Protect pregnant women and children from malaria

> Lazarus Sauti

Millions of women as well as children under the age of five continue to die from malaria – a disease that is both preventable and treatable with cheap and simple interventions: complete administration of an effective anti-malarial during antenatal care (ANC) visits and sleeping under an insecticide-treated net (ITN).

Valentina Buj, the United Nations Children’s Fund (UNICEF) Global Malaria Advisor, says:

“Women are particularly vulnerable to infection with the malaria parasite during their pregnancies because their immunity wanes. During this time, infection can be life-threatening for both the mother and child,” she said, adding that “rural women are at a distinct disadvantage: only 4 in 10 pregnant women living in rural areas of sub-Saharan Africa receive the recommended four antenatal care visits, compared to almost 7 in 10 women living in urban areas.”

The World Health Organisation (WHO), a specialised agency of the United Nations (UN) that is concerned with international public health, also says every year there are an estimated 10 000 maternal deaths as well as 75 000 to 200 000 deaths of children under the age of five in Africa, and these deaths are caused by malaria.

Sharing the same sentiments, Centers for Disease Control and Prevention (CDC), a federal agency that conducts and supports health promotion, prevention and preparedness activities in the United States with the goal of improving overall public health, notes that malaria infection during pregnancy can have adverse effects on both mother and fetus, including maternal anemia, fetal loss, premature delivery, intrauterine growth retardation, and delivery of low birth-weight infants (<2500 g or <5.5 pounds), a risk factor for death.

Further, and according to a study in mice done to investigate how malaria might affect unborn children, and published in the journal PLOS Pathogens on 24 September 2015, babies whose mothers contract malaria during pregnancy could suffer later problems, including depression and learning difficulties.

The study titled “Experimental malaria in pregnancy induces neurocognitive injury in uninfected offspring via a C5a-C5a receptor dependent pathway”, found that unborn babies whose mothers were infected with malaria had lower levels of the substances needed for normal brain development and function.

The reduction was thought to be caused by excess activation of an immune response in the mother that is used to tackle malaria, but that also appears to interfere with the production of these substances, the researchers say.

As a result of their mothers’ malaria infection, the mice developed symptoms of depression and cognitive impairment after birth, such as memory problems and reduced social interaction, the study says.

“We need to confirm the findings in humans,” says Kevin Kain, co-author of the study from the University of Toronto in Canada.

However, another study on a South Pacific island, says building strong family and community links should be a vital part of strategies not only to eliminate malaria in developing countries, but to protect pregnant women as well as children from malaria. The paper, published on 31 July 2015 in Malaria Journal, found that areas with strong communities have an advantage when it comes to tackling malaria.

“Health messages are distributed quicker and adhered to more strictly when spread through community sources, such as religious groups and village leaders.

“Close-knit families mean people are more likely to have access to money to pay for malaria treatment, and have less trouble getting lifts and help with reading advice about malaria prevention,” the researchers found.

Maternal health researcher, Rehana Abdus Salam, who studies malaria treatment, agrees.

“Community and family involvement is an ‘essential component’ of malaria-control because measures such as using insecticide-treated nets require behaviour change that must be implemented in households,” Salam said.

To encourage engagement on malaria treatment and prevention, Noriko Watanabe, a parasite researcher at Osaka City University Graduate School of Medicine in Japan, also said governments should focus more on local communities.

“If people are aware of their knowledge and resources, they will actively engage in decision-making,” she said.

As for Buj, governments in developing countries should be committed to the future generations; thus, the first step is protecting pregnant women and children from malaria.

Strong political will as well as financial commitments, she adds, are needed to develop robust health systems as well as effectively tackle malaria.

“Political and financial commitments are required to develop more efficient health systems in addition to strategies specifically tailored to combat malaria,” she said. “Governments must also increase domestic investment in malaria control.”

Buj also said mosquito nets should be used as a priority by pregnant women and children under five years of age, a fact supported by the WHO.

The leading health organisation also recommends that women receive four doses of a preventative anti-malarial medication (sulfadoxine-pyrimethamine, SP) during their antenatal care visits which is referred to as Intermittent Preventive Treatment during pregnancy (IPTp).

October 2015
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