The Need for Malaria Integration in Maternal and Newborn Health

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By: Katie Millar, Technical Writer, Women and Health Initiative, Harvard T.H. Chan School of Public Health

The release of the Roll Back Malaria (RBM) Partnership’s report, “The Contribution of Malaria Control to Maternal and Newborn Health,” made yesterday, July 10th, 2014, an important day for malaria in pregnancy research and programming. Pregnancy was previously identified as a particularly vulnerable time to contract malaria for both mom and baby, but this is the first time the RBM Partnership has released a thematic report specifically dedicated to how malaria affects pregnant women and their newborns.

The report was launched during the United Nations Economic and Social Council (ECOSOC) in New York by UN health and development leaders. The purpose of the report launch was to forge new partnerships and strengthen existing ones to expand malaria services to one of the most vulnerable populations, pregnant women.

An existing solution, with poor delivery

Intermittent preventative treatment during pregnancy (IPTp) and insecticide-treated mosquito nets (ITNs) have long been the standard for malaria prevention in pregnancy. In 2012, the World Health Organization (WHO) updated these standards by increasing the number of IPTp doses to four during pregnancy. This treatment, delivered during antenatal care (ANC), has existed for decades, but delivery is still poor. Although 77% of pregnant women receive at least one ANC visit in most countries, rates of IPTp and ITN use by pregnant women fall far below global and national targets.

Why is malaria prevention part of maternal health?

Malaria is both a direct and indirect cause of maternal mortality. Each year 10,000 pregnant women die of malaria infection. In addition, malaria is a major cause of anemia,  which  puts a woman at greater risk for post-partum hemorrhage, the number one cause of maternal death. WHO’s recommended treatment, four doses of IPTp and use of an ITN, can reduce severe maternal anemia by 38% and perinatal mortality by 27%. The treatment’s effectiveness plays a significant role in leading global progress on decreasing maternal mortality. But malaria prophylaxis saves not only women’s lives, but newborn lives as well.

Protecting health before birth

IPTp and use of ITNs can reduce a newborn’s risk of dying from malaria by 18% in the first 28 days of life; it also provides a 21% decrease in low birth weight, a risk factor for neonatal death. Every year, 75,000 to 200,000 infants die because of a  malaria infection during pregnancy. Also, an additional 100,000 neonatal deaths, or 11% of global neonatal mortality, are due to low birth weight resulting from Plasmodium falciparum, or malaria, infections in pregnancy.

Although scale-up of IPTp and ITNs did not meet the global coverage target of 80%, malaria prevention efforts between 2009 and 2012 saved about 94,000 newborns. If global targets had been met, this number could have tripled, with 300,000 neonatal deaths prevented. In addition to preventing neonatal deaths, IPTp and ITNs can reduce miscarriages and stillbirths by 33%.

Next steps

Although the WHO has given clear guidelines through Focused Antenatal Care (FANC), there is often fragmentation across ANC delivery platforms. Fragmentation makes it difficult to effectively deliver prophylactic malaria interventions through ANC. Solutions to this problem include integration of both funding and service-delivery for malaria, ANC, and maternal health interventions. In addition, countries must harmonize malaria control and maternal health efforts in national policies, guidelines, and funding. Malaria prevention is not just an addendum to current maternal and newborn health interventions, it ensures maternal and newborn health.  With integration we can save lives.