Malaria in pregnancy threatens the health of both mother and child. It contributes to maternal anaemia and low birth weight, and increases maternal and child mortality. In 1993 Malawi adopted a policy of treating all pregnant women with two doses of sulphadoxine-pyrimethamine (SP) to prevent malaria. But are all pregnant women receiving SP and does it work?

Research by the University of Malawi College of Medicine and the Liverpool School of Tropical Medicine, UK, examined the impact of this programme in Blantyre, Malawi. They found that SP reduces maternal anaemia and improves infant birth weight. However, implementation of the policy is incomplete and alternative drugs may be needed in the future.

The study involved more than a thousand women giving birth at a large urban hospital. Malaria is often thought to be primarily a problem in the first pregnancy. However, in Blantyre, the prevalence and intensity of infection is similar in first and second pregnancies, then decreases in subsequent pregnancies. Many pregnant women with malaria do not have any symptoms of disease. However, infected women are more likely to be anaemic and to have low birth weight babies, the study found. Treatment with SP is associated with:

• reduced malaria infection in the placenta
• decreased prevalence of maternal anaemia
• increased birth weight.

The research also showed that:

• These effects are most marked in first and second pregnancies.
• A single dose of SP is associated with an intermediate protective benefit on birth weight.
• More highly educated women are more likely to use SP and the drug appears to have the most benefit in these women.

However, SP does not have a positive effect on all aspects of malaria infection and disease. This could be a sign that SP resistance is emerging following widespread use of SP and similar drugs in Malawi. In addition, the policy of SP treatment in pregnancy is not widely implemented. A quarter of women are not prescribed any SP and only 30 percent receive the recommended two doses. Policymakers could address this gap in coverage by:

• increasing implementation and surveillance of SP treatment
• addressing barriers to SP use in pregnancy such as drug shortages, scarcity of water and lack of information
• evaluating alternative agents to SP in pregnancy before resistance becomes widespread.

Source(s):
‘Intermittent sulphadoxine-pyrimethamine in pregnancy: effectiveness against malaria morbidity in Blantyre, Malawi 1997-1999’ by S. Rogerson et al Transactions of the Royal Society for Tropical Medicine and Hygiene 94 (2000)

Funded by: The Wellcome Trust, UK

id21 Research Highlight: 26 January 2001

Further Information:
Stephen Rogerson
Department of Medicine (RMH/WH)
University of Melbourne
Post Office, Royal Melbourne Hospital
Parkville, Victoria 3050
Australia

Tel: +61 3 9344 5490
Fax: +61 3 9347 1863
Contact the contributor: srogerson@malawi.net

Liverpool School of Tropical Medicine (LSTM), UK

Contact the contributor: srogerson@ozemail.com.au

Malcolm Molyneux
Wellcome Trust Research Laboratories and Malaria Project
Box 30096
Chichiri
Blantyre 3
Malawi

Tel: +265 676 444
Fax: +265 675 774
Contact the contributor: mmolyneux@malawi.net

Other related links:
The Malaria Foundation has information on many malaria-related issues, including research, plus a forum for discussion.

Check the Roll Back Malaria site for the latest news and information on this WHO initiative.

The Multilateral Initiative on Malaria is an international collaboration for scientific research into malaria.

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Find details of research and other initiatives on the WHO's safer motherhood site.

Check the Safer Motherhood site for a variety of factsheets and other resources.