Protection of pregnant women against malaria remains inadequate
26 January 2011
A review of national control strategies by a team of international researchers, led by the Malaria in Pregnancy Consortium and funded by the Consortium and the Wellcome Trust, has concluded that despite major efforts, coverage is still inadequate in many areas and needs to be scaled up.
Malaria infection in pregnancy can lead to devastating consequences for both mother and child. The World Health Organization's recommended policy for malaria prevention and control is a package of intermittent preventive treatment - therapeutic doses of a drug at defined intervals to provide protection in young children and pregnant women - and insecticide-treated bednets. These interventions have the potential to substantially reduce the disease burden and adverse outcomes of malaria in pregnancy.
The Roll Back Malaria initiative aimed to ensure that all pregnant women could receive the drugs and that at least four out of five people at risk from malaria were using the nets in areas of high transmission by 2010.
Researchers from the Malaria in Pregnancy Consortium examined specific strategies for malaria control in pregnant women from national malaria policies and calculated the number of protected pregnancies using the most recent national household cluster sample surveys. They were able to compare this to levels of malaria risk by comparing them to maps generated by the Malaria Atlas Project.
The study found that 45 of 47 countries in sub-Saharan Africa had an bednet policy for pregnant women and that estimated coverage was 17 per cent among the nearly 28 million pregnancies at risk of malaria in the 32 countries for which information was available. Among 39 countries with a policy on intermittent preventive treatment, just one in four pregnant women had received some treatment, despite more than three-quarters visiting an antenatal clinic.
Professor Feiko ter Kuile, leader of the Malaria in Pregnancy Consortium and co-author of the study, said: "Ten years after the Abuja declaration, it is encouraging that the majority of malaria endemic countries in sub-Saharan Africa have now adopted insecticide-treated nets and intermittent preventive treatment and the number of countries with nationally representative coverage data has increased to 40 out of 47.
"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.
"Whilst most countries have adopted national policies aimed at reducing and controlling malaria in pregnancy, it is clear that, with some notable exceptions, not enough progress has been made towards the new Roll Back Malaria goals or the policy ambitions of each country.
"Greater effort to fully understand the reasons why coverage is so low and to develop strategies to combat this is urgently needed to protect the tens of millions of pregnancies in sub-Saharan Africa threatened by malaria every year."
Image: A female Anopheles gambiae mosquito biting human skin. Credit: Wellcome Images.
Reference
Van Eijk, AM. Mapping coverage of malaria protection among pregnant women in sub-Saharan Africa: a synthesis and analysis of national surveys. Lancet Infectious Diseases; e-pub 26 Jan 2011.
