Measuring Malaria as a Cause of Maternal Mortality

Advocacy for strengthening malaria in pregnancy control programs is founded on the assumption that malaria is an important cause of both maternal morbidity and mortality as well as child/birth outcomes. UNICEF has recently undertaken work in India to pinpoint more accurately the various causes of maternal deaths. According to The Hindu Newspaper, “The Maternal and Perinatal Death Inquiry (MAPEDI) or the social audit — also known as verbal autopsy.” The survey in West Bengal found that, “Of the 106 maternal mortalities reported … Fifty one per cent deaths were due to direct obstetric causes like bleeding, infection, eclampsia, and obstructed labour, 27 per cent due to indirect causes like anaemia, malaria, hepatitis, tuberculosis and cardiac, while 22 per cent died due to other causes.”

Measurement of exact cause of death in rural and poor communities can be difficult. Sometimes the association between maternal mortality and malaria is circumstantial. Romagosa et al. found in Mozambique that maternal mortality followed the same seasonal pattern as malaria illness. They reported that malaria accounted for 23% of maternal deaths.

A new study published by Fortrell et al., has shown the challenges of obtaining reliable and valid data on maternal deaths that might be malaria. These challenges included among others 1) a general underestimation of malaria in pregnancy, 2) difficulty in distinguishing clinically among febrile illnesses, and 3) HIV and malaria co-infection. Different models and approaches, including verbal autopsy, to analyzing death data in Burkina Faso yielded widely varying estimates of the cause specific mortality fraction for malaria from 10% to nearly 25%.

These efforts show that malaria is certainly a factor in maternal mortality. Continued research support is needed, as explained in the UNICEF study for, ” providing an understanding of the contributing factors that can be used by decision-makers and stakeholders to address obstacles to quality obstetric care and to identify ways to prevent avoidable deaths.”

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