Malaria in pregnancy

According to recent reports from the World Health Organization (WHO) and the most recent Global Burden of Disease estimates of malaria mortality, the number of deaths from malaria has fallen rapidly in recent years. Since 2000, mortality due to malaria has fallen 47% among all populations at risk and has fallen 54% in Africa. Given that approximately 80% of malaria cases are currently in Africa, this figure is especially impressive. Unfortunately, more than 500,000 deaths attributable to malaria were recorded in the last year, however.

Pregnant women and children are especially vulnerable to malaria. Despite important reductions in maternal mortality globally during this same time period, malaria in pregnancy continues to be a threat. The most recent World Malaria Report (published every December) notes that in sub-Saharan Africa, over 400,000 cases of maternal anemia and approximately 15% of maternal deaths were caused by malaria in pregnancy. It is also a significant threat to newborns leading to low birth weight in babies, spontaneous abortion, stillbirth, and premature delivery, among other adverse outcomes. The most recent figures note that between 75,000 and 200,000 newborn deaths were associated with malaria infection in the last year.

Malaria in pregnancy (MiP) programming is at a critical juncture. Important gains have been made in malaria control, but without continued efforts the gains achieved may quickly erode. Coverage of malaria prevention, screening and treatment among pregnant women remains low in many locations in sub-Saharan Africa, despite clear evidence of effective interventions and significant investment in this area.

In order to combat MiP, intermittent preventive treatment in pregnancy (IPTp) should start early in the second trimester of pregnancy with three or more doses of the antimalarial sulfadoxine-pyrimethamine (SP) over the course of the pregnancy. Yet, the most recent World Malaria Report notes that 15 million of the 35 million pregnant women at risk did not receive even one dose of intermittent preventive treatment in 2013.

Experts agree that the maternal health and malaria communities must work closer together in order to significantly increase coverage. Given the existing synergies and overlap between these communities, several opportunities exist to collaborate more effectively. These areas of overlap include the target population (pregnant women), common health outcomes (maternal and newborn mortality and morbidity) and a shared delivery mechanism (the antenatal care platform).

The Role of the MHTF

During the June 2012 technical meeting “Malaria in Pregnancy: A Solvable Problem—Bringing the Maternal Health and Malaria Communities Together” held in Istanbul by the Maternal Health Task Force (MHTF)—in collaboration with the Bill & Melinda Gates Foundation (BMGF), the Liverpool School of Tropical Medicine (LSTM), the London School of Hygiene and Tropical Medicine (LSHTM) and PATH—several challenges and opportunities to improve MiP outcomes were identified.

In October 2012, building on the Istanbul meeting, the BMGF awarded PATH and the WHO a one-year “Prevention of Malaria in Pregnancy” grant to reduce adverse outcomes due to malaria in pregnancy by increasing intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine and insecticide treated bed net uptake in selected countries in East Africa (Kenya, Tanzania, and Uganda). A two-day project kick-off/planning meeting was organized in Arusha, Tanzania in January 2013. The gathering included representatives from the MHTF; the BMGF; WHO; the United States Agency for International Development; PATH, the Maternal and Child Health Integrated Program; academia and country delegations from Kenya, Tanzania, Uganda and Zambia. Additional information is available in the Arusha meeting report (pdf).

At the Global Maternal Health Conference 2013 (GMHC2013) in Arusha, Tanzania in January 2013, MiP was well represented with 3 panels, 17 presentations, and an informal luncheon. The conference also provided an opportunity to disseminate the updated WHO Policy Recommendation on IPTp-SP (pdf) and “Malaria Protection in Pregnancy: A lifesaving intervention for preventing neonatal mortality and low birth weight,” a brief developed jointly by the President’s Malaria Initiative, WHO and MCHIP; the brief is available in both French (pdf) and English (pdf). Malaria in pregnancy presentations from GMHC2013 are available for viewing on the MHTF’s MiP Vimeo channel.

In addition to MHTF’s work fostering dialogue between the maternal health and malaria communities, the MHTF participates in Roll Back Malaria’s MiP working group and also coordinates a blog series (on the MHTF Blog) with posts from experts working to address MiP throughout sub-Saharan Africa. Posts share lessons from specific countries, organizations and projects; make the case for strengthening the antenatal care platform across sub-Saharan Africa and raise questions about next steps for increasing coverage of MiP interventions.

Photo Credit: Darfurians refugees in Eastern Chad © 2011 European Commission, used under a Creative Commons Attribution license:


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Technical Meeting

The MHTF collaborated with the Bill & Melinda Gates Foundation, Liverpool School of Tropical Medicine (LSTM), London School of Hygiene and Tropical Medicine (LSHTM), and PATH to convene a technical meeting, Malaria in Pregnancy: A Solvable Problem—Bringing the Maternal Health and Malaria Communities Together, in Istanbul, Turkey from 26-28 June 2012.

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