By Vivian Onyebukwa
Malaria is regarded as one of the killer diseases in the world right now. It is a life-threatening disease spread to humans by some types of mosquitoes, and it is mostly found in tropical countries.
Dr Demola Agbaje of Lagoon Hospital, Lagos, while examining some of the issues associated with malaria in pregnancy, said: “Malaria in pregnancy can affect the growth of the child. The baby may not grow up well at all. You may end up losing the pregnancy because malaria itself loves pregnant women and placenta. That is where it goes down and it causes the problem for both mother and the baby.”
He asserted that malaria is caused by an organism called Plasmodium Falciparum, and is transmitted by the bite of female anopheles mosquito. There are other species of plasmodium, he said, but most important is plasmodium falciparum.
Symptoms of malaria:
Agbaje said the symptoms range from mild to severe effects on the patient, which include headache, fever, chills, body-aches (Myalgia), generalised weakness, vomiting and hypoglycaemia.
In severe cases, he informed, the symptoms include convulsions, difficulty in breathing, reduced urinary outpu symptoms of organ damage. “There are a lot of other conditions that would present like malaria, but not malaria. You find out that when a pregnant woman goes to the hospital and complain of fever, catarrh and headache, doctors would ask her to go and run some tests to find out if it is malaria.”
He mentioned fever as one of the most important symptoms of malaria. “But it is not enough to say one has malaria because in pregnancy the woman’s body is hot. Because of the pregnancy the woman is carrying, her body is doing a lot of work. Again, when a woman is pregnant, she may start to feel that she is tired. Some might notice that their urines are getting dark. For some women, they may notice that their tummy is getting hard, and they are having contractions. Malaria can cause it. In very severe cases of malaria, you can have women who may lose consciousness. They are anaemic; their blood vessels are very low. They stand up, walk about five seconds and they collapse. All she needs to do is to go to the hospital for the doctors to run tests to find out if it is actually malaria. Going to the hospital to get treatment is a method of preventing complications of malaria in pregnancy.
Prevention and cure
However, Agbaje said, malaria in pregnancy is both preventable and curable. He maintained that a clean environment is the first and important step to prevent malaria.
“Take care of your environment by removing breeding areas for mosquitoes. Cut the bushes. Ensure that buckets of waters are empty to prevent mosquitoes from breeding and coming into the vicinity. Prevent contact with vectors (mosquitoes) by sleeping under insecticide treated nets, and putting mosquito nets on doors and windows. The purpose is to prevent mosquitoes from biting you.”
He mentioned the use of insecticides for the eradication of vectors, adding that it might be a very viable option especially where there are little children. “In using insecticide, one has to be very care careful because of the chemical for the sake of the baby,” he stated.
He also mentioned the importance of right drugs in the treatment of malaria in pregnancy. “Prophylactic medication is risky for some groups of people, especially pregnant women and children. Drugs are given at regular intervals. The tablets you use during pregnancy are very important.”
Improved nutrition, Agbaje said, is also one of the major ways to prevent malaria in pregnancy. “The immunity of first time mothers are very low for malaria, so eat food that would boost your immunity, a mix of proteinous food such as fish, milk, egg, and beans. “You must eat a balanced diet, not just starchy foods like rice. Fruits and vegetables are very good in preventing malaria in pregnancy,” he advised.
He also spoke on the effects of malaria during pregnancy. Hear him: “The plasmodium faciparum causes damage to red blood cells which are vital to carrying oxygen throughout the body. It can also cause micro-vascular sequestration. This leads to anaemia and end-organ (heart, liver, kidney, brain) damage and its consequences. In pregnant women, it can sequester there, cause damage and lead to poor growth of the baby and in extreme cases, death. In pregnancy, when the woman’s blood level is low, she does not have the energy to push. The baby does not have enough energy, either. This can cause problems for the baby,” Agbaje noted.
He further noted that before delivery, because the blood level of the pregnant woman is low, she can’t contrast and may continue to bleed and run into problems.
Malaria, he also said, can cause jaundice in the baby. So what should the pregnant woman do? “Attend anti-natal and listen to instructions from the health experts,” Agbaje advised.
And writing about malaria in the New England Journal of Medicine (NEJM), https://www.nejm.org/doi/full/10.1056/NEJMe1601193, Joel Tarning, Ph.D noted:
Malaria during pregnancy is a major public health concern and an important contributor to maternal and infant morbidity and mortality in malaria-endemic countries. Pregnant women are particularly susceptible to malaria, and in low-transmission settings they have a greater risk of severe Plasmodium falciparum malaria. P. falciparum–infected red cells sequester in the placenta, disrupting nutritional exchange between mother and fetus and causing intrauterine growth retardation. Malaria is associated with an increased risk of abortion, stillbirth, and low birth weight.
The World Health Organization (WHO) now recommends that all women in the second or third trimester of pregnancy who have uncomplicated P. falciparum malaria should be treated with artemisinin-based combination therapy. The short-acting but potent artemisinin component (i.e., artemether, artesunate, or dihydroartemisinin) reduces the number of parasites substantially during the first three days of treatment. The longer-acting partner drug (i.e., lumefantrine, piperaquine, amodiaquine, or mefloquine) eliminates the remaining parasites, thereby preventing recrudescent malaria. The longer-acting partner drug is also responsible for the post-treatment prophylactic effect, which prevents new infections while drug concentrations in blood exceed the minimum inhibitory concentration of the parasite. Thus, the duration of post-treatment prophylactic effect is a consequence of the potency and the elimination half-life of the drug. The same mechanism of action is used in intermittent preventive treatment, in which repeated curative antimalarial treatments eliminate potential asymptomatic infections and also prevent new infections. However, artemisinin-based combination therapy is not currently recommended for intermittent preventive treatment in pregnancy. The current recommendation from the WHO is for all women in malaria-endemic areas in Africa to receive intermittent preventive treatment with sulfadoxine–pyrimethamine as part of their antenatal care. Unfortunately, the effectiveness of sulfadoxine–pyrimethamine is challenged by widespread drug resistance in many areas.