Preventing malaria in pregnancy: Need for regular supply of Sulphadoxine –Pyrimethamine

It has been the case that some pregnant women would not report for antenatal care (ANC) when they got pregnant so that they would be put on malaria prevention treatment to protect themselves and their fetuses against the disease.

While increased education and construction of more health facilities have increased access to ANC services and consequent treatment for malaria in pregnancy, the regular shortage of Sulphadoxine–Pyrimethamine (SP) at health facilities has become a major setback to preventing malaria in pregnancy in the country.

Dangers of malaria in pregnancy and treatment
Malaria infection during pregnancy is a major public health problem with substantial risk for the mother, her fetus and the newborn, and women living in moderate-high transmission malaria areas in sub-Saharan Africa.

The failure to take sufficient doses of SP increases the woman's risk of malaria, anaemia, and subsequent stillbirth, preterm delivery, or delivery of a low birth weight infant.

The Ghana Health Service (GHS), therefore, recommends preventive treatment for malaria, using the Intermittent Preventive Treatment during pregnancy (IPTp) approach where SP drug is given to pregnant women when they are 16 weeks old, and once every four weeks until they deliver.

There is a benefit for each dose of SP, and pregnant women need to take sufficient doses to protect themselves and their fetuses.

Extent of shortage of SP

It is, therefore, crucial for pregnant women to always have access to SP and take the full course of doses to prevent malaria and or protect them and their fetuses. In view of this, one would have thought that SP would always be available at health facilities to be given to pregnant women.

A visit by the GNA to some primary health care facilities in the Tamale Metropolis and Sagnarigu Municipality, which are heavily patronised by pregnant women, showed that shortage of SP was a regular occurrence, threatening the country's response to malaria prevention in pregnancy.

The facilities visited were Tamale Central Health Centre, and Builpela Health Centre in the Tamale Metropolis, and Kalpohin Health Centre in the Sagnarigu Municipality. Madam Augusta Dorbu, Midwife in-charge of ANC at Kalpohin Health Centre, spoke about the extent of the shortage of SP at the facility.

Madam Dorbu said “When it is finished, we report to the District Health Directorate. We receive about 50 pregnant women in a day and our supply is not enough for the month. The Health Directorate is aware of the regular shortages. We record shortages almost every month sometimes lasting for more than a month before they supply us again.”

She added that “When we request for the SP, they say it is out of stock. So, if it is not there, we will also sit and wait for them. We give them monthly reports about the situation. So, they know that we do not always have the SP”. She said, “If we get premature labour, we refer them to hospitals where they have Neonatal Intensive Care Unit to take care of the baby”.

Madam Barikisu Adam, a Midwife at ANC at Tamale Central Health Centre, said: “It is not always that we get the SP. Sometimes, it will finish before a pregnant woman will come. So, we just encourage them to use mosquito repellent and or sleep under insecticide-treated nets, and not stay outside for long. We have nets and we give them. The authorities must always supply us the SP on time”.

Madam Ayesha Attu, a Midwife at ANC at Builpela Health Centre, said: “The shortage of SP is a general issue. We do not always get enough supply even though we receive high numbers of pregnant women, sometimes about 30 pregnant women in a day. The health directorate is aware of the situation. We need regular supply of SP so that all pregnant women will receive it at the facility.”

Reactions from Ghana Health Service

Mr James Frimpong, Deputy Programme Director, National Malaria Control Programme (NMCP), acknowledged the situation, and said it was among the general challenges such as inefficient transportation system and lack of cold chain storage facilities that the country’s health sector was grappling with.

Mr Frimpong said, “I admit that the supply of SP has not been apt but we are working to address the situation.”

The way forward

The IPTp is based on the assumption that every pregnant woman in a malaria endemic area has malaria parasites in her blood and or placenta, which is associated with complications whether or not she has symptoms of malaria.

Therefore, there is need for urgent and practical steps to be adopted by the NMCP and the GHS to prevent malaria in pregnancy and needless deaths.

The NMCP and GHS must support maternal health programming, ensure resilient health systems to provide early and frequent ANC, explore innovative strategies to reach all pregnant women, and ensure availability of quality assured SP where all pregnant women are able to receive the necessary doses of SP to reduce the risk of adverse outcomes.

This is crucial to attaining the goal of zero malaria in the country.