Malaria is the leading cause of morbidity and mortality in Kenya with the greatest burden in children under five years and pregnant women. Malaria is a top developmental concern for Kenya, 70% of total population is at risk of infection. Effects of malaria in pregnancy are greatest in primigravida, second pregnancy and HIV positive pregnant women including maternal anemia, miscarriages, intrauterine growth retardation, perinatal mortality, low birth weight and neonatal mortality. Approximately 1.5 million women become pregnant each year in Kenya with approximately 44% living in moderate to intense malaria endemic areas in the lake and coastal regions. Pregnant women are especially vulnerable to malaria infection due to pregnancy induced lowered immunity.
MOH policy on malaria in pregnancy
The Government of Kenya policy on Malaria in Pregnancy (MiP) recommends four strategic approaches in prevention and control of malaria. They include:
- Intermittent Preventive Treatment (IPTp) of MiP, with Sulfadoxine Pyrimethamine (SP) in areas with high malaria transmission such as Western, Nyanza and Coast regions.
- Long lasting Insecticidal Nets (LLINs) at the ANC and Child Welfare Clinics.
- Prompt diagnosis and effective treatment of malaria.
- Education and communication.
National Malaria Strategy 2009 – 2017
The Malaria prevention objective is to have at least 80% of people living in malaria risk areas use appropriate malaria preventive interventions by 2018.
- Provision of LLINs at ANC and Child Welfare Clinics.
- Provision of IPTp at ANC clinics.
- Promotion of MiP interventions at community level.
- Targeted implementation of IPTp only in the high malaria endemic regions.
- Revision of MiP guidelines.
- Integration of MiP interventions in the 'focused antenatal care package'.
- Integration of MiP indicators in the DHIS2.
- Training of MCH service providers on provision of IPTp-SP.
- Training of CHWs on MiP messaging to sensitise pregnant women to start early attendance of ANC which results to increase of IPTp2 coverage from 25% (KMIS 2010) to 63% in those counties.
- Low ITNs use inspite of high household LLIN ownership.
- Poor data management and reporting at the health facilities.
- Lack of incentives for CHWs to promote MiP and the uptake of IPTp.
- High staff turnover of trained health workers on IPTp affects provision of IPTp-SP as per national guidelines.
- Late ANC attendance.
The establishment of the devolved government necessitates continued capacity building among County and Sub-County malaria coordinators.