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West Africa Network Against Malaria During Pregnancy (RAOPAG; Réseau d'Afrique de l'Ouest Contre le Paludisme Pendant la Grossesse)

CDC has been working with a variety of partners, including the World Health Organization, JHPIEGO (an affiliate of Johns Hopkins University), UNICEF, and Ministries of Health to strengthen subregional efforts to control malaria during pregnancy in West Africa. In March 2002, the first Subregional Workshop on the Prevention of Malaria During Pregnancy in Francophone West Africa was held in Ouagadougou, Burkina Faso. At that meeting, data from 3 studies on malaria in pregnancy (Bénin, Burkina Faso, and Mali), on which CDC was a collaborator, were presented. Other countries represented (Côte d'Ivoire, Sénégal, and Togo) laid out their malaria and antenatal care programs for discussion.

Based on the data presented, which showed that the burden of malaria during pregnancy remained elevated in the subregion, and that intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp/SP) was more efficacious than weekly chemoprophylaxis with chloroquine, many countries at the meeting wrote action plans calling for pilot experiences with IPTp/SP or for outright policy change.

The 6 countries at the meeting also committed to form a network against malaria during pregnancy. The network is called Réseau d'Afrique de l'Ouest contre le Paludisme pendant la Grossesse (RAOPAG) and it held its constitutive meeting in October 2003 in Cotonou, Bénin, the site of the current RAOPAG secretariat (http://www.raopag.org).

During the meeting, the countries present decided that the network membership should be opened to all member countries of the Economic Community of West African States (ECOWAS): Bénin, Burkina Faso, Cape Verde, Côte d'Ivoire, The Gambia, Ghana, Guinea, Guinea Bissau, Liberia, Mali, Mauritania, Niger, Nigeria, Sénégal, Sierra Leone, and Togo.

In October 2005, RAOPAG held its 2nd annual meeting in Cotonou, Bénin. Nine member countries participated in the meeting. Among partners present were CDC, JHPIEGO, USAID/West Africa Regional Program, and WHO. The secretariat reported that all member countries had adopted IPTp as a national policy and were at different stages of implementation. Some member countries had achieved countrywide implementation of IPTp. Sénégal, a member country with countrywide IPTp coverage, shared its IPTp implementation experience with members. Sénégal's key actions included free provision of SP through antenatal clinics and the administration of SP as directly observed therapy (DOT).

There is already evidence that the cross border collaboration is bearing fruit in West Africa. A number of other countries have now joined RAOPAG, including the Gambia, Guinea, Mauritania, Madagascar, Niger, and Sierra Leone. Other countries have also expressed an interest in joining, including Ghana, Liberia, and Nigeria. Côte d'Ivoire, Ghana, Mali, and Sénégal have all formally adopted IPT with SP as a central strategy in the prevention of malaria during pregnancy. Bénin, Burkina Faso, and Niger are in the process of pilot testing the IPT strategy.

CDC is supportive of subregional networks.The networks bring together country programs within their subregion to share program experiences. They offer a forum to discuss problems specific to the subregion, set the research agenda for the subregion, and enhance resource utilization. Ultimately, such “South-South” collaboration builds a sustainable foundation for technical assistance and capacity building.