Pregnant women are particularly vulnerable to malaria, which can cause life-threatening anemia, low-birth weight, and even death for the infant. Yet the international public health community seems to be overlooking the risks pregnant women and their unborn children face when infected with malaria. And myths and misperceptions at the country level also hamper effective control of malaria in pregnancy (MIP).
Take a look at the WHOâ€™s Global Malaria Program (GMP) website and you will find that intermittent preventive treatment (IPT) for pregnant women has been replaced by indoor-residual spraying (IRS). Specifically in reference to a new publication on IRS, the website states, â€œIRS is now one of THREE main interventions promoted by WHO to control malaria,â€ and a closer reading of that document shows that IPT has been dropped in favor of IRS. Obviously WHO is not dropping MIP interventions, but the fall from grace for IPT in pregnancy is disconcerting when MIP is responsible for morbidity and mortality in both mothers and newborns. This is particularly discouraging since IPT and ITNs for pregnant women have been shown to be highly effective, and are delivered through established ante-natal services, making them an obvious choice for high impact at low cost.
In addition to benign neglect by international health officials, various myths have emerged about MIP interventions at the country level. Front line health workers and mothers in many countries still believe that the drug of choice, sulfadoxine-pyrimethamine (SP), is either unsafe or too strong for pregnant women. A second myth surrounds SP as an appropriate treatment â€“ the news about preventing further drug resistance in the general population by not using SP for curative care has not been heard or heeded, especially when the alternatives, artemisinin-based combination therapy (ACT), is so expensive.
Another myth is that since SP is relatively cheap, there is little need to focus major donor attention on strengthening IPT programming. Finally there is the myth that insecticide-treated nets (ITNs) will certainly reach pregnant women if community campaigns are conducted. Aside from the normal problems of leakage and poor documentation, separating ITN distribution from antenatal care removes an important incentive for women to safeguard their pregnancies through timely prenatal visits.
Recently the Roll Back Malaria Working Group on MIP held its seventh meeting in Abuja, Nigeria. A key recommendation was greater involvement, if not full leadership by the reproductive health (RH) community in the battle against malaria in pregnancy. The close integration of RH and malaria control programs can make sure IPT remains a priority intervention necessary to meet the goals detailed in the Abuja Declaration from 2000.