CHW) to implement scheduled intermittent screening at community level with RDT of pregnant women and if positive treat with anti-malarials (SST). In addition CHWs will encourage pregnant women to attend antenatal clinics (ANC) for other pregnancy-targeted interventions and IPTp/SP, thereby improving its coverage. This approach combines existing IPTp/SP with SST at village level as an extension of Home based management of malaria (HMM). This low cost (based on existing practice) and simple (diagnosis by RDTs) intervention improves maternal and newborn health and capitalise on an already existing intervention (HMM). The aim of this proposal is to determine the added value (as compared to IPTp/SP alone implemented in health facilities) of community SST of pregnant women implemented through the CHW involved in HMM. Objectives are: 1) Identify bottlenecks for implementation by CHW involved in HMM of SST; 2) determine impact of introducing SST in pregnancy on quality of HMM; 3) determine the impact of SST on ANC attendance and IPTp/SP coverage; 4) determine the impact of SST on LBW, anaemia and placenta malaria; 5) estimate cost-effectiveness of SST as compared to IPTp/SP alone and 6) formulate recommendations for possible implementation of the intervention.
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