Neonatal Mortality – how does malaria contribute?

Over 40% of child deaths are now due to neonatal mortality, according to National Public Radio (NPR). NPR was commenting on a new article published in PLoS Medicine that examines neonatal death trends between 1990 and 2009. Although reducing child deaths is a key component of the Millennium Development Goals, neonatal mortality rates have actually increased in eight African countries, many of which are endemic for malaria.

Malaria contributes to neonatal mortality in two ways.  First, malaria in pregnancy leads to stillbirth and low birth weight babies who are more prone to death that those of normal weight. In a recent review, Ishaque and colleagues reported that, “The clearest evidence of impact in stillbirth reduction was found for adequate prevention and treatment of syphilis infection and possibly malaria.” Low birth weight can be prevented by using intermittent preventive treatment during pregnancy (IPTp).

The second contribution of malaria to neonatal mortality is congenital and neonatal malaria. A recent study in Nigeria has re-emphasized the connection between placental malaria and congenital malaria. Again, IPTp has be found effective in reducing neonatal cases of malaria.

dscn8011-iptp.jpgPublished research from Mozambique confirm that, “IPTp-SP was highly cost-effective for both prevention of maternal malaria and reduction of neonatal mortality in Mozambique.” Ironically, IPTp coverage is one of the key malaria indicators that is lagging as we have passed the RBM 2010 target of 80% coverage with two doses minimum for each pregnant woman in stable transmission areas.

Sufphadoxine-pyrimethamine, the drug used for IPTp, is cheap.  Many women attend antenatal care clinics where IPTp is (or should be given), yet Demographic and Health Survey results show few countries nearing even the 60% coverage mark for two IPTp doses.  There are no excuses in 2011 for pregnant women suffer and their newborns die because of malaria in pregnancy.

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