Session: Malaria in Pregnancy
Session Rationale
This session will enable participants to work with pregnant women to encourage them to seek and adhere to Intermittent Preventative Treatment during pregnancy (IPTp). It will also enable participants to support Health Care Workers in the administration of IPTp.
Time Two hours, 5 minutes Audience Health Volunteers at IST
Terminal Learning Objective
After learning about malaria in pregnancy, participants, given a focused antenatal clinic (FANC) scenario, will detail at least two contextually appropriate activities they can do to increase Intermittent Preventative Treatment of Malaria (IPTp) rates for pregnant women.
Session Learning Objectives
1. Using lecture notes, participants will demonstrate comprehension of specific details about malaria in pregnancy by individually filling in a review handout.
2. In a one-on-one or small group setting, participants will practice an effective targeted explanation for women of low educational background concerning the reasons they are recommended to take Sulfadoxine pyrimethamine (SP) in pregnancy.
3. Participants will give culturally and contextually appropriate feedback to focused antenatal care (FANC) workers aimed at addressing commonly seen FANC problems.
4. Participants will adapt a health talk curriculum on IPTp to a specific strategically targeted audience and effectively present at least five minutes of the session to training group members.
Session Knowledge, Skills, and Attitudes (KSAs)
1. Explain the health risks of and treatment for malaria in pregnancy. (K)
2. List reasons women are recommended to take SP in pregnancy. (K)
3. Use local language and culturally appropriate approaches to explain to community members the reasons women are recommended to take Sulfadoxine Pyrimethamine in pregnancy. (S)
4. Use 360 analysis tool to make concrete observations about what is working and what needs to be improved at an antenatal clinic. (S)
5. Appreciate the barriers/challenges to IPTp and identify possible solutions to address them. (A, S)
Prerequisites
Introduction to Malaria Prevention; Introduction to Behavior Change
Sector: Health
Competency: Foster Improved Maternal, Neonatal, and Child Health
Training Package: Malaria Prevention and Control
Version: Dec-2014
Trainer Expertise: Trainers should be familiar with national FANC protocols (specifically IPTp)
/ Malaria Prevention and Control: Malaria in Pregnancy | Version: Dec-2014| Page 32 of 32Session Outline
Motivation 10 min 6
Overview of Session Topics 6
Information 1 15 min 7
Malaria in Pregnancy Background 7
Practice 1 10 min 9
Practice Conversations: How do I Explain This? 9
Information 2 15 min 10
Focused Antenatal Clinics – FANCs – the Delivery Mechanism for MiP Prevention 10
Practice 2 10 min 12
360 + the Checklist 12
Application 1 20 min 13
Tips for Providing Feedback or Instructions to CHW Counterparts 13
Applying Knowledge Through Constructive Feedback: Correcting the Identified Problems 14
Motivation 2 5 min 15
Getting women to their FANCs 15
Information 3 10 min 16
Getting Women to Their FANCs 16
Practice 3 10 min 17
Overcoming Cultural and Logistical Resistance to Community Acceptance and Care Seeking for IPTp 17
Application 2 20 min 18
Talking it Out 18
Assessment 19
Trainer Notes for Future Improvement 19
Resources 19
Handout 1: Lecture Notes 20
Handout 2: National IPTp Recommendations and Simplified Presentation 21
Handout 4: FANC Analysis Checklist 22
Handout 5: Scenario 23
Handout 6: Community Health Talk About IPTp 26
Trainer Material 1: Sample National IPTp Recommendations and Simplified Presentation 28
Trainer Material 2: Statistics on Impact of Malaria in Pregnancy 30
Trainer Material 3: Lecture Notes Answer Key 31
Trainer Material 5: 360-Degree Analysis Flip Chart 32
Trainer Material 6: Flip Chart with Partner Role-Play Instructions 32
Session: Malaria in Pregnancy
Date: [posts add date]
Time: [posts add xx minutes]
Trainer(s): [posts add names]
Trainer Preparation
1. At least two weeks prior to the session, print one copy per participant of Handout 3: USAID Program Brief – Adapting Focused Antenatal Care (see separate file). Distribute to participants at least two weeks prior to the session and ask them to read it completely as homework before the start of the session, and to highlight key points. Remind participants (ideally the day before the session) to please bring their copies for use in this session, for use in the Information 2 section.
2. Read the entire session plan and materials, and adapt as needed the session plan for the time you have available.
3. For Motivation Section 1: Add country specific statistics about the impact of malaria (in pregnancy specifically if possible) to Trainer Material 2. Print Trainer Material 2, and cut out each of the five separate statistics (or more if you added country-specific ones) to distribute to five participants to read aloud at the time indicated in that section.
4. For Information Section 1: Print one copy per participant of Handout 1 and print one copy of Trainer Material 3 for yourself to use as the answer key at the end.
5. If you are not already familiar with IPTp, review this summary information prior to the session: http://www.who.int/malaria/publications/atoz/iptp-sp-updated-policy-brief-24jan2014.pdf
6. LCF participation in Practice 1, Application 1, and Application 2: It would be helpful to have the LCF(s) on hand to assist the facilitator in listening to practice explanations by participants in Practice 1, Application 1, and Application 2. A few weeks before the session, invite any available LCFs to participate in all three activities.
o For Practice 1: Let the LCFs know that they can circulate and help small groups prepare their explanations (in local language to the extent possible), targeted to women of low educational background, for the reasons they are recommended to take Sulfadoxine pyrimethamine (SP) in pregnancy. And then, when participants practice, they can help the facilitator listen to and assess the spoken explanations of each participant. Let LCFs know if you would like them to provide immediate feedback to participants and if the feedback would involve correct use of content, cultural appropriateness, and/or language. Let LCFs know what time to arrive to the learning space for Practice 1.
o For Application 1: Like Practice 1, the LCFs can circulate and assist small groups with local vocabulary as they prepare their Volunteer and community health worker CHW role-play conversation. They can also help the facilitator assess the role-play conversations when presented. Share details regarding how you will assess conversations with the LCF.
o For Practice 3: LCFs can assist groups with local language, dialect phrases, and vocabulary.
o For Application 2: Just as in Practice 1 and Application 1, LCFs can for this activity assist participants with local language as they prepare their conversation, tailored to the perspective of the community leader, and then assist the facilitator with the assessments. Share details regarding how you will assess the conversations with the LCF.
7. Prior to the session, using Trainer Material 1 as a model or example, create Handout 2: National IPTp recommendations and simplified presentation. The content to be included in Handout 2 will be found by reviewing [your country’s] National IPTp recommendations, which your Ministry of Health and other governmental counterparts should be able to provide to you. Use that information to create Handout 2.
8. For Information 2 section:
o Print a few extra copies of Handout 3 (see separate file), in case some participants forget to bring their copy (or invite them to look on with another participant).
Note: Information 2 section covers focused antenatal clinics (FANCs) primarily for malaria in pregnancy scenarios. Depending on whether FANCs have already been covered in other sessions, you may be able to simply do a rapid review. For your reference, if participants have been trained with the Maternal and Newborn Health Training Package session titled “Pregnancy and Antenatal Care,” then they have already covered FANC in more detail.
If you wish to cover more detailed background information (beyond the malaria in pregnancy focus) related to FANCs, please see Trainer Material 4 (see separate file, which was also used as Handout 1 from the Maternal and Newborn Health Training Package session titled “Pregnancy and Antenatal Care”).
o Prepare Trainer Material 5 and Trainer Material 6 flip charts, and tape individual sheets up to hide what they say, to be revealed to participants when indicated in Information 2 and Application 1, respectfully.
9. Preparation for Information 2: Research the most common barriers to IPTp administration and localize the text in the section Information 2, Step 7. Possible locations to inform your research: your governmental counterparts, PMI’s Malaria Operation Plan or model for your country, your country’s governmental five-year malaria plan, national malaria control program or strategic plan, or DHS.
10. Before printing Handout 4, Examine the national protocol for FANCs and localize the checklist in Handout 4 to reflect all recommended procedures at a FANC, including all tests to be performed, drugs/supplements to be given, and any specific instructions the FANC worker should give the client. After updating Handout 4 with this information, print one copy per participant.
11. Print one copy per participant of Handout 5 and Handout 6.
Materials
Equipment
§ Projector, laptop, and screen for PowerPoint (if available)
§ Flip chart, tape, and markers
Handouts
§ Handout 1: Lecture Notes
§ Handout 2: National IPTp Recommendations and Simplified Presentation [ Country Specific – To be created by trainer]
§ Handout 3: USAID Program Brief – Adapting Focused Antenatal Care (see separate file)
§ Handout 4: FANC Analysis Checklist
§ Handout 5: Scenario
§ Handout 6: Community Health Talk About IPTp
Trainer Materials
§ Trainer Material 1: Sample National IPTp Recommendations and Simplified Presentation
§ Trainer Material 2: Statistics on Impact of Malaria in Pregnancy
§ Trainer Material 3: Lecture Notes Answer Key
§ Trainer Material 4: Focused Antenatal Care – Additional Information ( see separate file)
§ Trainer Material 5: 360-Degree Analysis Flip Chart
§ Trainer Material 6: Flip Chart with Partner Role-Play Instructions
Motivation 10 min
Overview of Session Topics
Participants will be provided with an overview of the session and an introduction to the scale and scope of issues related to malaria in pregnancy (MiP), including data that supports the efficacy of the interventions they will be taught and examples of Volunteers’ roles in addressing the issue.
1. Present the Learning Objectives for the session.
2. Distribute the five pieces of paper cut from Trainer Material 2, one each to five different participants. Invite these participants, one at a time, to share with the group their statistics about the impact of malaria in pregnancy worldwide, using a loud and clear voice.
Post Adaptation: The facilitator can make additional mention of statistics about the impact of malaria in your country.
3. After each statistic has been read aloud, ask participants to reflect on the impact of malaria on pregnant women in their communities.
Possible Script: Have any of you had any experience at focused antenatal clinics (FANCs) in your community or spent time with pregnant women who may have had malaria? What is the cultural attitude toward care seeking? Do you know any women in your community who have lost babies?
Note: As this is part of the Motivation section, the objective here is to engage participants’ knowledge of the human impact of MiP, NOT discuss in detail the functioning of the health system. Try to limit the conversation to 2-3 minutes.
4. Introduce participants to the success of Malaria in Pregnancy (MiP interventions: Bed nets and Intermittent Preventative Treatment in pregnancy, or IPTp.
Possible Script: The key interventions to prevent MiP are the use of long-lasting insecticidal nets (LLINs) and Intermittent Preventive Treatment in pregnancy (IPTp) with Sulfadoxine Pyremethamine. You’ve already learned about how effective LLINs are. Today we’re going to focus on IPTp.
In a study in Mozambique, IPTp reduced early neonatal deaths (within the first week) by 66 percent, all neonatal deaths (first 28 days) by 61.3 percent, and infant deaths (in the first year of life) by 35.2 percent. And all of these gains were in addition to using nets, that is to say using nets combined with IPTp prevented 66 percent more early neonatal deaths than just using LLINs plus a placebo.
5. Introduce participants to successes that other Volunteers in the country have had working with FANCs.
Post Adaptation: These success stories should be short (2 minutes) and drawn from the general Volunteer population, not a specialist Response Volunteer or third-year Volunteer. They should be representative of the kind of success that a Volunteer could see working at his or her FANC.
Information 1 15 min
Malaria in Pregnancy Background
Participants will understand the science behind why malaria in pregnancy is treated differently than malaria in the general population. They will gain a greater understanding of the specific dangers faced by pregnant women in malarial zones.
1. Hand out lecture notes to participants for the following Information section – Handout 1: Lecture Notes. Give participants 2 minutes to look over the notes to get an idea of what issues will be addressed. Invite them (over the next few minutes during this information sharing) to fill in the blanks while listening closely, and let them know we will review answers later.
2. Discuss placental malaria and its difference from regular malaria.
Possible Script: As you all know, malaria is a parasitic infection that attacks red blood cells, taking them over and using their resources to replicate itself. The body, however, has a defense against invaders in the blood— namely the spleen—which filters blood and attempts to get rid of invaders. Many of the malaria parasite’s evolutionary adaptations are aimed toward avoiding this filtering out process.
One of those strategies to avoid being filtered by the spleen is to “hide” in placental tissue of pregnant women.
Note: No, evolution doesn’t “aim” at anything, but this is in layman’s terms. Additionally, “hiding” is an exceptionally rough layman’s term for what the parasite is doing in the placenta. Participants wishing a more technical explanation can go to http://www.medicine.mcgill.ca/MJM/issues/v08n01/rev_articles/samak.pdf