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INTRODUCTION
Malaria, the mosquito-borne infectious disease
caused by parasites of the Plasmodium genus, continues to pose a significant
threat to maternal and child health worldwide (Anne et al., 2023).
While the disease
affects populations in diverse geographic regions, its impact on pregnant women
and their offspring is particularly concerning (Barken
and Iversen, 2021). In regions of the world where the
condition is endemic, such as sub-Saharan Africa and parts of Southeast Asia,
pregnant women are at an increased risk of malaria infection, which can have
profound implications for maternal and fetal health (Menaca
et al., 2013).
While continuing to
represent a substantial public health challenge, there is
an estimated 25% of pregnant women affected in areas with high transmission
rates (Oyerogba et al., 2023). According to the World Health Organization
(WHO), approximately 125 million pregnancies occur in malaria-endemic areas
each year, and the majority of these occur in sub-Saharan Africa and other
tropical regions where malaria transmission is prevalent (Hill and Kulie, 2018). In these settings, pregnant women are at an
increased risk of contracting malaria due to changes in their immune function,
making them more susceptible to infection and its associated complications
(Desai et al., 2018). The impact of malaria in pregnancy extends beyond the
immediate health consequences for the mother, as it also affects the developing
fetus. Malaria infection during pregnancy is associated with adverse outcomes,
including maternal anemia, low birth weight, preterm delivery, and increased
risk of infant mortality (Desai et al., 2018). These adverse effects not only
compromise the health and well-being of the mother and child but also
contribute to the intergenerational cycle of poverty and poor health outcomes
in malaria-endemic regions.
Despite the
recognized impact of malaria in pregnancy, several challenges persist in its
effective prevention and management. Access to preventive measures, such as
insecticide-treated bed nets and intermittent preventive treatment, remains
limited in many malaria-endemic regions, particularly in remote and
resource-constrained settings (Pell et al., 2013). Additionally, the emergence
of drug-resistant malaria strains poses a significant obstacle to the effective
treatment of malaria in pregnant women, necessitating the development of safe
and effective antimalarial therapies specifically tailored for use during
pregnancy (Khaja and Sequeira,
2021).
Furthermore, the complex interplay of social,
economic, and environmental factors contributes to the persistence of malaria
in pregnancy, highlighting the need for a comprehensive, multidisciplinary
approach to address this public health challenge (Almas et al., 2022).
Strengthening healthcare infrastructure, improving access to antenatal care,
and integrating malaria prevention and control measures into maternal and child
health programs are essential components of a holistic strategy to combat
malaria in pregnancy (Mills et al., 2008). Addressing the challenges associated
with malaria in pregnancy requires a concerted effort from governments,
healthcare organizations, and the international community to implement
sustainable interventions that can mitigate the impact of malaria on pregnant
women and contribute to improved maternal and child
health outcomes (Mills et al., 2008).
Prevalence of Malaria in Pregnancy in East
Africa
In
East Africa, over 70% of Kenya's population is at risk for contracting malaria,
and this continues to be a serious public health issue and a significant cause
of high morbidity and mortality. The burden of the virus in Kenya is
non-homogenous with places surrounding Lake Victoria and the Coastal region
having the highest risk locations with children below five years of age and
pregnant women being the most vulnerable to the infection (Okoyo,
2021). Pregnancy-related malaria infection in the country is a major public
health concern as it increases the risk of morbidity and mortality not only in
adults but also in both pregnant women and their unborn children.
Pregnancy-related malaria symptoms and problems vary depending on a person's
geographic location, level of acquired immunity, and the level of transmission
in a certain area. Malaria is typically asymptomatic in high-transmission
settings where acquired immunity to Plasmodium falciparum infection is
prevalent (Okoyo, 2021).
According to a recent Mozambican study that
used autopsy investigation to determine the cause of maternal mortality, up to
10% of maternal deaths were directly related to malaria infection and 13% were
due to HIV/AIDS, which can be made worse by concurrent malarial infection.
(Menéndez, 2018) This shows that malaria may be directly responsible for nearly
25% of all stillbirths in regions of the world where the disease is endemic.
In Ethiopia, the two main malaria-causing
species in Ethiopia are P. falciparum and P. vivax,
which account for 60% and 40% of cases, respectively. The primary malaria
vector is Anopheles arabiensis, whereas minor vectors
include An. pharoensis, An. funestus,
and An. nili (Assemie,
2022). In a recent study, the prevalence
of malaria and associated factors among symptomatic pregnant women attending
antenatal care at three health centers in north-west Ethiopia was analysed. The prevalence of malaria was 20.8%, which is
comparable to Ghana's prevalence of 22%. However, the prevalence is that of
Mali 28.1% and Burkina Faso (Almaw, et al, 2022). To
put all of these into perspective, the prevalence of malaria in Ethiopia is
quite lower compared to countries with some of the highest malaria prevalence
in Africa, such as Mali; which takes 3% of the cases globally, and Burkina
Faso; which takes about 3% of the cases globally. (WHO, 2020)
Although. the frequency of malaria among asymptomatic pregnant women
has been thoroughly studied (Almaw, et al, 2022),
yet, prevalence among symptomatic pregnant women continues to receive little
attention. Hence, there is a lack of information regarding the prevalence of
malaria and related variables among symptomatic pregnant women. Moreover,
Ethiopia has established goals for the eradication of malaria, with one of the
primary strategic goals being to treat all suspected instances of the disease
under recommended practices and undertake confirmatory testing on 100% of those
cases (Bugssa and Tedla,
2020).
Malaria in pregnancy
remains a significant public health issue in East Africa, with substantial
impacts on maternal and infant health. While strategies such as ITNs and IPTp have proven effective, additional measures are needed
to overcome the numerous challenges faced in the fight against this disease.
Ultimately, a comprehensive, multi-faceted approach integrating research,
policy implementation, and community engagement is required to effectively
address the prevalence of malaria in pregnancy in East Africa.
Malaria
in Pregnancy in West Africa
Malaria's prevalence in pregnancy across West
Africa is influenced by a myriad of factors, including regional climate,
healthcare infrastructure, and the presence of malaria-transmitting mosquitoes.
Malaria during pregnancy can profoundly impact both maternal and infant health
(Williams et al., 2016). Pregnant women with malaria are at an increased risk
for severe anemia, which can lead to maternal mortality (Brabin
et al., 2000). In a study by Oyerogba et al., (2023),
8.7% of pregnant women who participated in the study at the University College
Hospital, Ibadan, Oyo State, Nigeria, had malaria parasitaemia.
This rate is however lower than that of Ghana, Burkina Faso, and Malawi, which
reported rates of 10.2%, 20.4%, 18.1%, respectively.
Moreover, malaria in pregnancy
is a leading cause of low birth weight, a critical risk factor for neonatal
mortality and impaired child development (Guyatt and
Snow, 2004). Indeed, a study conducted in Nigeria revealed that about 25% of
low birth weight cases and 20% of infant deaths were attributable to malaria in
pregnancy (Menendez et al., 2000). The 2021 World Malaria Report asserts that
nearly 30% of pregnant women in malaria-endemic areas in West Africa experience
at least one incident of malaria during their pregnancy (WHO, 2021). In some
regions with high transmission rates, such as parts of Sierra Leone and
Nigeria, this percentage can increase to approximately 50% (Steketee
et al., 2021).
Research has indicated that
there is a substantial correlation between the frequency of malaria among
pregnant women in Nigeria and demographic characteristics such age, education
level, and occupation. Compared to their older, more educated, and wealthier
peers, younger pregnant women, those with lower educational attainment, and
those in low-income employment are more susceptible to malaria (Gontie et al., 2020). These results highlight the necessity
of focused interventions that take these demographic characteristics into
account in order to effectively control the malaria load among Nigerian
pregnant women (Mbachu, 2020).
In the West African nation
of Ghana, the burden of malaria in pregnancy (MIP) has been a significant
concern, with data from 2014 revealing that MIP accounted for 17.6% of
outpatient department attendance, 13.7% of hospital admissions among pregnant
women, and 3.4% of maternal deaths. However, there is reason for cautious
optimism, as subsequent data from 2015 indicated a decline in the first two
indicators to 14% and 11%, respectively (NMCP, 2015). This trend suggests that
efforts to combat malaria in pregnancy, such as the implementation of
preventive measures and improved access to healthcare services, may be yielding
positive results. Nonetheless, ongoing vigilance and continued research are
essential to further alleviate the burden of MIP and improve maternal and child
health outcomes in Ghana and beyond.
The significance of malaria
in pregnancy cannot also be overstated for the women of Côte d’Ivoire, as every
individual within the nation—a populace numbering approximately 24 million—is
constantly exposed to the threat of malaria year-round, with heightened
transmission occurring during the rainy season (Impact Malaria, 2020).
Addressing malaria in
pregnancy in West Africa is fraught with challenges, including limited access
to healthcare, socio-economic disparities, and a lack of safe and effective
antimalarial drugs for pregnant women (Bello and Ayede,
2019). To counter these issues, the WHO recommends the use of
insecticide-treated nets (ITNs), intermittent preventive treatment in pregnancy
(IPTp) with sulfadoxine-pyrimethamine
(SP), and efficient case management (WHO, 2021).
However, problems such as
drug resistance, difficulties in ITNs distribution, and socio-cultural beliefs
that hinder the adoption of preventive measures impede progress (Hill et al.,
2013). Therefore, research into novel drugs and strategies, extensive community
education, and efforts to strengthen healthcare systems are urgently needed in
the western region of Africa.
Malaria
in pregnancy in the Asia-Pacific region
The
Asia-Pacific area is home to the majority of pregnant women who are susceptible
to Plasmodium vivax infection (Rijken
et al., 2012). Nevertheless, few governments, policymakers, and donors in this
region recognize malaria in pregnancy as a priority. There are few reliable
statistics on the true impact of malaria during pregnancy. India, Papua New
Guinea, and Thailand are where the majority of information on the epidemiology,
impact, treatment, and prevention of malaria in pregnancy in the Asia-Pacific
area is found. The morbidity and mortality of malaria in pregnancy need to be
better estimated immediately. Accurate diagnosis and timely treatment are
required to avoid hazardous symptoms of sickness and minimize damage on fetuses
when malaria in pregnancy cannot be averted (Al Khaja
and Sequeira, 2021).
With 229 million infections and 409,000
fatalities from malaria reported in 2019, the disease continues to pose a
severe threat to public health. The Southeast Asia area recorded around 6.3
million cases, the majority of which were in India (Restrepo-Posada
et al., 2020). Health organizations have made a consistent and concentrated
effort over the past 20 years to minimize malaria infection, with some degree
of success; nonetheless, places with a high burden among the most susceptible
populations continue to be an issue (Restrepo-Posada
et al., 2020).
A study conducted in Gujarat, West India,
revealed that pregnant women are more susceptible to contracting malaria than
non-pregnant women. Another study from Odisha, east India, discovered that primigravidae
are more likely to develop parasitaemic infections
than multigravidae women, and that newborns are more
susceptible to infection overall (Nhama et al.,
2020). At health care facilities from Madhya Pradesh, the prevalence of malaria
in pregnant women was discovered to be somewhere between 6.4 and 55% (Jain et
al., 2023). More interventions to curb the prevalence of malaria in the region is necessary.
Malaria
in Pregnancy in South Africa and Central Africa
In
all 10 provinces of Zambia, malaria is endemic, and Plasmodium falciparum is
responsible for almost 95% of cases (Chaponda et al.,
2015). A Malaria Indicator Survey (MIS) has been carried out by the National
Malaria Control Programme every two years since 2006
to assess the prevalence of malaria in children under the age of five in
particular sites. Controlling malaria therefore continues to be a top concern
for public health in endemic nations like Zambia. Children under five years old
and pregnant women are two of the categories most at risk of contracting
malaria. Adverse birth outcomes that impact the mother, fetus, and infant are
linked to malaria infection. It has been demonstrated that HIV infection raises
the risk of malaria during pregnancy (Chaponda et
al., 2015. First-trimester treatment for uncomplicated malaria in pregnancy is
quinine, but the second and third trimesters are when ACT should be used (Enesia et al., 2015).
In terms of malaria burden, the Democratic
Republic of the Congo (DRC) is the second-highest country in the world (WHO,
2020). The general population frequently has asymptomatic malaria, and the
local prevalence can reach 48.2%. The average malaria prevalence in the country
is 37.2%. In four maternity centers in Kinshasa in 2006, the proportion of
measured malaria parasites was higher among first-time moms (26.5%) than
multiparas (18.8%) (Mudji et al.,
2021).
Since the 1970s, South Africa (SA) has used
IRS at homesteads to implement vector management techniques that provide
control for the general population in malarious
environments. So, the goal of malaria prevention is to protect the entire
population, not only expectant women. While IPTp has
been introduced in other malaria-endemic nations, South Africa has not, mostly
due to a lack of knowledge regarding the prevalence of malaria in pregnant
women (Njau et al., 2021).
In South Africa, although malaria is only
present in three provinces, which are Limpopo, Mpumalanga, and KwaZulu-Natal
(KZN)—it nevertheless poses a severe threat to public health across the country
(Njau et al., 2021).
Malaria
in Pregnancy in Europe
With 87 million migrants (30.9%), Europe is
presently the most popular destination for international migrants, according to
the World Migration Report 2022. In 2020, the majority of African-born migrants
living outside of the area resided in Europe (Marascia
et al., 2023). Although pregnancy-related occurrences of malaria are rare,
there is a definite group most at risk: newly arrived immigrants and young
sub-Saharan moms visiting friends and relatives without receiving pre-travel
counseling. Anaemia and stillbirth were the most
frequent unfavorable consequences on mothers and fetuses. Patients with
unexplained anemia arriving from endemic areas should always be evaluated for
malaria, as the disease might present silent. These results should raise
awareness among doctors and assist planners and implementers of Maternal Health
programs in focusing preventive interventions on the immigrant community (Jiménez et al., 2020).
CONCLUSION
Understanding the global prevalence of malaria in
pregnancy is a critical data point in the larger picture of malaria eradication
and control across the world. Knowledge of the prevalence of malaria in pregnant
women can guide health policy and resource allocation. As high prevalence is
detected in certain regions, more resources can be allocated for preventive
measures, treatment, and follow-up care in such areas. Thus,,
understanding global prevalence helps to target interventions more effectively.
These interventions can specifically include distribution of
insecticide-treated nets, intermittent preventive treatment, and effective case
management.
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