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Thursday, January 27, 2011

Pregnant women need better protection against malaria - study

Too many pregnant women in sub-Saharan Africa are still not receiving adequate protection against malaria, placing them and their unborn children at risk of serious health problems and even death. Writing in the journal The Lancet Infectious Diseases, scientists from Kenya, the Netherlands and the UK explain that in 2007, an estimated 23 million pregnant women were not protected by insecticide-treated nets (ITNs) and 19 million did not receive intermittent preventive treatment (IPT). The researchers warn that if the situation is not remedied rapidly, internationally agreed targets to reduce the incidence of malaria in pregnancy will not be met.

Every year, some 32 million pregnant women in sub-Saharan Africa are at risk of catching malaria. Contracting malaria during pregnancy can have serious consequences for mother and child, raising the risk of maternal anaemia, stillbirth, low birth weight and neonatal death. According to the World Health Organization (WHO), 10,000 women and 200,000 infants worldwide die every year as a result of malaria during pregnancy. The WHO recommends that pregnant women use ITNs and IPTs to lower their risk of developing malaria.
http://cordis.europa.eu/fetch?CALLER=EN_NEWS&ACTION=D&SESSION=&RCN=32998

Tackling malaria in pregnancy contributes to three of the Millennium Development Goals, namely goals 4 (reduce child mortality), 5 (improve maternal health) and 6 (combat HIV/AIDS, malaria and other diseases). In addition, the Roll Back Malaria initiative set itself the target of ensuring that 100% of pregnant women receive IPT and 80% of all people in affected areas use ITNs to keep mosquitoes at bay. Finally, in 2000, African leaders gathered in Abuja, Nigeria, pledged to take steps to provide 60% of pregnant women in malaria-endemic areas with effective intervention measures.

In this study, led by the Malaria in Pregnancy Consortium, researchers investigated how many pregnant women in sub-Saharan Africa are actually benefiting from malaria prevention measures.

The good news is that of 47 countries studied, 45 had policies to provide women with ITNs and 39 had IPT policies for pregnant women. However, the data revealed that despite these policies, many women went through pregnancy unprotected.

In 32 countries with an ITN policy and for which data was available, just 17% of pregnancies (4.7 million pregnant women out of 27.7 million) were actually protected by ITNs. On IPTs, of 31 countries with an IPT policy and data on uptake, only a quarter of pregnant women (6.4 million out of 25.6 million) received at least 1 dose of treatment.

In other words, 23 million pregnant women did not benefit from the protection offered by ITNs and 19 million did not receive IPT. The researchers point out that in the case of IPT, 77% of pregnant women in the countries studied attended an antenatal clinic at least once during their pregnancy, meaning that 13.4 million pregnant women attending these clinics missed an opportunity to receive IPT.

Furthermore, coverage by ITNs and IPT was lowest in areas of high-intensity malaria transmission where pregnant women need protection the most.

'Ten years after the Abuja declaration, it is encouraging that the majority of malaria endemic countries in [sub-Saharan Africa] have now adopted ITNs and IPTp and the number of countries with nationally representative coverage data has increased to 40 out of 47,' comments one of the authors of the paper, Professor Feiko ter Kuile of the Liverpool School of Tropical Medicine in the UK.

'However, very few countries have reached either the Abuja targets or their own policy ambition, and countries are even further away from the more recent [Roll Back Malaria] targets set for 2010. In addition, coverage was lowest in areas with high malaria transmission, where the need is greatest.'

'Despite success in a few countries, coverage of insecticide-treated nets and intermittent preventive treatment in pregnant African women is inadequate; increased efforts towards scale-up are needed.'

The Malaria in Pregnancy Consortium brings together scientists from 47 organisations in 31 countries worldwide. The consortium is funded by the Bill & Melinda Gates Foundation as well as the EU and the European and Developing Countries Clinical Trials Partnership (EDCTP).

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