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Increased malaria control during pregnancy needed in sub-Saharan Africa
van Eijk. Lancet. 2011;doi:10.1016/S1473-3099(10)70295-4.
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According to combined data from national surveys on malaria control during pregnancy in endemic African areas, efforts to increase preventive interventions are needed.
In areas of stable malaria transmission in Africa, the recommended malaria prevention and control during pregnancy — according to WHO — includes intermittent preventive treatment and insecticide-treated nets, along with effective management of clinical malaria and anemia.
“These interventions can substantially reduce disease burden and adverse outcomes of malaria in pregnancy, and are cheap and cost-effective,” the researchers wrote.
The absence of an analysis of coverage data at a subnational level led researchers from the United Kingdom, Kenya and the Netherlands to conduct the current study.
The researchers used national malaria policies from endemic countries in Africa to identify specific strategies for control in pregnant women. They gathered data on intermittent preventive treatment with sulfadoxine-pyrimethamine and the use of insecticide-treated nets from national household cluster-sample surveys. Using a model created from the collected data, the researchers estimated the number of pregnant women covered by a recommended intervention in 2007.
Policies promoting insecticide-treated nets for pregnant women were available in 45 of 47 countries surveyed. Information about net coverage was available for 32 countries; of 27.7 million pregnancies at risk for malaria in 2007, the researchers estimated that only 17% of those were protected by insecticide-treated nets.
Eight countries did not have policies for intermittent preventive treatment during pregnancy. The researchers estimated that 25% of 25.6 million pregnant women received at least one dose of treatment and 77% visited an antenatal clinic, according to the study. Areas with high-intensity malaria transmission had the lowest estimated coverage.
“Despite success in a few countries, coverage of insecticide-treated nets and intermittent preventive treatment in pregnant African women is inadequate; increased efforts toward scale-up are needed,” the researchers wrote.
In an accompanying editorial, Julie Gutman, MD, and Laurence Slutsker, MD, MPH, both with the CDC, said cost-effective ways to increase malaria control interventions are needed.
“High rates of attendance at antenatal clinic can provide an effective platform to deliver these services; success will require strengthened systems through training of health workers, education of clients and robust supply chains to ensure goals are achieved,” they wrote.
Malaria experts have called recently for broad efforts to eliminate malaria that reach all age and gender groups in affected communities. While the CDC supports these long-term goals, the fact remains that in the most highly malaria-affected regions of the world, pregnant women still experience a disproportionate burden, and the proven interventions to mitigate that burden have yet to reach many. I agree with the authors that, although there have been many successes, there is still much work to be done to reach this especially vulnerable group. CDC contributes to malaria control programs in endemic countries directly and through the US government's President's Malaria Initiative (PMI) in Africa and subregional programs for Latin America and Southeast Asia. In particular, PMI places priority on reaching pregnant women with insecticide-treated nets and intermittent preventive treatment and has contributed to expanding these programs in many countries.
–Stephen Kachur, MD
Division of parasitic diseases, CDC
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