Expecting infection? Preventing malaria and anaemia during pregnancy

In malaria endemic areas, pregnant women are more likely to be infected with malaria than other adults, particularly during the first pregnancy. They may not have symptoms of malaria, but infection can lead to severe anaemia and low birthweight, increasing maternal and infant mortality. What can health services do to lower the risk for pregnant women?

Researchers at the Kenyan Medical Research Institute and London School of Hygiene and Tropical Medicine showed that a programme of treatment with the anti-malarial drug combination, sulphadoxine-pyrimethamine (SP), for all women in their first pregnancy is an effective practical strategy to reduce severe anaemia in malarial areas.

The study took place in 1996-7 in Kilifi, a mainly rural district of Kenya. Malaria infection is the primary cause of severe anaemia in women in their first pregnancy in this area. Chloroquine used to be the main anti-malarial drug used in sub-Saharan Africa, but resistance to this drug is now very common. Is SP an effective alternative?

All women in their first pregnancy were given one, two or three doses of SP or a control pill. The number of doses depended on the duration of pregnancy when women first attended the clinic. Compared to those who receive no treatment, women given SP have a greatly reduced rate of malaria infection. Their risk of severe anaemia is reduced by 39 percent and they have significantly higher haemoglobin levels.

Women find SP easier to take than chloroquine, as it requires a maximum of three doses during pregnancy, rather than a weekly dose. The researchers also found that:

• The overall effect is the same in different rural populations, but less marked for urban women.
• SP is effective even if only one dose is given.
• Risks are reduced even for women who already use insecticide-treated bed nets.

This study has several implications for health policy, including:

• SP is an effective alternative to chloroquine for malaria prophylaxis programmes in pregnancy.
• Women who first attend antenatal clinics late in their pregnancy should be included in the programme, as one dose of SP has a significant protective effect. However, SP should not be given to women in the first trimester or the last month of pregnancy.
• Although no serious SP side-effects were seen in women or their babies, safety surveillance should continue if the treatment is introduced routinely for pregnancy.
• SP treatment should be used in addition to promotion of insecticide-treated bed-nets.
• Malarial resistance to SP should be monitored to ensure the treatment remains effective.

Source(s):
‘Intermittent sulphadoxine-pyrimethamine to prevent severe anaemia secondary to malaria in pregnancy: a randomised placebo-controlled trial’ by C. Shulman et al, The Lancet 353 (1999) Full document.

Funded by: UK Department for International Development; KEMRI, Kenya

id21 Research Highlight: 25 January 2001

Further Information:
Caroline Shulman
Department of Epidemiology and Population Health
London School of Hygiene and Tropical Medicine
49-51 Bedford Square
London
WC1B 3DP
UK

Tel: +44 (0)207 299 4600
Fax: +44 (0)207 299 4663
Contact the contributor: caroline.shulman@lshtm.ac.uk

London School of Hygiene and Tropical Medicine, UK

Other related links:
The Malaria Foundation has information on many malaria-related issues, including research, plus a forum for discussion.

Check the Roll Back Malaria site for the latest news and information on this WHO initiative.

Look at the issue of International Health Matters on malaria.

The Multilateral Initiative on Malaria is an international collaboration for scientific research into malaria.

The Malaria Consortium provides an interface between research and the operational realities of malaria control.

Refer to the Safer Motherhood site for a variety of factsheets and other resources.

Find details of research and other initiatives on the WHO's safer motherhood site.