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     2001-2010 United Nations Decade to Roll Back Malaria
What Is Malaria? PDF version |  Malaria in Africa  PDF version |  Malaria in Pregnancy PDF version |  Insecticide-Treated Mosquito Nets PDF version |  Children and Malaria PDF version |  RBM and Complex Emergencies PDF version |  Epidemic Prediction and Response PDF version |  Facts on ACTs PDF version |  Economic Costs of Malaria PDF version |  Monitoring and Evaluation PDF version

Malaria in pregnancy

Malarial infection during pregnancy is a major public health problem in tropical and subtropical regions throughout the world. In most endemic areas of the world, pregnant women are the main adult risk group for malaria. Malaria during pregnancy has been most widely evaluated in Africa south of the Sahara where 90% of the global malaria burden occurs. The burden of malaria infection during pregnancy is caused chiefly by Plasmodium falciparum, the most common malaria species in Africa. The impact of the other three human malaria parasites (P. vivax, P. malariae, and P. ovale) is less clear. Every year at least 30 million pregnancies occur among women in malarious areas of Africa, most of whom reside in areas of relatively stable malaria transmission.

The symptoms and complications of malaria during pregnancy differ with the intensity of malaria transmission and thus with the level of immunity the pregnant woman has acquired. While these settings are presented as two distinct epidemiologic conditions, in reality the intensity of transmission and immunity in pregnant women occurs on a continuum, with potentially diverse conditions occurring within a country.

Despite the toll that malaria exacts on pregnant women and their infants, until recently this was a relatively neglected problem, with less than 5% of pregnant women having access to effective interventions. The promising news is that during the past decade potentially more effective strategies for the prevention and control of malaria in pregnancy have been developed and demonstrated to have a remarkable impact on improving the health of mothers and infants. Malaria prevention and control during pregnancy has a three-pronged approach:

  1. intermittent preventive treatment;
  2. insecticide-treated nets; and
  3. case management of malaria illness.

The fact that in most African countries over 70% of pregnant women make multiple antenatal clinic visits provides a major opportunity for prevention of malaria, along with other priority diseases affecting pregnant women.

In areas of stable P. falciparum transmission, prevention of asymptomatic malaria infection through a two-pronged approach of IPT and ITNs will result in the greatest health benefits.

In areas of unstable P. falciparum transmission, non-immune pregnant women exposed to malaria require prompt case management of febrile illness. Although at present there are no fully effective tools to prevent malaria among non-immune women, ITNs will decrease exposure to infective mosquito bites and thus would be expected to provide benefit in decreasing symptomatic infections. Essential elements of the antenatal care package should, therefore, include malaria diagnosis, where available and needed, and treatment with antimalarial drugs that have an adequate safety and efficacy profile for use in pregnancy.

Roll Back Malaria, in partnership with Making Pregnancy Safer, has brought a new emphasis to the burden of malaria in pregnant women within malaria control efforts. However, there remain obstacles to implementing effective programmes and reaching women who will benefit the most from them, particularly high risk adolescents in their first pregnancies. Many women in Africa lack access to medical care and may have limited access to effective tools such as ITNs, especially in remote areas. Delivery of cost-effective malaria prevention to pregnant women will require:

The prize for doing so will be safer pregnancies and a reduction in newborn deaths in these settings.

 

Roll Back Malaria is a global partnership initiated by WHO, UNDP, UNICEF and the World Bank in 1998. It seeks to work with governments, other development agencies, NGOs, and private sector companies to reduce the human and socio-economic costs of malaria.
 
Roll Back Malaria, World Health Organization, 20 Avenue Appia, CH-1211 Geneva 27, Switzerland
Tel: +41 22 791 2891 E-mail: inforbm@who.int

www.rollbackmalaria.org