IPT as a key NMA Intervention in the COMPASS
by IPHF Nigeria on Tue Oct 30, 2007 3:19 pm
IPT as a key NMA Intervention in the COMPASS Reproductive Health Portfolio
Francis Ohanyido MBBS, PGDA, FIPH
NMA Catalyst, USAID/COMPASS Project, Nigeria
This is an overview paper to highlight the activities of the project since inception, in the area of
Malaria in pregnancy (MIP) through scaling up of Intermittent Prophylactic Treatment (IPT)
uptake at health facilities by women attending ANC.
Malaria transmission and burden
Malaria is highly endemic in Nigeria and it remains one of the leading causes of morbidity and
mortality in the country with prevalence rate of 919/100,000. Malaria accounts for 40% of disease
burden reported at the OPD/ANC. It accounts for 30% of all childhood deaths and is associated
with 11% of maternal deaths.
Malaria in Pregnancy (the Mother-Foetus-Newborn Spectrum)
• Parasitemia, spleen rates, morbidity, anemia, fever illness ,cerebral malaria ,hypoglycemia
,puerperal sepsis ,mortality, severe disease, hemorrhage
• Abortions, stillbirths, congenital infection
• low birthweight, prematurity, IUGR, malaria illness ,mortality
The Current Malaria Response
The African Summit on Roll Back Malaria (RBM) in April 2000 adopted the Abuja Declaration,
in which regional leaders committed to achieving 60% coverage of pregnant women at risk for
malaria with available control tools by 2005. This in itself is a multisectoral response to a disease
burden that is militating against attainment the MDGs. The initial IPT implementation pilot in
Oyo State as part of WHO/PREMA-EU collaboration to pilot malaria in pregnancy monitoring
tools has been a learning ground.
It was within this response background that the Community Participation for Action in the Social
Sector (COMPASS) Project , came into implementation under Cooperative Agreement No. 620-
A-00-04-00125-00 between Pathfinder International leading a consortium of 8 other partners of
which NMA is one , and the US Agency for International Development (USAID). It was
Launched in 2004, and designed to expand participation and ownership of healthcare and
education at community level in 51 LGAs in four states and the Federal Capital Territory of
Nigeria over a period of five years.
Even though the Federal Government has adopted IPT as an alternative to chemoprophylaxis to
prevent malaria in pregnancy, nationwide implementation has been slow. Sensitization of health
workers and promotion of IPT has however started in some states.
To date, the RBM guidelines and malaria policy documents or manuals have been poorly
disseminated to the community level facilities nationwide. The implementation of MIP/IPT has
been rolling and primarily handled by implementing and donor agencies that have shown
evidence of growing commitment for the implementation of MIP/IPT. However, the RBM
partnership still leaves much to be desired in terms of effective leadership.
Some pharmaceutical companies are producing SP, the drug of choice for IPT under close
monitoring by NAFDAC.
Many health providers are yet to convert from Chloroquine to SP, some are even ignorant of
IPT. COMPASS midline survey even showed that some thought that IPT was still
pyrimethamine-only weekly regimen!
The cost of the drug and generic versions is still a challenge in some communities
What is IPT?
The World Health Organisation (WHO) 20th Malaria Expert Committee designated IPT using an
efficacious, preferably single-dose, anti-malarial drug as the preferred approach to reduce the
adverse consequences of malaria during pregnancy. IPT involves the administration of full,
curative treatment doses of an effective antimalarial drug at predefined intervals during
pregnancy, beginning in the second trimester after quickening. IPT provides a highly effective
base for programmes through use of safe and effective antimalarial drugs in treatment doses
which can be linked to antenatal clinic visits. It is expected that at the time of delivery, the
woman would have completed two doses, or three in the case of HIV positive mothers.
Why is it so important?
• Drop in incidence of Anaemia in pregnancy
• Reduction of occurrence of congenital anaemia
• Decrease of incidence of prematurity
• Diminished incidence of foetal loss
• Cutback in Maternal Mortality
• Healthy mother and newborn
What is the potential of IPT uptake?
The potential of IPT to attain high levels of programme coverage and its benefit in reducing
maternal anaemia and LBW makes it a preferred strategy in Africa and Nigerian in areas of stable
malaria transmission due to the failed strategy of weekly CQ chemoprophylaxis.
What is COMPASS doing to scale-up IPT?
The strategy of WHO’s Making Pregnancy Safer (MPS) has been a watchword of the COMPASS
RH project in the general picture of its interventions.
COMPASS has been active in the MIP/IPT strategy at three-levels with NMA as a key Nigerian
- COMPASS is a member of the RBM coordinating partnership
- COMPASS is also on NMCP and its Subcommittee on malaria/ Malaria in pregnancy Working
Group (MIPWG) facilitated by ACCESS project that developed the new generic structure for
distribution of RH Commodities
- COMPASS-NMA/International Public Health Forum/African International Medical Services
advocated to the chairperson of Senate Committee on Health for Senators and Members of House
of Representatives to give strong voice in their states for free ANC and the procurement of SP for
- COMPASS-NMA/ACCESS advocated to Medical and Dental Council to make MIP one of the
core areas of its infectious disease /RH CMEs for medical doctors in Nigeria.
- COMPASS-NMA is a key player alongside the Communication and Mobilisation Unit led by
John Hopkins University (aegis of the COMPASS project) in the ongoing framework for a radical
malaria control initiative, being developed by the Federal Ministry of Health (FMoH).
COMPASS in close partnership with NMA developed and implemented state-specific advocacy
strategies towards ensuring that the states increase procurement of the commodity for onward
distribution to the health facilities. COMPASS does not procure SP for IPT.
Challenges at the states are:
•To standardize MIP policy implementation across States so impact measured
is comparable across the States
• Scale up the MIP policy
• Mobilize more resources and advocate for MIP
• Enhance effective M&E and reporting
• Ensure that SP is utilized for MIP because sometimes it is available in existing state facilities
and local pharmacy
- NMA in Kano has been organising CMEs on MIP. It has also featured on episodes of a VOA
Hausa service programme to promote focused –ANC and IPT
- COMPASS Bauchi advocated for Free maternity service which is now the policy, but yet to be
implemented by SMoH, while NMA Bauchi has met with the Commissioner for Health twice to
advocate for procurement of SP and scale –up of IPT. There will be further advocacy visits
involving COMPASS –ACO/NMA to give further emphasis to both issues as well as the need to
include SP in the Essential Drug List.
- COMPASS Lagos has organised CME training for Medical practitioners under the aegis of the
NMA affiliate Association of General and Private Medical Practitioners of Nigeria (AGPMPN)
on RH –related issues including IPT. There is significantly poor enthusiasm on the part of the
main NMA branch in Lagos.
- COMPASS-NMA in Nassarawa have severally advocated to SMOH on the need to scale up IPT
, particularly in the collection of its WB allocation of SP lying in Lagos warehouse
- COMPASS FCT advocated for Free maternity service which is now the policy being now on
verge of implementation by FCT Ministry. COMPASS FCT has recently been having market
clinic outreaches as windows of reaching women on IPT. NMA FCT has also had some relevant
• Facility: Compass is refocusing its orientations for provider’s knowledge of IPT and the need
for its use.
• peer health educators orientations are also to include basic knowledge of IPT for counselling
• Encouraging Men as Partners to ensure compliance to the IPT policy
• Mobilising communities to be aware of the dangers of MIP and need to complete the regimen of
Malaria in Pregnancy is more than just a term for COMPASS-NMA intervention in RH. It goes
beyond definitions to the community level where access and levels of delays have wreaked havoc
on Nigeria’s maternal outcome indices .There is need for urgent scaling up to reach these
pregnant women in need. MIP deserves strong focus of public resources at the PHC level with
enhanced case management skills of practitioners as well as partnership with the men as heads of
households to carry through the needs of focused antenatal care.
IPT is challenged by ANC utilization picture for each community, beliefs and attitudes, and
logistics, which the social capital and summative goodwill of Nigerian Medical Association and
other partners can work to overcome. The branches need to sit up and take up their leadership
mantle to great effect in the healthcare sector.
The Monitoring & Evaluation systems need improvement to document challenges and successes,
as well as the outpatient procurement of SP. These should go alongside well defined institutional
capacity building for all tiers within the system.
1. RBM NIGERIA. NIGERIA ROLL BACK MALARIA CONSULTATIVE MISSION:
ESSENTIAL ACTIONS TO SUPPORT THE ATTAINMENT OF THE ABUJA TARGETS –
2. ACCESS-NMCP: MIP Working Group (MIPWG) Meeting Report 2007
3. Tanzania: Increasing Uptake of Intermittent Preventive Treatment for Pregnant Women
through Scaling up Focused Antenatal care. JHPIEGO/ACCESS Project, (2007)
4. WHO. THE ROLL BACK MALARIA STRATEGY FOR IMPROVING ACCESS TO
TREATMENT THROUGH HOME MANAGEMENT OF MALARIA (2005)