Protection of Pregnant Women against Malaria still Inadequate

Millions of pregnant women in Sub-Saharan Africa still lack adequate access to Insecticide Treated Bednets and Intermittent Preventive Treatment, despite aggressive efforts in the past decade.

Despite aggressive policy efforts in the past decade, new research involving the KEMRI-Wellcome Trust Researchers has concluded that millions of pregnant women in Sub-Saharan Africa (SSA) still lack adequate acess to Insecticide Treated Bednets (ITNs) and Intermittent Preventive Treatment (IPTp).

The study published in the Lancet Infectious Diseases Journal shows that IPTp and ITNs are not being fully utilized to protect pregnant women form malaria in Sub-Saharan Africa (SSA).

The study reviewed national control strategies from 47 countries acrosss Sub-Saharan Africa and showed 23 million pregnancies in 2007 were unprotected by an insecticide-treated bednet and 19 million were unprotected by intermittent preventive treatment yet these countries had a national policy for these interventions. The paper concludes that despite success in a few countries, coverage of insecticide-treated bednets and intermittent preventive treatment in pregnant women is inadequate and needs scaling up.

"It is important to map malaria risk, map progress toward improving coverage of interventions in pregnant women and identify what we need to do to increase coverage in high risk areas. This paper shows that much remains to be done for many vulnerable pregnant women in highly malarious areas of Africa, '' says Professor Bob Snow, one of the lead researchers in the study and who is also the Head of the Malaria Public Health and Epidemiology Group at the KEMRI-Wellcome Trust Research Programme.

Viola Kirui, a researcher at the KEMRI-Wellcome Trust Research Programme and co-author of the paper adds: ''Kenya had commendably began implementing the distribution of insecticide treated bednets to pregnant women and children under five through maternal and child health clinics. We however need to scale up these efforts if we intend to meet and surpass the targets set in the new Kenya National Malaria Strategy.''

Professor Feiko Ter Kuile, the Malaria in Pregnancy Consortium leader and co-author of the paper, says: '' Ten years after the Abuja Declaration, it is encouraging that the majority of malaria endemic countries in SSA have now adopted ITNs and IPTp 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 RBM targets set for 2010. In addition, coverage was lowest in areas with high malaria transmission, where the need is greatest.

In general, low coverage with IPTp and ITNs contrasts with correspondingly high antenatal clinic attendance, indicating that there are missed opportunities for coverage and the attainment and maintenance of high coverage of ITNs remains challenging.

In summary, 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 RBM goals or the policy ambitions of each country.

With only five years in which to meet the Millenium Development Goals, it is sobering that in countries with a national policy for IPT and/or ITN, an estimated 23 million pregnancies remain unprotected by an ITN and 19 million remain unprotected by IPTp. 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.''

Malaria in pregnancy is a major public health concern in Kenya and other sub-Saharan African countries. The World Health Organisation (WHO) Expert Committee on Malaria recommends that Intermittent preventive treatment (IPTp) and Instecticide treated Nets (ITNs) be used to mitigate the effects of malaria in pregnancy.

Intervention with Intermittent preventive treatment (IPTp) requires that an effective anti-malarial drug be provided to pregnant women in highly endemic malaria zones as a routine part of antenatal care while Insecticide treated Nets (ITNs) require for pregnant women to sleep under insecticide treated mosquito nets to reduce the risk of malaria infection. These policy recommendations have fed into the work of the Roll Back Malaria Initiatiave (RBM) which aims to ensure that 100% of pregnant women receive Intermittent preventive treatment (IPTp) and at least 80% of people at risk from malaria are using Insecticide treated Nets (ITNs) in areas of high transmission by 2010.

Photo courtesy of Bombali Bana, 2010.

The study entitled ''Mapping coverage of malaria protection among pregnant women in sub-Saharan Africa: a synthesis and analysis of national surveys' is published in the Lancet Infectious Diseases and was led by the Malaria in Pregnancy Consortium based at the Liverpool School of Tropical Medicine, in association with the Malaria Public Health and Epidemiology Group at the Kenya Medical Research Institute-University of Oxford- Wellcome Trust Collaborative Programme; the Spatial Ecology and Epidemiology Group, the Department of Zoology, University of Oxford; the Department of Infectious Diseases, Academic Medical Centre, University of Amsterdam and the Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford.