Protecting pregnant women from malaria – a missed “quick win”

In the eight years since we commemorated the first World Malaria Day, millions of women and children have continued to die from a disease that is both preventable and treatable. Malaria takes the lives of more than 1,200 children under the age of 5 every day – the staggering equivalent of 50 children every hour.

I started to focus on malaria during pregnancy while working in Rwanda, and saw an alarming trend: many pregnant women were harbouring the malaria parasite, but most of them were asymptomatic. They neither suspected having malaria nor were they trying to find out if they were infected.

The truth is, women are particularly vulnerable to infection with the malaria parasite during their pregnancies because their immunity wanes. During this time, infection can be life-threating for both mother and baby. Every year there are an estimated 10,000 maternal deaths as well as 75,000-200,000 deaths of children under the age of one throughout sub-Saharan Africa.

©UNICEF/NYHQ2009-0462/Gangale
A pregnant woman in Nigeria holds a packet of sulfadoxine pyrimethamine. ©UNICEF/NYHQ2009-0462/Gangale

The tragedy is that these deaths are preventable with cheap and simple interventions: complete administration of an effective anti-malarial during antenatal care (ANC) visits and sleeping under an insecticide-treated net (ITN).

The World Health Organization recommends that women receive four doses of a preventative anti-malarial medication (sulfadoxine-pyrimethamine, SP) during their antenatal care visits which is referred to as Intermittent Preventive Treatment during pregnancy (IPTp). The medication is incredibly cheap: it costs 4 cents a tablet; 12 cents per dose, less than 50 cents to protect a woman throughout her entire pregnancy with the full four doses.

In 2014 in sub-Saharan Africa, a striking 28 million babies and many more unrecorded pregnant women did not receive IPTp. The effects of not administering this simple treatment include: low birth weight, pre-term or stillborn babies, anemia in both mother and child, maternal haemorrhage, or worse, maternal death.

In addition, rural women are at a distinct disadvantage: only 4 in 10 pregnant women living in rural areas of sub-Saharan Africa receive the recommended four antenatal care visits, compared to almost 7 in 10 women living in urban areas. In some countries the disparities in coverage are even worse: in Togo for example, 2 in 3 urban women receive IPTp, compared to only 1 in 3 women from the countryside.

©UNICEF/SLRA2013-0288/Asselin
Insecticide-treated nets, especially long-lasting insecticide-treated nets, are one of the most effective and cheapest methods of protecting pregnant women, their children and their families. ©UNICEF/SLRA2013-0288/Asselin

Insecticide-treated nets (ITNs), especially long-lasting insecticide-treated nets (LLINs) are one of the most effective and cheapest methods of protecting pregnant women, their children and their families – costing only $5 including delivery – less than a cup of specialty coffee. The world recently celebrated the delivery of the 1 billionth bed net*. However this wonderful number obscures some great disparities, especially when it comes to getting pregnant women under a bed net.

For example, while the Democratic Republic of the Congo (DRC) has made the incredible stride of raising its coverage of pregnant women sleeping under an insecticide net from 7% in 2007 to 60% by 2014, Congo its immediate neighbor across the river has barely progressed from 4% in 2005 to 21% by 2012**. The great difference is funding and investment – the DRC has received substantial malaria funding from donors particularly The Global Fund to Fight AIDS, Tuberculosis, and Malaria, whereas Congo is languishing as a donor orphan.

Back in the days when I was based in Rwanda and still today, some of my most frustrating moments are knowing that women are turned away from receiving care for themselves and their babies. The reasons vary – at times there are no health workers, or even when workers are present they do not know how to properly or completely administer IPTp.

In other instances, health posts are stocked out of drugs, and/or lack an adequate supply of bed nets to ensure that women are covered throughout their pregnancies. When countries are asked what their biggest obstacles are, their responses are nearly unanimous – the problems are stock-outs of drugs, lack of funding to retrain workers, and financial barriers preventing women from attending ANC visits***.

©UNICEF/PFPG2014-1177/Hallahan
©UNICEF/PFPG2014-1177/Hallahan

Despite these obstacles, the desire to eliminate malaria within a generation has started to coalesce over the last few years. Some would call it a “fever dream” but as a global community we are taking those first steps on the road to a world free from malaria.

I firmly believe in UNICEF’s mandate that every child has the right to a prosperous, healthy life and every expectant mother should have the opportunity to provide that life for her child. From the UNICEF perspective I would like that to start with protecting pregnant women and children from malaria – it is their right and should be our commitment to the future generation.

Valentina Buj is a Global Malaria Advisor at UNICEF

*However, only ~617 million of these nets are viable for use.  Millions of nets come to the end of their useful lifespan every year and need to be replaced.  On average ~200 million new nets are needed throughout sub-Saharan Africa to meet demand.

**Correction: Updated 13:18, 27 April 2015 due to reflect correct figures.

***This information was provided by the following UNICEF country offices: Burkina Faso, Cameroon, Central African Republic, Congo, Côte d’Ivoire, Democratic Republic of the Congo, Madagascar, and Togo.

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