AS the world observes the annual World Malaria Day (WMD) on Wednesday with theme, “Ready to Beat Malaria’’, the high toll on pregnant women and children readily comes to mind.
It is not in doubt that Nigeria has the greatest burden of the disease in Africa.
The National Malaria Strategic Plan 2014-2020 notes that the disease accounts for 11 per cent of maternal deaths in pregnancy; can occur with or without symptoms, can cause anemia in the mother and can lead to miscarriage.
A publication in the African Journal of Reproductive Health, says the Global Technical Strategy for Malaria (2016-2030) has called for a 40 per cent reduction in malaria cases by 2020.
But only half of malaria endemic countries are currently on track to achieve this goal.
Pregnant women and newborns living in malaria endemic areas are, especially vulnerable. Malaria in pregnancy (MiP) continues to play a large role in global maternal deaths.
In 2015, malaria was the third most common cause of death among women of reproductive age in Africa. During that year, MiP was estimated to have been responsible for more than 400,000 cases of maternal anemia and approximately 15 per cent of maternal deaths globally.
Unfortunately, the women who are most vulnerable to malaria are often the least protected against it. MiP also poses a significant threat to newborns because it can cause spontaneous abortion, stillbirth, premature delivery, low birth weight and neonatal death.
During pregnancy, malaria parasites can hide in the placenta and interfere with transfer of oxygen and nutrients to the baby.
The 2018 World Malaria Day (WMD) poses yet another opportunity to weigh the effect of malaria and impact done to eradicate it.
Experts say it is important to tackle malaria in pregnancy, to especially reduce Nigeria’s high maternal mortality rate.
Dr Olawale Oba, an Obstetrician and Gynaecologist in the Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital (LUTH), Idi-Araba, says that malaria is caused by transmission of the parasite plasmodium into the blood stream of humans.
“The parasite is carried by Anopheles mosquito and transferred to the blood of humans when they are bitten by the mosquito.
“The parasite stays in the liver of the human and undergoes some changes till an adult parasite is formed and capable of causing the infestation,’’ he said.
On malaria in pregnancy, he said: “It is largely a maternal disease which could also affect the fetus when the level of parasitaemia becomes considerably high.
“The fetus can be affected because when the parasites are found within the placenta tissue, it is capable of congenital fetal malaria infestation.’’
The gynaecologist said that the burden of malaria in pregnancy was multi-faceted and contributed to about 15 per cent of the causes of maternal anaemia in pregnancy.
“It contributes to about 14 per cent of low birth weight, 30 per cent of preventable low birth weight and 70 per cent of intrauterine growth restriction.
“It also contributes to 36 per cent of premature delivery and eight per cent of infant mortality.
“Its prevalence varies considerably in different location, with about 7.7 per cent prevalence in Lagos, South-Western Nigeria.
“This depends on the level of education among such populace, the level of training of personnel in diagnosing the disease, and the rate of use of hospital facilities,’’ he said.
Also, Prof. Olugbenga Mokuolu, a Pediatrician at the Neonatal Intensive Care Unit, University of Ilorin Teaching Hospital, Ilorin, said that Malaria had grave consequences if not managed well.
Mokuolu said: “The direct effect of malaria contributes significantly to perinatal disease burden in terms of pregnancy losses, prematurity due to preterm labour and prevalence of low birth weight babies.
“The peculiarity of malaria in the new born is related to various dimensions, including malaria in pregnancy, Congenital Malaria and Neonatal Malaria.
“This makes malaria a daily threat with half the world’s population still at risk and there are opportunities to save lives today by reducing transmission and eliminating the disease where possible,’’ he said.
Mrs Itohowo Uko, the Head of Advocacy, Communication and Social Mobilisation in National Malaria Elimination Programme (NMEP), said that Malaria in Pregnancy accounted for 11 per cent of maternal deaths, giving concerns for urgent measures to be made against it.
According to her, the NMEP has a Prevention of Malaria in Pregnancy (MIP) strategy.
“This strategy advocates using Focused Antenatal Care (ANC), The Intermittent Preventive Treatment (IPTp), regular and appropriate use of Long Lasting Insecticide Nets (LLINs) in addition to early diagnosis and prompt treatment in pregnant women,’’ she said.
Dr Tolu Arowolo of the World Health Organisation (WHO), said that early Antenatal Care (ANC) played important role in preventing and managing malaria during pregnancy.
According to her, booking and administering of IPTp are critical in preventing malaria during pregnancy.
“IPTp is based on the assumption that every pregnant woman living in an area of high malaria transmission has malaria in her blood stream or placenta, whether or not she has symptoms of malaria.
“A pregnant woman is supposed to receive a minimum of three doses of Sulphadoxine-Pyrimethamine (SP) before delivery.
“IPTp is to be administered at regular intervals to prevent malaria during pregnancy and the medicine of choice in Nigeria is Sulphadoxine-Pyrimethamine (SP).
“Single dose of three tablets is given to pregnant women when they perceive movement of the baby and at monthly intervals, four weeks apart, up to delivery.
“Women are expected to receive at least three or more doses during one pregnancy and the administration should be by Directly Observed Therapy (DOT).’’
She said: “Every pregnant woman should attend four scheduled visits to ANC.
“The first visit should be before 16 weeks, second visit by 16 weeks to less than 28 weeks, third visit from 28 to less than 32 weeks and the fourth visit from 32 to 40 weeks.
“These personalised visits provide the opportunity for a pregnant woman to be in contact with trained health care providers who can make regular malaria prevention and treatment interventions available to them,’’ Arowolo said.
“ Some of the benefits of sticking to this schedule is that it reduces the number of malaria parasites in pregnant women.
“It provides significant protection against anaemia and maternal mortality, reduces risk of miscarriage, stillbirth and pre-term delivery.
“It has no adverse effects on the safety of the pregnancy and so, it should be adhered to.
“In addition, sleeping under LLINs and good nutrition are good interventions against malaria.’’
According to her, good nutrition helps to nourish the mother and foetus, as well as boost the immune system.
Dr Bartholomew Odio, a gynaecologist, urged the people, especially pregnant women to always request for testing before the treatment of malaria fever.
Odio, who is the Malaria Technical Advisor with Jhpiego Nigeria, an affiliate organisation to John Hopkins University, U.S., advised them to always demand to know the drugs that were given to them.
“When a pregnant woman has fever, she must go to the hospital to have a test done.
“Malaria can be confirmed by a positive Rapid Diagnostic Test kits for Malaria (mRDT) or by Microscopy test done by an expert laboratory scientist.
“Medicines to treat malaria must be in line with the National Treatment Guideline for Case Management at the nearest health facility,’’ Odio advised. (NAN
– Apr. 24, 2018 @ 14:21 GMT