The persistence of community health workers in Guinea-Bissau helps health facilities meet their targets, but not only that: it also helps prevent deaths. When they sensitise pregnant women in communities to attend pre-natal consultations, they are contributing to the control of 18 possible diseases that may impede the normal development of pregnancy. When they also inform women about the benefits that receiving free preventive drug treatment to prevent malaria will have for them and for their babies, they are protecting the lives of both.

According to the World Malaria Report 2021, West Africa had in 2020 the highest prevalence of exposure to malaria during pregnancy at almost 40%, while malaria prevalence in East and Southern Africa was 22%. It is estimated that malaria infections during pregnancy in the region resulted in over 800,000 children with low birthweight, which is closely linked to neonatal mortality and inhibited growth and cognitive development, among other complications. “Malaria can have very negative consequences for pregnant women and their babies: premature rupture of the amniotic membrane, premature birth, miscarriage, and even higher HIV mother to child transmission” says Maieutica Cabral, nurse in the Bairro Militar Health Centre in Guinea-Bissau’s capital city. “Preventive malaria treatment is administered to all pregnant women who come to pre-natal clinics and are at or above 13 weeks' gestational age, with a maximum of five doses until the end of pregnancy” she explains.

Intermittent preventive treatment in pregnancy (IPTp) is one of the WHO-recommended strategies for malaria prevention, together with the seasonal malaria chemoprevention (SMC) which UNDP is implementing in Guinea-Bissau in partnership with the National Malaria Control Programme of the Ministry of Public Health, and The Global Fund funding. According to the World Health Organization, IPTp and SMC have shown to be safe, efficient, and cost-effective interventions for reducing the disease burden and saving lives. In Guinea-Bissau, where malaria is an endemic disease with stable transmission during the dry season and high prevalence during the rainy season, IPTp is administered throughout the year. “During health education sessions in communities, we explain to pregnant women how the process will be at the pre-natal visit where they will receive the treatment," relates Valdimar Luis Mancanha, a community health worker at the Biombo Regional Health Directorate since 2014. “The IPTp protection lasts 30 days, so three pills are taken at each pre-natal consultation. If a pregnant woman gets malaria when she has been taking the IPTp, the symptoms will be much milder, and also risk of mother-to-child HIV transmission will be lower”, elaborates Cabral. 

Awa Camara has been the head midwife at the Maternity Service at the Bairro Militar Health Centre since 2015. She has been delivering babies for 20 years and enjoys her job because “I can save two lives, the mother’s, and the baby's”. She and her team see between 40 and 60 pregnant women every day. "Complications such as infections, HIV or malaria need to be ruled out. If women come for pre-natal consultations, they can have general tests and ultrasound scans and their diseases are treated” Camara says. “Sometimes they are infected with malaria but have no symptoms and only find out when they do the routine tests in the pre-natal visits. So, it is important that they come and that they always take preventive drugs” notes her colleague clinical doctor Cadidjato Baldé. 

In 2020, over 1.3 million insecticide-treated mosquito nets were distributed to the entire population in Guinea-Bissau and the number is expected to rise to almost1.5 million in 2023.  Pregnant women also receive these nets at their first antenatal visit and in the first half of 2022 alone, almost 16,000 nets were distributed. The date when the nets are delivered to them is always noted in the register book that is filled in with all the information about their pre-natal consultations. Weight, uterine height, blood pressure and vaccinations administered to patients are measured and recorded. "If pregnant women come from other health centres in Bissau or even from other regions, we also attend them and include all the information on their cards. If they stay until the end of the pregnancy to be attended to with us, the information is also recorded in the centre's register book”. In the Maternity Service only pregnancy tests and general examinations are paid for, all other procedures are free of charge: health cards, ultrasound scans, consultations, malaria prophylaxis, vaccinations, and mosquito nets. This is possible thanks to the support of international donors such as The Global Fund, which guarantees free malaria, TB and HIV medical supplies in health facilities throughout the country.

“Many women do not understand the importance of pre-natal and postpartum visits. It is very important to monitor pre-natal visits and to emphasise awareness-raising so that pregnant women who go for their first visit complete all of them to the end” Valdimar Luis Mancanha reflects. It is essential that women who are now expecting their babies are aware that pre-natal consultations can save their lives and the lives of their children. Deusa, Isaura, Cumba, Aïssatu and almost 10,000 pregnant women are seen every month at health facilities like the one in Bairro Militar. By attending pre-natal consultations and taking malaria intermittent preventive treatment in pregnancy, they are contributing not only to their own wellbeing and that of their babies, but also to the control of preventable deaths in Guinea-Bissau and to the achievement of the SDG3 (Ensure healthy lives and promote well-being for all at all ages) targets in the country.