When Everything Stops
“Malaria affects every family in this community. If two children get malaria, all other family activities stop, like school, because all money and resources go into treating the children.”
— Maria Matondo, community health worker, Democratic Republic of the Congo
Batu Angela is pregnant with her eighth child, and she’s rightfully frightened: Two of her children died young — one of malaria. Her small community is constantly stricken by the disease.
“I have had malaria many times,” the 38-year-old mother says. “I wasn’t pregnant, though.”
Malaria is a fact of life in Mbambamu, a town in the southwestern Kwango Province of Democratic Republic of the Congo (DRC). Angela had malaria just last year , but the disease becomes much direr in pregnancy.
Pregnant women infected with malaria are at an increased risk of severe anemia and even death, and their babies are more likely to be born at a low birth weight. One in five stillbirths in sub-Saharan Africa can be attributed to malaria in pregnancy.
“I have been trying to come [to the health facility] every month to take my medicine so that I don’t get malaria while pregnant,” Angela says. “I come because it is important for the health of my baby and for my own health.”
“It is the community health worker who reminds me to come if I forget,” she says.
Maria Matondo has been a volunteer community health worker in Angela’s community for nearly a decade. “We do household visits, monitor the community health, and monitor how many women are pregnant and have babies,” she says. “We make sure that women are using mosquito nets in their family homes.”
Malaria impacts every facet of a family’s life in the community. “If two children get malaria, then all other family activities stop, like school, because all money and resources go into treating the children,” Maria says. “It really affects everyone.”
While many in the community have learned to sleep under insecticide-treated bed nets, avoiding mosquitos entirely is simply not possible. So Maria encourages pregnant women like Angela to regularly attend prenatal care check-ups at their local health facility, where they receive preventive treatment to help ensure a malaria-free pregnancy.
“We tell them to come,” Maria says. “Some just forget. Sometimes they don’t have money for transport to come, and sometimes they are too busy with their other children, or they’re working. Or often, they will have children who are sick, so they must look after them.”
TIPTOP — An Innovative New Malaria Initiative
A new project in communities in four key countries highly burdened by malaria aims to improve the care pregnant women like Angela receive. The Transforming Intermittent Preventive Treatment for Optimal Pregnancy (TIPTOP) project, led by Jhpiego with funding from Unitaid, will support ministries of health to introduce and expand an innovative community-based approach that will give pregnant women the chance to receive the antimalarial therapy they need when they need it at community and health facility levels.
Through TIPTOP, community health workers like Maria will be trained to go house to house regularly and distribute preventive medicine that stops malaria in pregnancy directly to a pregnant woman’s door. They will also help ensure stronger linkages to the local health facility for comprehensive care during pregnancy.
“Maternal mortality and morbidity remains an important public health problem in DRC,” says Jhpiego Country Director, Virgile Kikaya. “Malaria impacts so many women. Too many newborns are dying needlessly because of malaria in pregnancy. TIPTOP is working to change that from the community by preventing malaria throughout pregnancy”.
“TIPTOP is a groundbreaking project that will increase coverage among pregnant women through a no-missed-opportunities approach. Pregnant women will be able to receive antimalarial therapy in their community and at their local health facility. DRC’s support for TIPTOP is helping to lead the way,” says Elaine Roman, TIPTOP project director.
“Our biggest challenge is being able to have a good life — to find money for food and to look after my family,” Angela says. “My hope for the future is that my children will one day grow and be successful.”
That’s a hope that starts early, with a healthy, malaria-free pregnancy. It’s an urgent hope that will come true for thousands of women like Angela in the coming years as TIPTOP-trained health workers extend care far and wide.