Systematic assessment of factors affecting the delivery, access and use of interventions to control malaria in pregnancy in sub-Saharan Africa

Each year, an estimated 31 million pregnancies occur in areas of stable malaria Plasmodium falciparum transmission in sub-Saharan Africa. Malaria in pregnancy can have serious adverse consequences on maternal, newborn and child health, including maternal anaemia, spontaneous abortion, stillbirth and low birth weight infants, and yet the harmful effects are preventable. Prevention of malaria in pregnancy with intermittent preventive treatment (IPTp) and insecticide treated nets (ITNs) offers two of the most cost-effective interventions available to improve maternal, neonatal and child health in sub-Saharan Africa. IPTp with sulphadoxine-pyrimethamine (SP), a drug with a good safety and efficacy profile and a single-dose regimen, offers the opportunity for providing each dose under directly observed therapy to women attending antenatal clinics in their second and third trimesters. ITNs can be delivered to pregnant women at their first antenatal care visit but provides greater challenges with ensuring subsequent use. The case management of malaria is the third strategy recommended by the World Health Organisation (WHO) to control malaria in pregnancy in Africa.
This thesis presents the results from a series of systematic reviews and meta-analyses, and from field-based studies in Kenya and Mali, to explore the factors affecting the delivery, access and use of interventions to control malaria in pregnancy in sub-Saharan Africa.