It is not new that malaria, one of the most severe public health problems, particularly in Africa, has been a major cause of maternal death and infant morbidity.
During pregnancy, malaria parasites can hide in the placenta and interfere with transfer of oxygen and nutrients to the baby.
This increases the risk of miscarriage, still-birth, pre-term birth, as well as low birth weight, which is a great risk factor for death of babies in the first month of life.
The 2018 World Malaria Day (WMD) presents another opportunity to weigh the effects of malaria and efforts made to eradicate it.
The WMD is celebrated annually on April 25. The theme of the 2018 World Malaria Day is “Ready to Beat Malaria’’.
Medical experts say it is important to tackle malaria in pregnancy to reduce Nigeria’s high maternal mortality rate.
Dr Olawale Oba, Senior Registrar, Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital (LUTH), Idi-Araba, explains that malaria is caused by transmission of parasite plasmodium into the blood stream of humans.
“The parasite is carried by anopheles mosquito and transferred to the blood of human when such human is bitten by the mosquito.
“The parasite stays in the liver of human and undergoes some changes till an adult parasite is formed and capable of causing the infestation,’’ he explains.
According to him, the parasite can also infest the foetus.
“It is largely a maternal disease which could also affect the fetus when the level of parasitaemia becomes considerably high.
“When the parasite is found within the placenta tissue, it is capable of congenital fetal malaria infestation,’’ he says.
The gynaecologist notes that the burden of malaria in pregnancy is still multi-faceted and contributes 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.
“This depend 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 says.
Also on malaria effects on pregnancy, Prof. Olugbenga Mokuolu, a Pediatrician at the Neonatal Intensive Care Unit, University of Ilorin Teaching Hospital, warns that the disease has grave consequences if not managed well.
Mokuolu notes: “The direct effect of malaria contributes significantly to perinatal disease burden in terms of pregnancy losses, prematurity due to pre-term labour and prevalence of low birth weight babies.
“The peculiarity of malaria in the newborn is related to the various dimensions, which includes malaria in pregnancy, congenital malaria and neonatal malaria.
“This makes malaria a daily threat with half the world’s population still at risk.’’
The expert is convinced that there are opportunities to save lives in spite of the burden.
He says lives can be saved from malaria by reducing its transmission and eliminating the disease where possible.
Mrs Itohowo Uko, the Head of Advocacy, Communication and Social Mobilisation in NMEP, adds that malaria in pregnancy accounts for 11 per cent of maternal deaths.
Uko believes that this calls for urgent measures against the menace.
According to her, NMEP has a Prevention of Malaria in Pregnancy (PMP) Strategy.
“This strategy advocates using Focused Antenatal Care (ANC), Intermittent Preventive Treatment (IPTp), regular and appropriate use of Long Lasting Insectide Nets (LLINs) in addition to early diagnosis and prompt treatment of malaria in pregnant women,’’ she says.
For Dr Tolu Arowolo of the World Health Organisation (WHO), early antenatal care plays an 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 before delivery.
“The Intermittent Preventive Treatment (IPTp) is to be administered at regular intervals to prevent malaria during pregnancy; the medicine of choice in Nigeria is sulphadoxine-pyrimethamine.
“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.’’
The WHO official advises that a pregnant woman should attend four scheduled ANC visits.
“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 healthcare providers who can make regular malaria prevention and treatment interventions available to them,’’ the experts says.
She lists some benefits of sticking to the schedule to include reduction 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 pregnancy and, therefore, should be adhered to.
“In addition, sleeping under LLINs and good nutrition are good interventions against malaria,’’ Arowolo argues.
She emphasises that good nutrition helps to nourish the mother and foetus as well as boost the immune system.
Dr Bartholomew Odio, a gynaecologist, urges Nigerians, especially pregnant women to always request for testing before treating malaria fever.
Odio, the Malaria Technical Advisor with Jhpiego Nig., an affiliate organisation to John Hopkins University, U.S, advises pregnant to demand to know drugs given to them.
“On diagnosis and treatment of malaria in pregnancy, when a pregnant woman has fever, she must go to a hospital to have a test done.
“Malaria can be confirmed by a Rapid Diagnostic Test kit 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 adds.
In the view of the Malaria Society of Nigeria (MSN), Nigeria should pay more attention to research on malaria to strengthen the fight against the disease.
The President of the society, Dr Babajide Puddicombe, says investment in research on the disease will dig deeper into the menace and proffer more solutions.
“Nigeria is endowed with researchers who can compete favourably with their counterparts from any part of the globe, but they are not adequately funded.
“Some of their equipment are obsolete,’’ he regrets.
He calls for collective efforts in the fight against the disease to save more preganant women and children as well as other members of the society.
“For Nigeria to be ready to beat malaria as is the theme for the 2018 World Malaria Day, all hands must be on deck as government cannot do it alone.
“Recognised NGOs should be involved in this fight which has been 0n for over 100 years.
According to WHO, the theme of the 2018 WMD shows the need for collective commitment of the global malaria community to uniting in the common goal of a world free of malaria.
“The global response to malaria is at a crossroads. After an unprecedented period of success in malaria control, progress has stalled.
“The current pace is insufficient to achieve the 2020 milestones of the WHO Global Technical Strategy for Malaria 2016 to 2030 targets calling for a 40 per cent reduction in malaria incidence and death rates,’’ the world body points out.
It calls for greater investment in the prevention, diagnosis and treatment malaria.
Analysts are optimistic that the 2018 WMD celebration in Nigeria will raise more concerns about malaria burden and stir more efforts to tackle, more efficiently, one of humanity’s oldest diseases.
Alake and Ihechu write for News Agency of Nigeria, NAN.
Omowunmi Alake/Vivian Ihechu