Options for Treatment and Control of Malaria in Pregnancy in Zambia

Thesis summary

Malaria is one of the most important causes of morbidity and mortality worldwide, with pregnant women being among the most severely affected.  Sub Saharan Africa, has the highest malaria-related deaths, and also HIV as a major public health problem compounding the malaria situation.  Zambia is part if this region.  P.falciparum malaria in pregnancy causes adverse outcomes including abortion, anaemia and low birth weight (LBW), as well as maternal, foetal and neonatal morbidity and mortality.

The World Health Organization (WHO) recommends the use of preventive measures to limit the occurrence of malaria in pregnancy in stable malaria transmission areas, such as insecticide-treated nets (ITNs), intermittent preventive treatment (IPTp) and prompt treatment with an effective anti-malarial drug.  Artemisinin-based combination therapies (ACTs) are effective and well tolerated but are not used especially during the first trimester because of limited safety data.

Prophylaxis with efficacious antimalarials can reduce the incidence of placental parasitaemia, LBW and maternal anaemia. Presently SP is the only antimalarial being used for IPTp. Unfortunately, there is documented increase of parasite resistance to it. Clinical trials to explore malaria treatment options and to find alternative drugs to bridge the gap for alternative prophylactic drugs following the documented increase of parasite resistance to SP were explored. These form the basis of this thesis.

The findings revealed that exposure to AL in pregnancy, including the first trimester, is probably not associated with particular safety risks in terms of perinatal mortality (stillbirths and neonatal deaths), preterm deliveries, and low birth weights. Infant neurodevelopmental assessments up to 12 months were also similar. The adverse effects of P. falciparum malaria in the first trimester substantially outweigh any adverse effects of its treatment.

CTX long term use indicated that it can prevent and treat malaria. However, the global review revealed no information on its use in pregnancy irrespective of HIV status. A randomized clinical trial reported that exposure to CTX during the latter part of pregnancy may not be associated with increased safety risks.

There is need of exploring further the safety, efficacy and effectiveness of daily CTX and its role in preventing malaria during pregnancy irrespective of HIV status.