Opportunistic Infections

Tuesday, January 08, 2008

Malaria - Life threatening during pregnancy

By, Pushpa Jamieson, The Chronicle Newspaper (Lilongwe), December 31, 2007

With the continued high infections of HIV, opportunistic diseases like malaria have become life threatening, especially for women who are HIV positive.

Malaria infection during pregnancy can have adverse effects on both the fetus and the mother. These include sever anemia, miscarriage or fetal loss, retarded growth of the fetus, premature birth and delivery of a low birth-weight baby.

The more dangerous Plasmodium falciparum malaria parasite is found in sub-Saharan Africa where it has been estimated that malaria causes 400,000 cases of sever maternal anemia resulting in approximately 10,000 deaths annually.

Although malaria is considered a danger to expectant women, correct and effective interventions during pregnancy can reduce the risks of complications or death of both mother and infant.

Speaking at a recent Women Edition conference in London, Dr. Scott Filler from the Centre of Disease Control (CDC) in the United States expanding on the interventions for prevention and control of malaria in pregnant women recommended by the World Health Organization said women should be supplied with anti malarial drugs as Intermittent Preventative Treatment (IPT). All pregnant women living in malaria infection areas should receive at least two doses of IPT after the first trimester.

The recommended anti malarial drug is sulfadoxine pyrimethamine more commonly known as SP because of its ability to provide protection against infection for a longer period.

Reports of resistant of the SP by the malaria parasite has resulted in antenatal clinics being advised to provide the IPT at every clinical visit by pregnant women provided there has been a time laps of more than four weeks to ensure that she remains protected against malaria.

Providing IPT at antenatal clinic ensures that medical staff provide direct observation treatment (DOT) and physically observe that the woman has taken the medication.

The use of insecticide treated bed net by pregnant women was also highlighted. Where possible, insecticide treated nets (ITNs) should be provided to pregnant women at first visit to antenatal clinic. The use of the net should be encouraged through out pregnancy and after delivery. Providing ITNs to women before her first trimester would protect her from malaria until she is able to take SP.

Effective case management of malaria and anemia for all pregnant women should be guaranteed and iron supplements should be given to those who require it. Screening for anemia should be routine and cases of moderate to severe anemia should be properly manages.

Recommendations by WHO will see a reduction in maternal mortality due to malaria but the majority of countries with extremely high maternal mortality rates are some of the poorest and least developed and lack health systems to deliver.

It has been said that the provision of maternal health to women is the litmus test for the state of the health system of any country.

Insufficient staff, lack of medication and an improper and effective referral system have been major contributors to the non implementation of the recommendations so far.

Announcing an additional 100 million pound over five years to help prevent unwanted pregnancies and to make childbirth safer, the UK's Secretary of State for International Development Douglas Alexander said: "We need to ensure health services do not only function, but also reflect the needs of women. Women must have a voice to demand better services and to vote for an MP who puts women's health at the top of the political agenda".

The recent announcement of an aditional100 million pounds from Britain and contributions from donors and other development partners can make a difference to the high mortality rate in sub-Saharan Africa.

Acknowledgement of the importance of a good reproductive health system and the political will and commitment by leaders of poor and developing countries to addresses the issues of reproductive health is essential to the success of the reduction of maternal mortality in affected countries.

Source: http://allafrica.com/stories/200712310659.html

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