Prevention of malaria during pregnancy in West Africa: policy change and the power of subregional action

Despite a broadening consensus about the effectiveness of intermittent preventive treatment (IPTp) in preventing the adverse outcomes of malaria during pregnancy policy change to IPTp was initially limited to East Africa. In West Africa where the policy change process for the prevention of malaria during pregnancy started much later IPTp has been taken up swiftly. The objective was to describe the factors that contributed to the rapid adoption of policies to prevent malaria during pregnancy in West Africa. Several factors appear to have accelerated the process: (1) recognition of the extent of the problem of malaria during pregnancy and its adverse consequences; (2) a clear evidence based program strategy strongly articulated by an important multilateral organization (World Health Organization); (3) subregionally generated evidence to support the proposed strategy; (4) a subregional forum for dissemination of data and discussion regarding the proposed policy changes; (5) widespread availability of the proposed intervention drug (sulfadoxine-pyrimethamine); (6) technical support from reputable and respected institutions in drafting new policies and planning for implementation; (7) donor support for pilot experiences in integrating proposed policy change into a package of preventive services; and (8) financial support for scaling up the proposed interventions. (authors)