By PCV Alexia Kime
The Senegalese health system mandates that pregnant women see a health care provider 3 times during their pregnancy and also ideally at birth. This service is crucial in providing women not only with check-ups and prescriptions for iron, but with malaria prophylaxis (SP) as well as a Long Lasting Insecticide-treated Net (LLIN). Preventive medications for malaria are free and are supposed to be given to pregnant women twice after the fetus has quickened (at about 4 months). However, a large number of women are not receiving these services.
For the last year I have been working with Drs. Julie Thwing (Malaria Technical Advisor, PMI at Centers for Disease Control and Prevention in Senegal) and Julie Gutman (CDC/CGH/DPDM in Atlanta) on data collection and research related to pre-natal consultations, specifically Intermittent Preventive Treatment of malaria for pregnant women (IPTp), missed visits and the reasons for them. The over-reaching goal is to have all pregnant women covered.
In creating a malarial study for improving pre-natal visits as related to malaria medications, preliminary steps included observations and data collections. Research has thus far shown that information on medications, notably malaria prophylaxis, are largely communicated through infrequent talks in the waiting area to large groups of people and are not done as frequently or consistently as necessary to make this method effective. Pre-natal consultations are not attended as recommended. Of the data I reviewed from 2011 to present it appeared that less than half of pregnant women received malaria medications an adequate number of times. However, though documentation is available it is not always accurate or complete.
Culturally, people in Senegal believe in the power of divine will. People live and die as God wills it. This belief is ingrained in their culture and can create a barrier in terms of medical coverage. I believe that the lack of education regarding pregnancies and an inadequate system in sharing medical information contributes to the low level of IPTp coverage. A large number of women and their husbands currently do not understand the importance of pre-natal consultations. Pregnancies need to be monitored from start to finish; my research has shown that this is inconsistently being done. Without an increase in the awareness of the importance of medical coverage, paired with open dialogue, and improved doctor-patient relations, this will never change.
Coming up, I will be doing observations for a week of health workers in relation to IPTp coverage in tandem with a chart review. I will be able to observe what is said and done in a consultation versus what is written down in the register and on the pre-natal cards. From this, I plan to work with the head doctor, my counterpart, on creating a checklist of “what to do for a pre-natal visit” to hang in the consultation room. I will eventually follow-up with further observations and another chart review. My Peace Corps service is fast coming to a close, but hopefully I also will be able to do a pilot study of interviews of women at the community level. This would then cover all parties involved, helping health workers to be more effective as well as gaining from women their views on pre-natal coverage, what they know, and why they come or do not come to pre-natal consultations. The research gained will eventually allow us to develop a way to increase the number of visits that pregnant women attend in order to meet the recommended number of visits and thus also receive IPTp.
Pre-natal research is important as it can tell us what is currently being done and to whom. Continued work in this area will eventually allow pregnant women to have the best access to life-saving drugs for a safer pregnancy. Hopefully, the positive results of the women currently attending visits will be realized by other local women who will then also seek treatment. As a bi-product of improved coverage and trust in the health system, ideally women will continue to use the health system as their children grow healthy.
Focusing on the health of the next generation, this is such an important area to cover. As Peace Corps volunteers we have a responsibility to help those who want to be helped. I believe this starts with education – on all sides. The information and data I have collected can be passed on and added to. I can only hope that other volunteers pick up and/or continue my work in the area of pre-natal and IPTp coverage. Paired with assistance from CDC staff we will hopefully be able to increase awareness and usage of the health services currently available across Senegal.