Malaria is a mass killer that every family in Africa dreads. In 2013 statistics showed that about 3.2 billion people – almost half of the world’s population – were at risk of malaria. There were about 198 million malaria cases and an estimated 584 000 malaria deaths; of these 90% occured in sub-Saharan Africa. This is according to World Health Organization (WHO) statistics that continue to state that pregnant women are at high risk of dying from the complications of severe malaria. Malaria is also a cause of spontaneous abortion, premature delivery, stillbirth and severe maternal anaemia, and is responsible for about one third of preventable low-birth-weight babies.
Pregnant women are more susceptible than the general population to malaria. However, there is good news on the malaria front: researchers at Liverpool School of Tropical Medicine (LSTM), working with colleagues of the Centres for Disease Control and Prevention (CDC) in Kenya and USA, and from the Kenya Medical Research Institution have found that a new drug may be more effective at preventing malaria in pregnant woman, especially where there is resistance to current treatments.
The study noted that WHO currently recommends that women in areas of stable malaria transmission receive intermittent preventative treatment in pregnancy (IPTp) with the antimalarial drug sulfadoxine-pyrimethamine (SP), however high levels of resistance from the malaria parasite to this drug threatens its efficacy. This study looked at two alternatives to the recommended treatment strategy, intermittent screening with malaria rapid diagnostic tests (RDTs) and treatment of RDT-positive women with the new drug dihydroartemisinin-piperaquine (ISTp-DP); and intermittent preventative treatment with dihydroartemisinin-piperaquine (IPTp-DP). It was found that there were more instances of malaria with ISTp-DP compared to the existing IPTp-SP strategy, however there was a much lower instance of malaria in the IPTp-DP treated group.
This equated to an 84% reduction in the incidence of clinical malaria during the pregnancy, a 68% reduction in the risk of malaria infection at delivery and a 22% lower risk of anemia at delivery. IPTp-DP was also associated with up to 75% lower risk of stillbirths and early infant mortality than with SP. The drug was safe and very well tolerated by pregnant women.
Malaria in pregnancy remains a significant public health problem, and in areas of high resistance to sulfadoxine-pyrimethamine it is clear that an alternative treatment is needed. Our study showed that test and treat approaches are not a suitable alternative, at least not with the current generation of rapid diagnostic tests which still miss many infections, however it is a positive sign that prevention with the new drug dihydroartemisinin-piperaquine fared well in the study, and could be a promising alternative to SP following further investigation. – Senior author on the study and head of the Malaria in Pregnancy (MiP) Consortium, Professor Feiko ter Kuile.
With this study, the good news of pregnancy can be enjoyed be African women because the fear of malaria would be reduced.