Every year, maternal malaria takes the lives of thousands of pregnant women and their babies. The World Health Organization (WHO) has described malaria as ‘one of the world’s major diseases, particularly in the tropics and the subtropics of Africa, Asia, the Americas, and Oceania.’ Physiological changes during pregnancy increase malaria-related complications in organs and pregnant women as compared to non-pregnant women. This article will discuss the pregnancy danger signs of maternal malaria and outline the ways preventive measures can be put in place to protect both mothers and their babies.
Understanding Maternal Malaria
Malaria is caused by Plasmodium parasites; mosquitoes are the vectors, specifically those belonging to the Anopheles genus. The disease has several forms, but Plasmodium falciparum is considered the most virulent and deadly, possibly the most dangerous form affecting pregnant women.
Impact on Maternal Health
Pregnancy, with its related immunologic changes, puts infected women at high risk of becoming very sick with malaria. Pregnancy creates a state where mothers experience suppression of their immune system and increased susceptibility to infections. Though pregnancy is generally a happy time for women, this immunological response puts pregnant women at high risk for many infections. Malaria can cause anemia, a severe form of malaria that damages the kidneys, acute respiratory distress syndrome, and – in the worst cases – coma.
Impact on Fetal Health
Maternal malaria can also harm the fetus. The placenta may allow the parasite to enter the fetus, leading to a variety of adverse outcomes:
- Low Birth Weight: Malaria during pregnancy can cause low birth weight, which in turn causes an increased mortality for the infant at birth, and raises the risk for the child to develop morbidities over the long term.
- Preterm Birth: Malaria can induce preterm labor, leading to premature birth and associated complications.
- Stillbirth: Severe cases of malaria can result in stillbirth or miscarriage.
Preventive Measures for Maternal Malaria
To prevent malaria during pregnancy, a range of interventions both medical and community are essential. Here are several ways to do that effectively
1. Antenatal Care and Malaria Screening
Routine antenatal care is essential to ensure early diagnosis and management of malaria in pregnancy. Pregnant women should attend regular antenatal clinics to monitor their pregnancy progress and detect malaria early. Healthcare providers first identify malaria infections using a rapid diagnostic kit or microscopy.
2. Intermittent Preventive Treatment (IPT)
Another cornerstone of malaria prevention during pregnancy is intermittent preventive treatment (IPT), which involves administering antimalarial drugs at specific intervals throughout pregnancy, regardless of the woman’s infection status. According to WHO recommendations, IPT with sulfadoxine-pyrimethamine (SP) is the preferred regimen for use in settings where P falciparum is the dominating strain and where there is little or no drug resistance.
3. Insecticide-treated nets (ITNs)
Mosquitoes are the vectors of the malaria parasite, which infects humans through a mosquito bite. Therefore, the best way to prevent malaria is by preventing mosquito bites. Pregnant women in particular should be advised to use ITNs because malaria is a major killer of pregnant women. Infant children are also highly vulnerable to malaria.
ITNs are effective in preventing the entry of mosquitoes into a sleeping space and providing a protective barrier between humans and mosquitoes. ITNs are also treated with insecticides that kill the insect or repel it from entering the sleeping space.
4. Indoor Residual Spraying (IRS)
Indoor Residual Spraying (IRS) involves spraying the interior walls of buildings in an area with a long-lasting insecticide to control malaria transmission by killing mosquitoes (photo of a sprayer at work in India, by the World Mosquito Program). This method is effective for controlling malaria vectors when deployed over large areas and used with other insecticides. Its use should be encouraged in high-endemic settings.
5. Education and Community Engagement
We need to establish awareness programs that focus on malaria prevention and the benefits of attending antenatal clinics. These initiatives will educate pregnant women and their families on how to prevent malaria, recognize its symptoms, and seek timely medical attention. We can further develop community engagement initiatives to actively promote the use of insecticide-treated nets (ITNs), Intermittent Preventive Treatment (IPT), and other preventive measures. These initiatives will ensure that everyone is informed and empowered to take action against malaria, fostering a collective commitment to health and prevention in the community.
6. Improving Access to Health Services
Pregnant women should have access to high-quality health care, for instance, facilities should be provided with the capability of testing and treating malaria infections, as well as to provide preventive services. Ideally, health care should have infrastructure in more remote areas, or underserved areas.
7. Research and Innovation
Efforts to develop new means of treating and preventing maternal malaria must continue to unfold. Novel diagnostic technologies, treatments, or preventive measures can help to improve malaria control programs. Research collaboration between researchers, governments, and international bodies is vital to continue marching towards malaria control.
Challenges in Preventing Maternal Malaria
Despite effective preventive measures, the successful control of malaria among pregnant women faces several obstacles:
1. Drug Resistance
Resistance to antimalarial drugs, including resistance to sulfadoxine-pyrimethamine (the most common IPT drug) is one of the most serious challenges for IPT programs. Ongoing surveillance of drug efficacy and changing treatment guidelines accordingly are essential in addressing issues of resistance.
2. Inadequate Health Infrastructure
Data from areas hard hit by malaria show that health infrastructure is too poor to meet the needs of women seeking antenatal care. So, strengthening health systems and improving service delivery, across all levels, are equally important in helping women get the care they need during pregnancy, and to prevent malaria.
3. Socioeconomic Factors
Socioeconomic factors, including poverty and limited educational opportunities, can come into play, as can access to preventive measures and health care services. By addressing some of these factors with effective community-based interventions or social support programs, it might be possible to improve malaria outcomes.
4. Cultural Beliefs and Practices
Cultural norms and practices can affect the willingness of individuals and communities to adopt and use malaria prevention strategies. Community engagement can help to deconstruct the cultural barriers to take-up.
Maternal malaria is a major public health problem, calling for multifaceted preventive measures to safeguard the health of pregnant women and their fetuses. These measures include antenatal care, intermittent preventive treatment with antimalarials, insecticide-treated nets, and indoor residual spraying. Combining such measures and addressing drug resistance, health infrastructure (eg, insurance, professional training, laboratory tests, etc), and sociocultural issues will improve malaria control.
An effective effort to accomplish this will involve multiple participating actors, and thus require cooperation among governments and international health agencies, additional efforts by healthcare providers to provide access to needed support and medicines, the involvement of researchers, and sustained support by communities and community leaders. Maternal malaria counts as one of the old diseases made new. It is not insurmountable, and should not be accepted as an insoluble mystery. Given sustained global efforts in support of both malaria prevention and prenatal care, and a ramping up of research into this area, it shouldn’t be beyond our means to effect greater declines in cases of maternal malaria, and hopefully reduce some of the burden that haunts the childhoods and futures of children.
