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Table 2 WHO guidelines, national guidelines and implementation coverage on HIV, malaria, TB, prevention, screening and treatment during pregnancy in sub-Saharan Africa

From: Achieving development goals for HIV, tuberculosis and malaria in sub-Saharan Africa through integrated antenatal care: barriers and challenges

Intervention

WHO recommendationsa

Inclusion in national guidelinesb

Coverage (%)c; median (range)

HIV

 Prevention

ART prophylaxis from 14 weeks for PMTCT

Yes

No data

 Screening

HIV testing at first ANC visit

Yes

37.9%

(14.7–52.4%)

 Treatment

ART for mother starting immediately if CD4 count ≤ 350 cells/mm3 for mother’s own health (treatment of HIV and PMTCT)

Sometimes

No data

Malaria

 Prevention

IPTp at each ANC visit from 2nd trimester to delivery, doses ≥ 1 month apart, preferably DOT

Sometimes

6.6%

(0.1–40.9%)d

 

Receive one LLIN through ANC visits

Sometimese

39.7%

(16.0–75.4%)f

 Screening

No guidelines

N/A

N/A

 Treatment

‘Effective case management’ – presumptive treatment of symptoms/fever as per national guidelines

Rarely

No data

TB

 Prevention

TB infection control in PMTCT settings

No

No data

 Screening

TB signs and/or symptoms should be evaluated for active TB

HIV positive pregnant women should be screened for TB during HIV post-test counselling

Rarely

Rarely

No data

No data

 Treatment

All first-line TB drugs (except streptomycin)

No

No data

  1. ANC antenatal care, ART antiretroviral therapy, DOT directly observed treatment, IPTp intermittent preventive therapy in pregnancy, ITN insecticide-treated net, LLIN long-lasting insecticide-treated net, SP sulfadoxine-pyrimethamine, TB tuberculosis, PMTCT prevention of mother-to-child transmission
  2. aAdapted from WHO guidelines [78–85]
  3. bNational Guidelines of the nine countries (Botswana, Tanzania, Uganda, Liberia, Mozambique, Namibia, Nigeria, South Africa, and Swaziland) with accessible guidelines/policies/strategies on Ministry of Health (or similar) websites. The recommended components of ANC vary widely between and within countries, often depending on the level of care (community, district, regional or national) at which ANC is provided. Other components generally included in ANC are blood tests for blood group, anaemia, HIV and syphilis, urine dipstick for protein and glucose, checking blood pressure, providing tetanus toxoid, iron and folic acid, assessment of substance use, and performing nutrition and hygiene counselling
  4. cImplementation coverage data is based on STATcompiler: The DHS Program. Data is median (range) coverage data available for HIV screening (data from four countries) and malaria prevention (IPTp 34 countries; ITN/LLIN 25 countries)
  5. dCoverage is reported as percentage of women receiving 3+ doses of SP/Fansidar, with at least one dose during ANC visit (DOT)
  6. eIncluding any reference to provision of LLINs, ITNs or mosquito nets in general
  7. fPercentage coverage of pregnant women who slept under a LLIN the night before the survey
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BMC Medicine

ISSN: 1741-7015

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