Malaria in pregnant women: research, epidemiology, policy and practice.
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Date
1999
Authors
Journal Title
Journal ISSN
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Publisher
Annals of Tropical Medicine & Parasitology
Abstract
Malaria in pregnant women contributes to
maternal anaemia and increases the risk of low
birthweight, which is the principle contributor
to infant mortality. Initial observations of
the problem of malaria in pregnancy were
described in the 1930s (Wickramasuriya,
1937); the breadth of the impact was apparent
by the 1950s (Archibald, 1956; Spitz, 1959)
and 1960s Oellife, 1968). By the 1980s, a
broader description of the problem in sub-
Saharan Africa was available (Brabin, 1983)
and a clear and detailed description of the
extent of the problem in a malaria-endemic
setting was published (McGregor et al., 1983).
The work by McGregor and colleagues led to
the beginning of a wider discussion of the
problem of malaria in pregnancy and the sub-
ject was trumpeted at the American Society of
Tropical Medicine and Hygiene, as the Soper
Lecture in 1984 (McGregor, 1984). Subse-
quently, symposia on the topic have been held
and the extent and diversity of the problems
in a variety of malarious settings have been
discussed. Recently, investigators from a var-
iety of disciplines gathered in Kisumu, Kenya,
to discuss the basic biology, pathophysiology,
epidemiology and control opportunities for
the problem of malaria in pregnant women
(Phillips-Howard, 1999), and the current re-
ports, from an informal gathering during the
Second European Congress on Tropical
Medicine in Liverpool in 1998, continue this
process.
The articles in this supplement embrace the
similarities and the differences across geogra-
phy (Thailand, India, and sub-Saharan Africa)
and across malarial parasites (Plasmodium fa/-
ciparum and P. vivax). The articles also de-
scribe some of the current thinking on
immunology, placentology, epidemiology, and
prevention and control programmes. The arti-
cles raise some of the many challenges and
opportunities. With malaria control employing
antimalarial drugs for treatment, chemopro-
phylaxis, or prevention with intermittent pre-
sumptive therapy, there comes the problem of
drug resistance. As we enter the next millen-
nium, chloroquine has little efficacy against
falciparum malaria. Other drugs and drug
combinations still have substantial efficacy in
sub-Saharan Africa. However, as McGready
and Nosten (1999) describe, multi-drug resist-
ance in P. fa/ciparum comes with the avail-
ability and use of new agents, and pregnant
women will be no different in this respect to
anyone else. Moreover, these other drugs and
drug combinations may involve more complex
delivery and are bound to be more expensive,
sometimes beyond the affordable limits of in-
dividuals, rural communities, and govern-
ments in Africa.
The search for answers to the questions:
'why is the first pregnancy so susceptible to
the infection and consequences of malaria?',
and 'why are parasites more concentrated or
sequestered in placental blood?' remains in the
research realm. Currently, the answers are
elusive and lack a clear link to a specific
intervention strategy. In the interim, deploy-
ment of available interventions and possibly
multiple interventions is the most obvious best
option.
The papers are presented by researchers,
and there is a call for a link between re-
searchers and the people responsible for
public-health interventions and prevention
programmes-including the involvement of
communities, the private sector, and other
partners. Upon reading the papers, many of
the gaps in our knowledge and in our ability to
Description
Keywords
Malaria, Epidemiology, Pregnant women
Citation
Steketee, R.W. and Mutabingwa, T.K., 1999. Malaria in pregnant women: research, epidemiology, policy and practice. Annals of Tropical Medicine & Parasitology, 93(sup1), pp.S7-S9.