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 Are pregnant women more vulnerable to malaria?
Yes! Studies have found that women have decreased resistance to
malaria during pregnancy. That is why so many pregnant woman in
Zambia and the rest of Africa have malaria; according to WHO (1991),
60% of women pregnant with their first child in Africa are infected.
During pregnancy malaria episodes are more frequent and infections
are more severe (McGregor, et. al, 1983; Brabin, et. al, 1983).
In most endemic areas of the world, including Zambia, pregnant women
are the main adult risk group for malaria. The burden of malaria
infection during pregnancy is caused mostly by P. falciparum, the
parasite causing 95% of Zambia’s malaria.
What happens to a pregnant woman and/or her foetus when infected with
malaria?
In high transmission areas like Zambia, most of the cases of malaria
in pregnancy do not have symptoms. A pregnant woman may not even know
that she is infected. (McDermott, et.al, 1988). Malaria in pregnancy
increases the chance of maternal anemia, abortion, stillbirth,
premature birth, intra-uterine growth retardation, and low birth weight (Steketee,
et. al, 1996; Menendez, et. al, 1995).
For this reason Intermittent Presumptive Preventative Treatment (IPT;
see below) is essential for all pregnant women.
Can pregnant women with malaria receive treatment for the disease?
Yes! If women do develop symptoms of malaria, they must be treated
immediately to help prevent malaria-related adverse pregnancy
outcomes.
How can malaria during pregnancy be
prevented?
There are three main approaches for malaria prevention and control
during pregnancy:
• intermittent preventive treatment (IPT)
• insecticide treated nets (ITNs)
• case management of malaria illness
What is IPT?
Intermittent preventive treatment (IPT) involves providing all
pregnant women with
preventive treatment doses of an effective anti-malarial drug during routine antenatal clinic visits.
Approximately 60% of pregnant Zambian women make multiple antenatal
clinic visits, providing a major opportunity to address malaria prevention
and other health issues facing pregnant and postpartum women.
In Zambia, this IPT consists of monthly doses of SP (Fansidar) during the
second and third trimesters. This approach has been shown to be safe,
inexpensive, and effective. (For more information on IPT, see January 2004 issue of the Zambia RBM
Newsletter -- available electronically on this website).
Zambia
National Policy for IPT
Women should
receive three SP doses one month after quickening
(16 weeks).
- SP doses/full
doses of three tabs: 1st after 16 weeks (quickening), 2nd
at least one month later and 3rd a least a month after
that.
Uncomplicated Malaria in Pregnancy:
-First line treatment
- Quinine in the 1st
trimester (SP is an antifolate which could have a possible impact on folic acid levels. With already high threats of anemia in
pregnancy, it is best to receive quinine treatment.)
- SP in the 2nd and 3rd
trimesters of pregnancy
- If there are no others options
available Coartem can be given under supervision in the 2nd and 3rd trimesters.
This requires follow up of pregnant women
until delivery to monitor outcome of pregnancy and birth of child.
Severe Malaria
-Quinine is the drug of choice
irrespective of gestation. MUST be injected until can receive orally.
Use of ITNs by pregnant women
Insecticide-treated nets (ITNs) decrease both the number of malaria
cases and malaria death rates in pregnant women and their children by
stopping mosquitoes from biting and killing them if they land on the
net. Pregnant women should use ITNs from as early in pregnancy as
possible. Use should be encouraged for women throughout
pregnancy, during the postpartum period, and when she is not pregnant.
In Zambia, NGOs and private partners are providing nets for sale
through the commercial market and subsidy. In addition, using
vouchers, subsidized nets can be procured from health centres
during ante-natal clinics. The voucher programme is intended to
support the social marketing and lobbying that are helping to
encourage pregnant women to use ITNs.
In Zambia, PSI local partner,
SFH
(Society for Family Health) is the national implementer of the
malaria in pregnancy programme.
Additional
Resources
-WHO Lives at Risk:
malaria in pregnancy
-Malaria
Site: Malaria in pregnancy
-Malaria
Journal 2005:
Intermittent
preventive treatment of malaria during pregnancy: a qualitative study
of knowledge, attitudes and practices of district health managers,
antenatal care staff and pregnant women in Korogwe District,
North-Eastern Tanzania
-CORE
Working Group Technical Update 2004:
Malaria in Pregnancy: Latest research,
emerging issues, promising interventions & programmatic experiences
from Burkina Faso & Tanzania.
-CDC:
Malaria during pregnancy: data driven best practices
-Postgraduate
Research Training in Reproductive Health 2004: includes
information on lifecylce of plasmodium, immunity, physiological
affects of malaria on pregnancy, labor, and after, and treatment.
-New
England Journal of Medicine 31 Aug, 2000: Rolling Back Malaria In
Pregnancy
-The
Lancet
- Vol. 363, Issue 9424,
5 June 2004, Pages 1860-1867:
Impairment of humoral immunity to Plasmodium falciparum
malaria in
pregnancy by
HIV infection
-AIDS:
Volume 18(7)
30 April 2004
pp 1051-1059:
The effect of Plasmodium falciparum
malaria on peripheral and placental HIV-1 RNA concentrations in
pregnant Malawian women.
-JHPIEGO:
Check out the Johns Hopkins affiliate pulications section for malaria
during pregnancy multimedia tutorials. |
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