Oral Presentation First Malaria World Congress 2018

Prevention of malaria in pregnancy among pastoralists in a humanitarian setting: An exploratory study of ambulatory service delivery models for administering prophylaxis (#117)

Emmanuel Victor EVO Odjidja 1
  1. Village Health Works, Kigutu, NON-US/NON-CANADIAN, Burundi

Malarial infection during pregnancy (MIP) remains a public health problem that affects pregnant women and the developing foetus. A review and meta-analysis of seven trials associates MIP with severe anaemia, cerebral malaria and low neonatal birth weight (LBW) [1]. In moderate and high malarial transmission areas, WHO recommends a minimum of three doses of intermittent preventive treatment (IPTp) for pregnant women during routine antenatal care (ANC) after 16 weeks of pregnancy [2]

Among pastoralists, conception usually occurs during the early dry season which is transitioning from a wet season [3]. This period happens to be the peak season for malaria transmission [3]. Yet, antenatal care attendance among pregnant pastoralists remains relatively lower than the general population [4].


The study was conducted in four areas of Kapoeta County in the Eastern Equatoria of South Sudan. A stepwise approach of four stages were taken to achieve the set objectives using multiple methods from ethnography to social network analysis 


Social network analysis shows that the strongest influencer to ANC attendance are the hegemony that exists within the household and community as a whole. Three models emerged as possible strategies for implementing ambulatory care. These were: community health workers as mobilisers for administering IPTp monthly, mobile clinic facilitated by skilled health workers to provide comprehensive ANC care including malaria prophylaxis and finally, self-medication in the form of distributing sulphadoxine tablets to pregnant women.  The final qualitative evaluation showed that while all models were potentially effective in encouraging optimal uptake of IPTp, safety of drugs could only be assured when delivered via the mobile clinic.


Mobile clinics have proven to be a cost-effective intervention in several settings. In humanitarian setting where there are apparent weaker health system, mobile clinics are relevant ensures that safe and optimal doses of IPTp are administered.