Malaria infections, primarily in sub-Saharan Africa, are responsible for the deaths of some 200,000 newborns and 10,000 new mothers each year. The parasitic illness can also cause miscarriage and premature birth, increasing the risk of death. There are low cost, lifesaving interventions to prevent infection, yet, according to a new study, there are significant barriers to implementing them.
For the past 20 years, the World Health Organization (WHO) has recommended that pregnant women in areas with high rates of malaria receive insecticide-treated bed nets and periodic doses of a cheap drug to prevent the disease.
Yet, despite relatively high attendance at clinics for expectant mothers and their newborns throughout sub-Saharan Africa, statistics show that just a little over 21 percent of women are receiving intermittent preventive treatment in pregnancy, or IPT, and fewer than 40 percent of them are being given protective bed nets.
Jenny Hill of the Liverpool School of Tropical Medicine is program manager for a research partnership called the Malaria and Pregnancy Consortium.
Hill says an analysis of 98 studies found a number of barriers to malaria prevention, including unclear policy and guidance from government ministers and health care officials and, at the clinical level, lack of clean water, drug shortages and confusion about procedures for administering IPT.
“They were unclear on when to give it in terms of gestational age of pregnancy and whether it could be given to women on an empty stomach, whether it should be given under observation in clinics, and so on and so forth," she said. "So quite a few of those barriers were around lack of clear policy and guidance.”
The WHO recommends that expectant women receive IPT during regular visits to pre-natal clinic, usually around four times in the course of a pregnancy.
Free intermittent preventive treatment of pregnancy is the policy in 37 countries across the region, according to Hill. Yet, investigators found pre-natal clinics, known as ANCs, posed economic obstacles which discouraged women from coming back.
“When they arrive at the clinic for a first ANC visit they have to register, and that requires a registration fee," she said. "And there are also fees around getting lab tests and around some drugs.”
Hill says countries can reduce the number of deaths and pre-term births due to malaria by ensuring the WHO policy on IPT is fully implemented, earmarking more money for drugs so there’s no shortage, and publicizing the importance of malaria prevention among women at highest risk for the parasitic illness.
“They are very powerful interventions that could go a long way to reducing the burden of malaria and improving the outcomes, both in pregnant women and their infants,” she said.
An analysis of maternal and infant malaria prevention measures is published in the journal PLoS Medicine.