Posts or Comments 25 February 2021

Monthly Archive for "January 2016"



Malaria in Pregnancy &Stillbirth Bill Brieger | 19 Jan 2016

Malaria and Stillbirths – preventable scourges

silence around stillbirthsThis month The Lancet is publishing a series of articles and commentaries about the unspeakable silence around the problem of stillbirths. Luc de Bernis and co-authors state the political side of the equation: “Stillbirths have had even less political attention than other important public health issues, such as HIV or malaria, even though the burden is greater and solutions exist that would benefit women and children.” By their estimate in, “sub-Saharan Africa … malaria in pregnancy is estimated to be associated with about 20% of stillbirths.”

A summary of the series makes it clear that, “Most result from preventable conditions such as maternal infections (notably syphilis and malaria), non-communicable diseases, and obstetric complications.” The key role of malaria is not surprising since “75% (of stillbirths occur) in sub-Saharan Africa and south Asia” where malaria is endemic.

DSCN8010 Providing IPTp in ANCAs part of the Lancet Series Joy Lawn and colleagues explain that, “Many disorders associated with stillbirths are potentially modifiable and often coexist, such as maternal infections (population attributable fraction: malaria 8·0% and syphilis 7·7%).” Of course action against malaria takes recognition of the problem. In a commentary as part of the Lancet series Juliet Kiguli et al. present a case study of a woman who reported several bouts of malaria prior to her stillbirth, but they lamented that a greater understanding of social and cultural factors is needed because in many communities people attribute stillbirths to spirits and super-natural forces and may fail to see a simple solution like preventing malaria in pregnancy.

Unfortunately methods to prevent malaria in pregnancy through intermittent preventive treatment and insecticide treated nets lag far behind targets. The Global Call to Action to defeat malaria in pregnancy reported that …

  • While IPTp increased from <5 % (2003) >20 % (2010) average coverage rates have stagnated between 22 % and 24 %, which is very much lower than global targets o 80 % by 2010, and 100 % (universal coverage) by 2015
  • ITN coverage is comparatively better that IPTp but is still unacceptably low at 38 % overall

Women do attend antenatal care clinics where these preventive services are offered, but health systems failures such as poor commodity planning lead to stockouts. Community delivery of MIP services helps, but only if health staff accept community partnership and make commodities available. Until we can break the silence on stillbirths and the lack of action of malaria in pregnancy prevention, unborn children and their mothers will continue to suffer.

Diagnosis &Lassa Fever Bill Brieger | 17 Jan 2016

Lassa Fever in Nigeria

Fever brings to mind ‘malaria’ for most health workers often resulting in dangerous nmis-diagnoses. Not all fevers are alike, and when health workers do not practice infection procedures in examining a febrile patient, they put themselves, their families and all people at their clinic at risk.

lassa-distribution-map smWitness the Ebola outbreak in Guinea, Liberia and Sierra Leone where health workers disproportionately died. And just as happened with Ebola, the Guardian reported that, “A medical doctor in Rivers State has been confirmed dead after being diagnosed of See WHO’s Lassa fever fact sheetin the state’s apex hospital, the Brewaithe Memorial Specialist Hospital (BMH), Port Harcourt.”

As of 9th January the death toll rose to 35 with 81 cases. The Guardian Newspaper noted that “Non-Specific Symptoms Of Ailment Threaten Interruption Efforts, ” and that at the rate the current Lassa Fever outbreak is ravaging in the country, the federal government may soon have no option but to declare an emergency to hasten containment.”

By January 16th the number of deaths had risen to 44 as reported by MENAFN.com. They also explained that Lassa is “transmitted through the faeces, urine and blood of rats (and subsequently) human bodily fluids,” of those infected via rats. Rats closely inhabit spaces with humans, while fruit bats that carry Ebola are more confined to forests (which unfortunately have been pushed back through human activity).

Lassa is endemic in Nigeria and West Africa across to Liberia, Sierra Leone and Guinea where some suspected the initial Ebola cases might have been Lassa. The first cases were CDC: documented in Nigeria in 1969, and as the AllAfrica.Com, Guardian: Ministry of Health noted, “Lassa fever which has over the years registered its presence in the country, supposed not to have taken us by surprise.”

The US Centers for Disease Control and Prevention/CDC provides the following useful information showing that while infectious, Lassa may not be as dangerous as Ebola:

  • “Signs and symptoms of Lassa fever typically occur 1-3 weeks after the patient comes into contact with the virus. For the majority of Lassa fever virus infections (approximately 80%), symptoms are mild and are undiagnosed. Mild symptoms include slight fever, general malaise and weakness, and headache. In 20% of infected individuals, however, disease may progress to more serious symptoms including hemorrhaging (in gums, eyes, or nose, as examples), respiratory distress, repeated vomiting, facial swelling, pain in the chest, back, and abdomen, and shock. Neurological problems have also been described, including hearing loss, tremors, and encephalitis. Death may occur within two weeks after symptom onset due to multi-organ failure.”

7 pricks finger for blood collection 2Finally CDC cautions health workers to protect themselves and not assume every fever is malaria. “When caring for patients with Lassa fever, further transmission of the disease through person-to-person contact or nosocomial routes can be avoided by taking preventive precautions against contact with patient secretions (called VHF isolation precautions or barrier nursing methods). Such precautions include wearing protective clothing, such as masks, gloves, gowns, and goggles; using infection control measures, such as complete equipment sterilization; and isolating infected patients from contact with unprotected persons until the disease has run its course.”

While health workers at the front line are encouraged to use malaria Rapid Diagnostic Tests to determine or exclude a diagnosis of malaria, they must remember that RDTs involve blood. Protective materials are always required, even for ‘simple’ malaria. Health systems – public and private – need to ensure health workers have these life saving materials.