By Brenda Zulu
In Zambia, women
living in malaria endemic areas become pregnant every year. Malaria still
remains a threat both to themselves and their babies as a result of malaria in
pregnancy.
Recently, I attend
a funeral of a woman who died from malaria in pregnancy in my neighbourhood.
She was three months pregnant when she died.
She is said to have been on self treatment of malaria.
According to the World Health Organisation (WHO), pregnant
women are particularly vulnerable to malaria as pregnancy reduces a woman’s
immunity making her more susceptible to malaria infection and increasing the
risk of illness, severe anemia and death. For the unborn child, maternal malaria
increases the risk of spontaneous abortion, stillbirth, premature delivery and
low birth weight a leading cause of child mortality.
The 2007 Zambia Demographic Health Survey shows
that Malaria is endemic in Zambia with seasonal and geographical variations. In
2007, 4.3 millioncases of malaria (confirmed and unconfirmed) were reported
countrywide with 6,149 deaths (MOH, 2008). The annual malaria incidence was
estimated at 358 cases per 1,000 population in 2007, a drop from 412 cases per
1,000 population in 2006 (MOH, 2008). Northern and Eastern provinces had the highest
annual incidence of malaria, while the disease was lowest in Lusaka province.
Malaria accounts for up to 40 percent of all infant mortality and 20 percent of
all maternal mortality in Zambia (MOH, 2008). Malaria poses a severe social and
economic burden on communities living in endemic areas.
The Government of the Republic of Zambia has
identified the eradication of malaria and other major diseases as a priority to
attain the Millennium Development Goals targets for reducing maternal and child
mortality rates in Zambia (MOFNP, 2006). The country is also implementing
specific short- and medium-term programmes under the National Malaria Control
Action Plan (NMCAP) aimed at scaling up malaria control and prevention
strategies. These measures include a target to reduce malaria incidence by
75 percent
by 2010 (MOH, 2007).
A visit to the
Macha Research Trust revealed that babies could be born with malaria. Dr Phil
Thuma, a Senior Scientific Advisor at Macha Research Trust said previous
research found malaria parasites in the placenta.
“We also did a study in Macha way back in the
1980s showing that babies could be born with malaria from their mother as it
can go past the placenta called congenital malaria. So even if the baby
survives the pregnancy they could even be born with malaria. It is not seen
often but it is seen in places where malaria is very endemic.
So if you are born
with malaria it is going to lead to anemia later in life and this is also passed
on to the baby,” said Dr Thuma.
He added that
there was evidence that suggests that malaria was the main cause of miscarriage
especially in the first pregnancy because of the act on the placenta.
“Historically we
have felt that malaria is one of the causes of a miscarriage or abortion. When
the mother gets pregnant and she does not immediately show signs of malaria we
know that the parasite likes to live in the placenta. In fact there are many
studies done on the fact that the parasite goes to live in the placenta. You
might even look in their blood and not see it but it is hiding in the placenta
that interferes with proper blood supply to the fetus and can lead to
miscarriages,” explained Dr Thuma.
Explaining why
expectant mothers die from Malaria, Dr Thuma said women die because in the
first pregnancy because of the way each woman’s immune system reacts, one is more
likely to get severe forms of malaria like cerebral malaria depending on their
immune system reaction.
“Most of the
deaths in malaria in pregnancy are due to cerebral malaria. If you get cerebral
malaria you get very sick very quickly. You go into a coma and even sometimes
when we treat it you can’t survive. The
increased death in pregnancy and malaria is related to severe forms of malaria
due to cerebral malaria. Those forms of malaria seem to be related to the way one’s
immune system reacts,” explained Dr Thuma.
Explaining why self treatment was bad for
pregnant mothers, Dr Thuma said
usually if a
pregnant mother tried to be on self treatment she does not always try and
finish the course properly.
“In pregnancy, in
the first trimester we should not use the usual malaria drug like Coartem. If a
mother uses Coartem she could harm the fetus and in using self treatment she
might not know that she should not use Coartem in the first place. Most mothers never finish the dosage when they
are on self treatment,” said Dr Thuma.
Making a comment on
the abuse of the malaria drug he recalled the old days when Chloroquine was
used for abortion by women. He was
however saddened by press reports which showed that Coartem the one supplied
for public health was being sold to private chemists of which he said that was
a form of abuse.
In an effort to
protect women based on available evidence, the World Health Organisation (WHO)
recommends the use of Insecticide treated nets (ITNs), intermitted preventive
treatment and the effective case management of malaria illness. It is also important
that all pregnant women attend the antenatal clinics presenting a major
opportunity to prevent and treat malaria.
In an effort to overcome malaria in pregnancy challenges
major issues to be considered include the issue of drug resistance and safe and
appropriate use of different anti malarial drugs increases during pregnancy.
Research in this area is high priority. There is also a challenge of health
care reaching pregnant women who do not attend antenatal clinics or those who
attend only for the first visit or too late during pregnancy.
The availability
of insecticide treated nets, effective intermittent preventive treatment and a
means of delivery through anatenal clinics, provide a unique opportunity that
must be taken to protect the millions of Zambian women who become pregnant each year
and their babies.
Meanwhile, Dr
Thuma observed that not all women give birth at the rural health center. He
observed that even when it is now government policy that all pregnant women
should deliver at a hospital the reality of it is in the rural areas was that women still deliver at home.
A visit to a
Habulile Rural Health Centre in Chief Chikanta’s area showed that the centre
was under staffed as the nurse who manages it had gone to church. There were
were only two mothers in the labour ward of which one had delivered while the
other one had just entered into labour. The rural health center needs more
staff.
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