In Africa, 30 million women living in malaria-endemic areas become pregnant each year. For these women, malaria is a threat both to themselves and to their babies, with up to 200 000 newborn deaths each year as a result of malaria in pregnancy.
The problem has long been neglected, but new approaches and commitment offer hope for reducing the burden of malaria in pregnancy and improving the health of mothers and newborns.
Protecting pregnant womenBased on available evidence, WHO recommends a three-pronged approach to the prevention and management of malaria during pregnancy:
- Insecticide-treated nets (ITNs)
- Intermittent preventive treatment
- Effective case management of malarial illness.
In areas of low or unstable malaria transmission, pregnant women have low immunity to malaria and a two- to threefold higher risk of severe malarial illness than non-pregnant women. In these areas, use of ITNs and prompt case management of pregnant women with fever and malarial illness are the main strategies for malaria prevention and treatment.
Delivering malaria interventions through antenatal careAbout two thirds of pregnant women in sub-Saharan Africa attend antenatal clinics at least once during pregnancy, presenting a major opportunity to prevent and treat malaria. The aim is to deliver this package - especially intermittent preventive treatment - to pregnant women as part of their routine antenatal care, using and strengthening the existing antenatal care infrastructure. This strategy is now an integral part of WHO’s “Making Pregnancy Safer” initiative, which aims to strengthen antenatal services and provide preventive measures, treatment, care and counseling to improve all aspects of health in pregnant women and their newborns.
Overcoming challengesAt the first African Summit on Malaria in Abuja, Nigeria, 2000, African heads of state committed to providing effective malaria interventions to at least 60% of pregnant women by 2005. To achieve this goal, several challenges must be overcome:
- Delivery of malaria interventions through antenatal clinics in Africa needs to be widespread. This approach is currently the exception rather than the rule. However, large-scale programmes are now being developed, and several African countries are reviewing their policies in light of the WHO recommendations. A few have already adopted the strategy as policy.
- Major issues of concern still have to be addressed. These include drug resistance and the safe and appropriate use of different antimalarial drugs during pregnancy. As resistance to antimalarial drugs increases, the challenges of treatment and prevention of malaria among pregnant women become greater. Research in this area is therefore a high priority. There is also a need for research to develop prevention strategies for women residing in areas of low or unstable transmission, and in areas where the Plasmodium vivax type of malaria is a problem in pregnancy.
- Pregnant women who do not attend antenatal clinics or who attend only for the first visit or too late during pregnancy need to be reached. New strategies will be required to encourage these women to attend antenatal care early and consistently.