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About the project

In countries where malaria is endemic, pregnant women have a higher risk of malaria than other adults. This risk is even higher among women who are pregnant for the first time, infected with the human immunodeficiency virus or in those from non-endemic countries because they did not acquire any immunity before pregnancy.
Malaria during pregnancy can have severe adverse effects on both the mother and the child. Consequences can be low birth weight babies who have a significantly higher risk of dying before their first birthday, preterm delivery, maternal death during pregnancy or during delivery, or severe complications from the malaria infection itself.

In sub-Saharan Africa, over 30 million women living in malaria endemic areas become pregnant each year with malaria, causing an estimated >10,000 maternal deaths and 75,000 – 200,000 infant deaths each year. Malaria is also responsible for 2 – 15% of maternal anemia cases and up to 14% of low birth weight babies resulting in poor growth and development.


Current control measures of malaria in pregnancy

Successful control of malaria in pregnancy saves the lives of mothers and babies and is an essential part of antenatal care in endemic areas. For sub-Saharan Africa, the World Health Organization has developed guidelines for the control of malaria in pregnancy based on:
  • Prompt and effective management of clinical cases
  • The use of bed nets
  • Intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP).
Intermittent preventive treatment is a simple policy that is based on the observed administration of sulphadoxine-pyrimethamine in a single dose. IPTp/SP consists of at least 2 full doses of SP administered after the first movement of the baby is observed by the mother and at least 1 month later, regardless of malaria infection or clinical symptoms. This IPTp/SP treatment can then clear any existing infection and provides protection for a certain period of time.


The current policy in the three countries involved in this proposal (Benin, The Gambia and Burkina Faso) is to give an antimalarial preventive treatment to women when they attend the antenatal clinic at a given health facility.
However, this means the health system essentially waits for the women to attend the facility, a facility that women may not have easy access to or not use at all. COSMIC aims to bring health services close to where women live, using community health workers to provide an antimalarial intervention to women with difficult access to the formal health system. Cosmic will do this by building on the use of community health workers (CHWs), who are already managing malaria cases within the communities. However, the current work terrain of these community health workers consists of testing and treating children under 5 and not pregnant women yet.
CHWs could encourage pregnant women within their communities to attend antenatal clinics (ANCs) for IPTp/SP and other pregnancy-targeted interventions, screen them between ANC visits with RDT for malaria and treat them if the test is positive.
COSMIC will thus combine existing IPTp/SP with systematic screening and treatment at the village level as an extension of existing community case management. This should improve both IPTp/SP coverage as CHWs encourage women to attend the antenatal care for the IPTp at the right time, and also provide opportunities to treat malaria when the protective effect of the IPTp has ended.