Malaria in pregnancy: its relevance to safe-motherhood programmes

Abstract

Severe anaemia in pregnancy is an important contributor to maternal and perinatal morbidity and mortality. In sub-Saharan Africa severe anaemia in pregnancy is very common, the main causes being iron and folate deficiency, malaria, hookworm infestation and advanced HIV infection. Though most of these causes are preventable, the overall prevalence of anaemia has not changed over many years. This is probably due to a mixture of reasons, including operational problems and inadequate interventions. In addition, a true effect on severe anaemia may have been missed if the only measure taken is of the overall prevalence of anaemia. One cause of anaemia that has been neglected by safe-motherhood programmes has been malaria in pregnancy. In endemic areas, malaria in pregnancy is usually asymptomatic and often associated with a negative peripheral-blood film. Hence the condition needs to be treated and prevented as a matter of routine in all women at risk of infection. A trial conducted in Kenya demonstrated that intermittent treatment with the antimalarial sulfadoxine-pyrimethamine (SP), given a couple of times during pregnancy when women attend for antenatal care, can reduce severe anaemia in primigravidae by 39%. The results of this study demonstrate the important contribution of malaria to severe anaemia in pregnancy in areas of endemic transmission. Intermittent treatment with SP in pregnancy has also been shown to be effective in improving birthweight. Though questions remain about the optimal way to deliver this intervention to different groups of women, we cannot afford to wait for all of the answers. The degree to which malaria contributes to severe anaemia in pregnancy is now clear. In Kenya intermittent SP is now policy for pregnant women from malarious areas. The challenge now is for this regimen to be successfully implemented as part of an integrated programme of anaemia control in pregnancy.

Factors influencing urban malaria: a comparative study of two communities in the Accra Metropolis

“…Self-medication was preferred among the general population, but was practiced more amongst residents of Kaneshie. Shulman 14 observed that self-medication has become popular as a result of the creation of awareness through education on home management and control of malaria. During this study, we observed that people from both sites had adequate information on home management of malaria, especially through awareness programs organised through the media.…”

The epidemiology and burden of Plasmodium falciparum-related anemia among pregnant women in sub-Saharan Africa

“…83 There is also good evidence that severe anemia increases the risk of maternal mortality. 2 If one assumes a maternal mortality ratio for sub-Saharan Africa (excluding southern Africa) of 1,000 per 100,000 live births), 84 and if one assumes that between 8% and 20% of these deaths are caused by severe anemia, 2 this would translate to up to 10,000 malarial anemia-related deaths per year.…”

“…These lacunae have hampered effective lobbying for the inclusion of malaria prevention in the new Safe Motherhood Initiatives. 2 This article reviews the available evidence on the coincidental risks of anemia and malaria among pregnant women in sub-Saharan Africa.…”

Reduction of Malaria During Pregnancy by Permethrin-Treated Bed Nets in an Area of Intense Perennial Malaria Transmission in Western Kenya

“…The Kenyan Ministry of Health introduced national guidelines for the control of malaria in pregnancy, which included the use of intermittent preventive treatment with SP in 1999, after this study was completed. 4 Study design and randomization. This study was conducted within the context of a large community based group randomized controlled trial designed to assess the impact of ITNs on mortality in children less than five years of age.…”

“…1,2 In areas with stable malaria transmission, which represents most of sub-Saharan Africa, the vast majority of infections with Plasmodium falciparum in pregnancy remain asymptomatic, undetected and untreated. 3,4 The major impact of malaria during pregnancy in these regions is caused by persistent or recurrent, predominantly lowgrade, sometimes sub-patent [5][6][7] parasitemia, resulting in maternal anemia and a reduced birth weight. 8 Primigravidae and secundigravidae are most at risk, but in areas with moderateto-intense transmission, or a high prevalence of infection with human immunodeficiency virus (HIV), women of higher gravidity are also affected.…”