A Looming Threat for Pregnant Women

Malaria in Africa: A Looming Threat for Pregnant Women

Lay summary

Malaria is a parasitic disease that is caused by the female anopheles mosquito. It is a disease that is not transmitted from one person to another; these symptoms present themselves in form of high temperatures, painful joints and fever. Malaria is very common in pregnant women and children below the age of five. It is a life threatening tropical disease that cause by the caused by a protozoan parasite belonging to the to the Plasmodium genus. The disease exists in different types which include; P. falciparum, P. vivax, P. ovale, P. malaria and P. knowlesi

The disease is most prevalent in tropical and subtropical regions of the world, making Africa the most affected continent. These endemic countries have the most severe cases that require attention failure to which results in multiple deaths. Children below five years (especially those below 12 months) are at a greater risk of mortality. Pregnant women suffering from malaria experience complications such as low birth weight or still born babies.

The world health organization (WHO) has programs in place that distribute drugs and treated mosquito nets that protect people from infection. Currently all pregnant women receive free mosquito nets to protect them from contracting the disease. A vaccine that is partially effective is being piloted in some of the African countries to help regulate on the infection, as these parasites have developed resistance to the common drugs that are used in treating the disease. This review discusses malaria as a looming threat for pregnant women in Africa and the strategies that have been put in place to treat and prevent malaria infection in pregnant women in Africa, with specific reference to sub Saharan countries.

Introduction

Malaria is a plasmodium parasitic disease that is spread when human beings are bitten by the female anopheles mosquito that causes the virus (5). These parasites in most cases are referred to us malaria vectors, which exist in five different forms which include P. falciparum, P. vivax, P. ovale, P. malariae and P. knowlesi, the first two are considered the most dangerous of all and result into death when not treated effectively. According to WHO, 2018 recorded more than 99 % of malaria cases of P. falciparum, with 50% of this cases emerging from Africa (9). In people with low immunity, the symptoms usually appear 10-15 days after infection, with headache, fever and chills presenting themselves as mild and difficult to recognize. In Africa, people have developed partial immunity that allows for symptoms not to manifest (10). In 2019, malaria cases in sub Saharan Africa results to multiple death cases recorded over the years. Chronic symptoms can progress to anemia and jaundice, and if not treated can then lead to severe kidney failure, seizures and mental confusion (9). The world health organization has recommended for three doses of the intermittent preventative treatment (IPT), Sulfadoxine-pyrimethamine (SP) injection to pregnant women in high risk areas in their second and third trimester of their pregnancy. However, despite the efforts put in place by WHO to control and minimize the risk of infection, statistics show that only 25 % of the pregnant women receive one of these doses let alone three(10). The failure of WHO to address this challenge calls for more integrated measure that would help remedy the current status of malaria infection in Africa.

Epidemiology

Malaria has presented itself as the most important public health issue of concern in the recent decades (5). Compared with other diseases it is the most leading case infant and adult mortality rates in sub Saharan Africa. Pregnant women and children below five years are the most vulnerable when it comes to malaria. Back in 2004, it was estimated that more than 107 countries were reported to have malaria cases (7). More than 3.2 billion people worldwide suffer the risk of being infected by the disease. The world health organization has tabulated numbers to approximately 350-300 clinical cases of malaria occur every year with more than 1 million people dying from the pandemic (6). In Africa, these cases are widely distributed across other countries, with sub-Saharan Africa recording the most cases and deaths. It is estimated that 200,000 newborn deaths occur every yeah as a result of infection during pregnancy period. Africa accounts for more than 60% cases in infection with more than 80% of deaths as a result of malaria infection (6). It is estimated that 1 in 5 of the cases in sub-Saharan Africa are malaria related deaths. The most common principle vector of malaria in sub Saharan Africa is the P.falciparum causes 93% of the infections (8). The anopheles gambiae and anopheles funestus are the two most efficient vectors that transmit the disease.

Why pregnant women are at risk?

Individuals who have survived repeated malaria infections through their lifetime have gained partial immunity to the disease (3). Women are the most exposed to the disease as their immune system undergoes rapid changes during pregnancy. These women lose their immunity partial y to malaria, with both the mother and the foetus being affected (4). These may result into anemia like conditions, still born babies and low birth weight and death to the mother as a risk factor. Malaria infection is adverse to women during their first and second trimester and the condition becomes even more adverse to those pregnant women that are infected with HIV. In pregnant women, placental malaria is determined after birth where the placenta is placed under a micro scope and red blood cells observed will determine if the mother was infected during pregnancy (3). P. falciparum in a common type of parasite in pregnant women, hence leading to the failure of the placenta to perform its functions hence death of the fetus. These effects vary depending on the level of transmission, with areas that are prone to malaria having higher levels of transmission. Women have developed immunity in higher transmission areas which prevents the severity of the infection.

Interventions and treatment

Women in their second trimester receive the intermittent preventative treatment that act as a strategy that reduces the risk of infection (1). These women are given treated mosquito nets on their first visit to the clinic, sleeping under this net prevents mosquito bites; hence reduce the occurrence of the disease (2). Women are advised to seek immediate care where they have fever and malaria related symptoms. Two patients of African origin were given a diagnosis of malaria, the P. falciparum type in Netherlands without a travel history (6). Patient I who was from Liberia aged 23 after physical examination; he did not appear ill and had a normal blood pressure. After examining the patient blood, it was found out that he was infected with P. falciparum malaria after which he was treated for three days and fully recovered. Patient 2 was aged 34 and from sierra Leon he had malaria symptoms and travel history suggested that he visited malaria prevalent countries (6). After physical examination, the patient did not appear sick with a normal blood pressure and pulse. Lab test results showed no trace of malaria but his hemoglobin levels were low suggesting that the patient was suffering from anemia. The study showed that malaria infections are rarely considered in the diagnosis of different patients exhibit fever like conditions. Hence malaria is a traveler’s disease only when patients are travelling from Africa.

Conclusion

Malaria has presented itself as a threat in most regions of the world with most of the cases in Africa, specifically sub-Saharan Africa. The condition arises when a female anopheles mosquito bites human beings. There are five types of malaria presented which include; P. falciparum, P. vivax, P. ovale, P. malariae and P. knowlesi with the first two type’s common in Africa. Women and children below five years are the most affected, with 90% of the deaths occurring in sub Saharan Africa. Prevention has been established to be a hard task since resources are scarce, leading few drugs and nets distribute to these regions. Spraying with insecticides and use of treated mosquito nets reduces acts a preventative measure. There is no probable vaccination for the disease although studies have continued to unveil more on the real defense against the parasite.

Reference

1. A strategic framework for malaria prevention and control during pregnancy in the African region (2004). Harare, World Health Organization, Regional Office for Africa.

2. Bradley DJ, Bannister B, (2003) Health Protection Agency Advisory Committee on Malaria Prevention for UK Travellers, Guidelines for malaria prevention in travellers from the United Kingdom , Communicable Disease and Public Health, 2003; 6(3): 180-99. Available online at: https://www.hpa.org.uk/cdph/issues/CDPHvol6/No3/6(3)p180-99.pdf

3. Chico, R.M., Chaponda, E.B., Ariti, C. &Chandramohan, D. (2017). Sulfadoxine-Pyrimethamine Exhibits Dose-Response Protection Against Adverse Birth Outcomes Related to Malaria and Sexually Transmitted and Reproductive Tract Infections. Clinical Infectious Disease, 64(8) pp.1043-1051.

4. Guyatt, H.L. & Snow, R.W. (2004). Impact of Malaria during Pregnancy on Low Birth Weight in Sub-Saharan Africa. Clinical Microbiology Reviews, 17(4) pp.760-769.

5. Hawker J, Begg N, Blair I, Reintjes R, Weinberg J. (2005) Communicable Disease Control Handbook, Blackwell.

6. Health Protection Agency (2005). Foreign travel-associated illness. England, Wales and Northern Ireland - Annual Repot . London: Health Protection Agency Centre for Infections; . Available at; https://www.hpa.org.uk/infections/topics_az/travel/pdf/Baseline/full_version.pdf

7. Kleinschmidt, I., Schwabe, C., Shiva, M., Segura, J.L., Sima, V., Mabunda, S.J.A. & Coleman, M. (2013). Combining Indoor Residual Spraying and Insecticide-Treated Net Interventions. European Journal Tropical Medicine Hygiene, 81(3) pp.519-524.

8. Korenromp E, Miller J, Nahlen B, Wardlaw T, Young M, (2005)World Health Organization (WHO) Roll Back Malaria (RBM) Department and the United Nations Children's Fund (UNICEF), World Malaria Report, Geneva, World Health Organization 2005. available online at; https://www.rbm.who.int/wmr2005/html/toc.htm

9. World Health Organization (2020) Intermittent preventive treatment in pregnancy (IPTp). Available at: https://www.who.int/malaria/areas/preventive_therapies/pregnancy/en/ (Accessed at 22ndMarch, 2021)

10. World Health Organization(2003), Malaria in Pregnancy, Fact Sheet. Available online at; https://www.who.int/features/2003/04b/en/

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