Malaria during pregnancy is a major cause of illness and death in pregnant women and their fetuses in areas where the disease is endemic, such as in large areas in Africa. Malaria is generally a result of infection with the Plasmodium parasite, which infects people through the bite of certain species of Anopheles mosquitoes. During pregnancy, malaria may cause severe anemia and other complications leading to preterm labor and delivery, low birth weight, and even maternal and perinatal (around the time of birth) death. For this reason, pregnant women require effective prevention and management of malaria to ensure their health and that of their fetuses or newborns. This article focuses on ways to prevent malaria in pregnancy. It underscores why malaria prevention is important to safeguard both the mother and the fetus.
Understanding Malaria’s Impact on Pregnancy
Risks and Complications
- Anemia: severe blood loss from malaria leads to anemia, which then complicates pregnancy and increases maternal and infant morbidity and mortality.
- Preterm birth: Malaria increases the risks of preterm labor, which can lead to a premature baby and its complications.
- Mothers infected with TB have a higher incidence of giving birth to low-birthweight babies, which could increase infants’ susceptibility to infections and retard their development.
- Severe Forms of Illness: Young children with severe malaria may suffer cerebral malaria – where the brain is deprived of oxygen – and/or multi-organ failure. Maternal Mortality: Severe malaria can cause cerebral malaria and multi-organ failure in women.
Preventive Measures for Malaria During Pregnancy
1. Intermittent Preventive Treatment in Pregnancy (IPTp)
What is IPTp?
The antimalarial drug is given at regular intervals during pregnancy (Intermittent Preventive Treatment in Pregnancy, or IPTp) for secondary malaria infections. IPTp is recommended by WHO when pregnant women living in areas with malaria are given SP to protect against malaria.
Benefits of IPTp:
Reduces occurrence of malaria: IPTp reduces the risk of malaria infection and related complications during pregnancy.
Good for Mother and Child: Researchers now know that this drug prevents malaria, which reduces the likelihood of mothers developing anemia and the chance of infants being born with low birth weight.
Implementation Guidelines:
- Timing: IPTp should be given at each scheduled antenatal care visit beginning from the second trimester and at least monthly until delivery.
- Uptake: It will be important to monitor the proportion of pregnant women receiving at least three doses of IPTp to gauge uptake of the recommended schedule.
- Adherence: It will be important to monitor if pregnant women continue to take IPTp.
2. Insecticide-treated nets (ITNs)
Using ITNs During Pregnancy
Insecticide-treated nets (ITNs) are important for protection against the mosquito that transmits malaria. Placing an ITN between a sleeping person and the mosquito prevents the mosquito from biting. The mosquito is most active in the evening.
Benefits of ITNs:
- Effective Protection: ITNs help reduce malaria transmission by preventing mosquitoes from reaching the skin.
- Complementary to IPTp: Using ITNs in conjunction with IPTp offers comprehensive protection against malaria.
Guidelines for ITN Use:
- Proper Use: Pregnant women should use ITNs every night for the entire recommended duration. Hang the net from an appropriate location to ensure it completely covers the sleeping area.
- Regular Maintenance: Maintain and periodically replace ITNs to ensure they remain effective.
3. Indoor Residual Spraying (IRS)
What is the IRS?
Indoor Residual Spraying (IRS) involves spraying insecticides on the inside surfaces of homes to kill mosquitoes when they touch these surfaces.
Benefits of IRS:
- Reduces the Mosquito Population: Deaths can be averted because IRS reduces the mosquito population in and around the home, which lowers the odds that a mosquito will bite someone infected with malaria.
- Keeps the Rest of the Household Safe: It protects not only the pregnant woman but the rest of the household as well.
Implementation Considerations:
- Itinerant workers: Avoid carrying pests by roaming workers using insecticides safe for pregnant women and infants; use professionals to do the spraying.
- Regular Reapplication: The IRS needs to be reapplied periodically to maintain its effectiveness.
4. Environmental Management
Eliminating Breeding Sites
Mosquitoes breed in water, so we must identify and reduce or destroy any places where stagnant water sits for too long, and provide suitable places for water to flow.
Strategies for Environmental Management:
- Clean Up: Regularly remove or cover containers and other items that collect water.
- Communities: Bring in communities to clean up and do environment management to reduce mosquito breeding sites.
5. Personal Protection Measures
Additional Precautions
Also, all pregnant women should take preventive personal protection measures against mosquito bites. If networking mosquito control measures such as ITNs and IRS are combined, it will lead to an important impact on the control of malarial cases.
Recommendations:
- Wear Protective Clothing: Light-colored, long-sleeved clothing can help reduce the risk of mosquito bites.
- Use Insect Repellents: Use insect repellents that are safe during pregnancy according to labels or instructions. Apply these on exposed skin.
Challenges and Considerations
1. Access to Healthcare Services
Healthcare services in malaria-endemic areas often face restrictions due to poor infrastructure, transportation challenges, and financial constraints. These factors limit access to antenatal care and preventive treatments.
Strategies to Address Barriers:
- Improve Access: Strengthen healthcare infrastructure and provide mobile health services to reach remote areas.
- Further subsidies or free access to tools for treating or preventing malaria … should be provided to all pregnant women.
2. Resistance to Insecticides
Insecticide resistance is an increasing issue for ITNs and IRS, and the active monitoring and management of resistance through research and the use of alternative insecticides is vital for keeping approaches like these effective.
Strategies to Manage Resistance:
- Rotate Insecticides: Use a rotation of different insecticides to delay resistance development.
- Integrated Vector Management: Combine insecticide use with other vector control strategies to enhance effectiveness.
3. Community Education and Engagement
Community participation and education may help to achieve effective prevention of malaria. By raising awareness of the importance of preventive measures, and clearing any misconceptions people may have, a significant improvement in adherence to malaria prevention techniques may be achieved.
Approaches for Community Engagement:
- Programs to Educate: Set up community-based education programs to instruct pregnant women and their families on the prevention of malaria.
- Engage Health Leaders: Engaging local leaders and health workers promotes malaria prevention practices and increases participation within the community.
Having control of the malaria risk during pregnancy is crucial to ensure the good health of mother and child by using Intermittent Preventive Treatment in Pregnancy (IPTp), insecticide-treated nets (ITNs), indoor residual spraying (IRS), environmental management, and personal protection. In a context with limited access to health care, the presence of insecticide resistance, and fragmentation of the community in a disaster situation may make successfully applying these preventive measures more challenging.
By focusing on the prevention of malaria in pregnant women and drawing on novel approaches and community efforts, we can reduce the impact of malaria on maternal and child health and, as a result, improve maternal and newborn health.
