Malaria in pregnancy responsible for child, maternal deaths

2nd from right- Chioma Obinna, president, HEWAN; 4th Mrs Uko, Head Advocacy Communication & Social Mobilization NMEP; 5th Mrs Tolu Arowolo, WHO; 6th Dr. Odio Batholomew, Malaria Tech. Adviser, Thpiego and Aishatu Bintu Gubio

Malaria in pregnancy have caused many Nigerian women to suffer miscarriages, have premature babies and even die in pregnancy.

This was made known to newsmen during a Media Chat on Malaria organized by the National Malaria Elimination Programme in collaboration with Health Writers Association of Nigeria (HEWAN) few days ago with the theme: ’Malaria in Pregnancy.’

In her presentation, Mrs. Itohowo Uko, Deputy Director & Head Advocacy, Communication Social Mobilization National Malaria Elimination Programme (NMEP), said malaria in pregnancy often start without symptoms, and if not treated properly can become complicated leading to several unhealthy situations for the unborn baby, mother or even children under five years.

She said almost all Nigerians, at least 97% are at risk of getting malaria and it is responsible for 11% of maternal deaths in pregnancy.

“It can cause anemia in the mother; it can also lead to miscarriage. Malaria parasites can hide in the placenta and interfere with transfer of oxygen and nutrients to the baby. This increases the risk of: Miscarriage, still birth, pre-term birth, low birth weight -a great risk factor for death of new born in the first month of life,” she explained.

Throwing light on focused antenatal care, Mrs. Uko explained that every pregnant woman should attend four schedule visits to antenatal as follow: 1st visit: before 16 weeks, 2nd visit: 16 to <28 weeks, 3rd visit: 28 to < to 32 weeks and finally, 4th visit: 32 to 40 weeks.

“These personalised visits provide the opportunity for a pregnant woman to be in contact with trained health care providers who can make regular malaria prevention and treatment interventions available to them,” Mrs. Uko said.

Also on Intermittent Preventive Treatment in pregnancy (IPTP) which is the use of Sulphadoxine-Pyremethamine tablets, she said Sulphadoxine-Pyrimethamine (SP) is a medicine of choice for Nigeria and for prevention of malaria in pregnancy and not for treatment of malaria. She said SP should be administered at regular intervals to prevent malaria during pregnancy and single dose of 3 tablets is given to pregnant women as follow:
“When pregnant women perceives movement of the baby; at monthly interval (4 weeks apart) up to delivery; women should receive at 3 or more doses during one pregnancy; administration should be by Directly Observed Therapy (DOT),” she said.

She noted that IPTp uptake is still relatively low, adding that only 19 pet cent of pregnant women reported receiving at least 3 doses of SP as at 2015.

She appealed to all pregnant women to continue to sleep under Long Lasting Insecticidal Nets (LLINs) despite all the myths and misconception towards it, emphasizing that it reduces human-vector contact by: Creating a physical barrier, repelling and killing the vector, mosquitoes and also reduces risk of malaria-related illness as well.

Speaking on diagnosis and treatment of malaria in pregnancy she said: “When a pregnant woman has fever, she must go to the hospital to have a test done. Malaria can be confirmed by a positive Rapid Diagnostic Test kits for Malaria (mRDT) or by Microscopy test done by an expert laboratory scientist. Medicines to treat malaria must be in line with the National Treatment Guideline for Case Management at the nearest health facility. Pregnant women with symptomatic malaria are a high-risk group.

“Do not delay parasitological diagnosis and effective treatment at a health facility,” Mrs Uko said.

In addition, Dr Tolu Arowolo, from World Health Organization (WHO) ecplained that not all fevers are malaria which is why testing with Rapid Diagnostic Test (RDT) or microscopy to confirm malaria before treatment with Artemisinin-based Combination Therapy (ACT) is necessary.
She also pointed that virtually everybody is at risk of malaria and the most vulnerable groups include: pregnant women, children Under 5 years of age, foreigners or people from non-endemic countries and people living with HIV/AIDS.

She said that early detection and treatment of malaria reduces the severity of the disease and prevents deaths.

“NMEP directs that all fever cases should be tested with either Rapid Diagnostic Test (RDT) or parasite-based diagnostic testing (microscopy) before treatment. Also, the use of monotherapies (e.g., Chloroquine) has been banned”, she added.