Malaria chemoprophylaxis to pregnant women provided by community health workers in Saradidi, Kenya. II. Effect on parasitaemia and haemoglobin levels

To determine the effects of chloroquine phosphate (300 mg base weekly) chemoprophylaxis for malaria provided by volunteer village health helpers (VHH's), pregnant women attending antenatal clinics in Saradidi, Kenya, were examined each month. Parasitaemia, haemoglobin level, and the presence of urinary 4-aminoquinolines were determined at each visit. The age composition and parity of women taking chemoprophylaxis were not statistically significantly different from those of the other women.A total of 104 (29.1%) of 357 pregnant women from 23 villages where chemprophylaxis was provided by VHH's said they were taking it. Women 30 to 44 years of age (43.9% of 82) were more often taking prophylaxis than those younger (25.1% of 271) (P<0.0005).An additional 573 pregnant women to whom regular chemoprophylaxis was not provided from 33 control villages were also examined at least once. When compared with those from women not taking prophylaxis, blood samples from pregnant women on antimalarial prophylaxis had lower parasite rates (17.7% of 265 compared with 26.2% of 1700, P<0.005), higher haemoglobin levels (59.1% of 127 were ≥10.0 g l−1compared with 49.7% of 1111, P<0.05), and a higher mean haemoglobin level (9.95 g dl−1compared with 9.62, P=0.019) and urine samples were more often positive for 4-aminoquinolines (15.7% of 255 compared with 8.3% of 1656, P<0.0005). For women with two or more parasitologic samples, 69.6% of 79 pregnant women on prophylaxis had no parasites found on any visit compared with 51.6% of 516 women not on chemoprophylaxis (P<0.005).Parasitaemia rates in samples from 317 infants were high (37.3% of 1047). Infection was present in 2.3% of 43 samples from infants less than one month and by four months of age 49.6% of 135 samples were positive. Although samples from infants whose mothers said they were taking chemoprophylaxis had a lower prevalence of parasitaemia (32.6% of 190) than those from the other infants (38.4% of 857), the difference was not statistically significant.Although community-based delivery of antimalarial chemoprophylaxis by VHH's appeared to be successful in reducing parasitaemia and increasing haemoglobin levels, antenatal clinics may be a better way of providing chemoprophylaxis to pregnant women. The additional responsibility may be too much for community health workers. At the clinic chemoprophylaxis can be presented as part of comprehensive antenatal care. After delivery, care can then be extended to the infant.