Brahmbhatt et al., have just reported that, “Placental malaria increases the risk of MTCT after adjustment for viral load.” They likewise found that, “HIV-positive mothers with serological ICT (rapid immunochromatographic test) malaria were significantly more likely to have low-birth-weight infants, and low-birth-weight infants had significantly higher risk of MTCT compared with infants of normal birth weight.” The following conclusion was offered: “Programs should focus on enhanced malaria prevention during pregnancy to decrease the risk of adverse birth outcomes and MTCT.” The study took place in Rakai, Uganda using data gathered from 1994-2000, and the authors did caution that different results reported in other studies could be due to epidemiological differences in different settings.
Coincidentally and unfortunately we just shared with our readers the results of another study and recent DHS results from Uganda showing how poorly pregnant women are being protected from malaria. The women in Rakai study community had been monitored during the prenatal and postnatal periods, and in the present day would be more likely to benefit from preventive malaria interventions than those in the general population where stock supply and health personnel problems would be more serious.
These findings reinforce the need to integrate malaria in pregnancy control services such that maternal and child health and programs and the national malaria control programs actually work together to reach this important segment of the population at risk for malaria.
The added message is the need for better coordination between HIV and Malaria programs. Services for HIV positive women must ensure that they get LLINs and IPTp (unless receiving cotrimoxazole prophylaxis) not only to protect their own health, but also to prevent HIV transmission to their infants. When Round 8 Global Fund grant proposals come in for review, such program linkages should be be clearly emphasized. Current efforts to coordinate between PEPFAR and PMI could serve as a model.