The document summarizes a community-directed intervention project in Nigeria to improve malaria control among pregnant women. Key points: - The project trained community volunteers to provide intermittent preventive treatment (IPTp) and insecticide-treated bednets in their communities, in addition to clinic services. This increased access to malaria prevention and treatment. - Evaluation found higher uptake of IPTp and bednets in intervention areas compared to control areas relying solely on clinics. However, stockouts of commodities and user fees reduced impact. - Community involvement through volunteers was effective but regular support is needed. Advocacy is also key to ensure free services and continuous supply of medicines and bednets.

1. COMMUNITY DIRECTED INTERVENTIONS TO IMPROVE MALARIA IN PREGNANCY CONTROL SERVICES IN NIGERIA William R Brieger, Bright Orji, Joseph Okeibunor, Emmanuel Otolorin, Gbenga Ishola, Barbara Rawlins

4. Akwa Ibom State, Nigeria: Year Round Malaria Risk CDI MP PILOT

5. Baseline in 2007 - MIP Indicators during Last Pregnancy 60% was RBM Target for 2005

6. Nigeria MIP Partnership Concept and Project Design CLINIC MIP performance standards developed and implemented COMMUNITY MIP skills and responsibilities implemented through community directed intervention Training, Supervision Mobilization, Commodities Referrals, Records, Feedback

12. IPTp and ITN Delivery

13. Service Statistics: IPTp2 Distribution LLINs Q1 '09 Q2 '09 Q3 '09 Q4 '09 Total Coverage Control Clinic 251 360 292 187 1090 18.7% Intervention Clinic 395 384 409 385 1573 21.4% Community Distributors 2092 1246 1617 1823 6778 92.2%

14. Exit Interviews at Intervention Clinics

15. CDDs trained for ITN Distribution

16. Service Statistics: LLIN Distribution LLINs Q1 '09 Q2 '09 Q3 '09 Q4 '09 Total Coverage Control Clinic 40 25 8 0 73 3.8% Intervention Clinic 20 0 2 8 30 0.4% Community Distributors 1683 37 225 3699 5644 76.8%

17. Service Statistics: ANC Attendance 2009

18. Service Statistics: ANC Attendees Receiving Tetanus Toxoid in 2009

19. Improving Performance Quality

20. SBM-R Scores (%) for ANC Services

21. Follow-up Results

22. Malaria Transmission Knowledge: Mosquitoes

23. IPTp – Took SP Twice Last Pregnancy IPTp with SP was provided in the intervention arm at both ANC Clinics and through volunteer Community Directed Distributors. In the control area SP was made available at the clinics.

24. At Ikot Ebok TBA/CDD Brought Her Clients to Receive ANC Services TBA/CDD

25. Attended ANC at Local Government Clinic Community Directed Distributors were trained to refer pregnant women to the ANC clinic. One challenge was ANC card fee charges of N200-300.

26. Used ITN During Last Pregnancy ITN supplies were difficult to obtain. The World Bank Booster support for Akwa Ibom State was delayed and not available throughout the intervention period.

28. Advocacy: State Commissioner, LGA Chairs and Legislators

32. Thank you