Every year over 20 million women become pregnant in malaria affected areas in Africa. If a pregnant woman becomes infected with malaria, she is at risk of developing maternal anaemia and having a low birth weight baby. This in turn increases the chances of her baby dying in infancy. It is estimated that about 6 % of infant deaths are due to malaria-associated low birth weight. Although strategies have been developed to reduce the spread of malaria in pregnant women in Kenya, relatively few women are taking these measures.

There are a number of measures that can help a pregnant woman reduce the risk of developing malaria and putting her child’s life at risk. Insecticide-treated bednets (ITNs) and intermittent presumptive treatment (IPT) of malaria infection with two doses of sulphadoxine-pyrimethamine (SP) – one each in the second and third trimesters of pregnancy – are promoted by the Roll Back Malaria (RBM) initiative for this purpose.

IPT has become part of national policy in a number of sub-Saharan African countries. African ministers recently set a goal of administering IPT or chemoprophylaxis to at least 60 % of pregnant women in malaria-endemic regions by 2005. Kenya committed itself to this goal at Abuja in 2000 and launched a strategy to reach its target, including getting 60 % of pregnant women to sleep under ITNs. A report by the Kenya Medical Research Institute looks at whether the nationally recommended malaria prevention strategies of ITNs and IPT with SP have reached pregnant women in four malaria-endemic regions in the country.

The research found that the coverage of pregnant women with ITNs and IPT in 2001 was less than 10 % of the targets set for 2005. Moreover:

• about 5 % of pregnant women used ITNs and only 5 % who were not diagnosed with malaria received two or more doses of SP. Less than 1 % of women used both measures
• a further 8 % of women used an untreated bednet during pregnancy, more than half of which were bought from a shop or market (80 %): only 9 % of commercially-bought nets were treated with insecticide
• 27 % of pregnant women in cities used bednets compared with only 11 % of rural women. Lack of finances has been previously cited as the major reason in households across Africa, raising concern over the promotion of commercial bednets as a preventive measure
• although 96 % of staff representatives at the 46 antenatal clinics (ANCs) knew of the availability of IPT with SP for pregnant women, the treatment was routinely given out by only 72 % of ANCs
• a fifth of pregnant women took one or more doses of SP – but most took just one dose. Only half of these were given to women who were not diagnosed with malaria
• only 9 % of pregnant women had more than one dose of SP, and only 5 % had at least two doses of IPT during a visit to an ANC.

Calls are being made for ITNs to be handed out free of charge to pregnant women in order that coverage is more equitable and comprehensive. The report proposes that:

• The use of malaria preventive measures for pregnant women in Kenya needs to be increased 12-fold in order to meet the target set at Abuja.
• Access to malaria preventive services needs to be increased swiftly if national and international targets are to be met by 2005.
• The distribution of free ITNs to pregnant women through ANCs should be regarded as a viable option nationally, as ANCs are well attended.
• Malaria prevention programmes could be intensified through the ANCs as 74 % of women visited ANCs two or more times during their pregnancy.

Kenya has a long way to go if its nationally recommended strategies for preventing malaria are to achieve comprehensive coverage of all pregnant women. To date the greatest barriers to success are the poor supply of ITNs and IPT with SP, and the cost of these preventive measures to pregnant women.

Source(s):
‘Use of intermittent presumptive treatment and insecticide treated bed nets by pregnant women in four Kenyan districts’, Tropical Medicine and International Health 9(2): 255-261, by H.L. Guyatt et al, 2004
HINARI subscribers can access the full-text article here. Full document.

Funded by: Roll Back Malaria Initiative; AFRO; Kenya’s Ministry of Health; The Wellcome Trust; DFID-Kenya; UNICEF; the Kenya Medical Research Institute

id21 Research Highlight: 19 July 2004

Further Information:
Helen Guyatt
Loc Fossatello 52
05019 Orvieto Scallo (TR)
Italy

Tel: +39 (0)763 308246
Fax: +39 (0)763 308246
Contact the contributor: helenguyatt@yahoo.com

Kenya Medical Research Institute

Other related links:
'Targeting the causes of perinatal mortality in a Kenyan hospital'

'Rolling back reality: making malaria control accessible to all'

'Net cost - affording bednets in rural highland Kenya'

'Casting the net – free bednets for pregnant Kenyan women'

'Control panel - tools to prevent malaria epidemics in highland Africa'

See id21's collection of links relevant to infectious diseases.

See id21's collection of links relevant to maternal and child health.