MALARIA AND PREGNANCY – THE HIDDEN RISK FACTOR

Pregnant women are one of the groups most at risk from malaria. When a woman is pregnant her immunity is reduced, making her more vulnerable to malaria with dangerous consequences for the mother and her child. At least 24 million pregnancies are threatened each year in Africa and malaria causes up to 15% of maternal anaemia and about 35 % of preventable low birth-weight.

Simple, cost-effective solutions to the problem exist. One is a therapy called preventive intermittent treatment (PIT), which involves the administration of full, curative-treatment doses of an effective anti-malarial drug at predefined intervals during pregnancy. The other is the use of insecticide-treated bed-nets. So far, only two African countries are implementing PIT as a policy: Kenya and Malawi. Other countries, such as Nigeria, Tanzania, Uganda and Zambia, which have successfully lowered taxes on bed-nets to make them more affordable, are in the process of formulating the necessary policies for PIT.

Studies in Kenya and Malawi indicate that rates of placental malaria, severe anaemia and low birth weight can be significantly reduced if women in their first and second pregnancies receive PIT as part of antenatal care. In Malawi, where the therapy has been part of national health policy since 1993, women receiving PIT during their pregnancy had significantly lower rates of placental infection, reduced from 32 % to 23 %, and a lower rate of low birth weight babies, a reduction from 23 % to 10 %.

PIT should be started from the second trimester onwards and should be given at intervals not less than 1 month apart. In areas of East Africa with increasing chloroquine resistance, large-scale trials have shown that intermittent treatment with a single-treatment dose of sulfadoxine pyrimethamine (SP) at the beginning of the second and third trimesters significantly reduces the prevalence of anaemia and low birth weight – the latter being the greatest single risk factor for a baby dying within the its first month of life.

Along with anaemia, malaria infection of the placenta is a major contributor to low birth-weight and premature delivery; major factors in infant illness and death. Low-birth weight is also a major cause of problems in subsequent child development. In areas of unstable transmission, adult women do not have good pre-existing immunity, and when pregnant and infected with malaria may themselves be at risk of severe disease and death.

Sleeping under insecticide treated bed nets remains a solid solution to the reduction of malaria infection and hence reduces the burden of anaemia during pregnancy. At the Abuja Summit, African Heads of State committed themselves to the battle against malaria. Amongst the commitments made, one goal is to provide effective malaria interventions to at least 60 % of women by the year 2005.

To achieve this goal, governments need to adopt and implement policies on anti-malaria drugs and protocols for malaria in pregnancy. Additional efforts need to be made to ensure the availability and affordability of effective anti-malarial drugs and insecticide-treated bed-nets.