Pregnant women have an enhanced risk of malaria in regions where transmission rates are high. Is this also true in areas of low transmission? Researchers from the London School of Hygiene and Tropical Medicine tackled this question in Byumba District Hospital, Rwanda.

In low transmission areas, the entire population is at risk, but pregnant women are especially vulnerable, particularly during epidemics. Byumba District is at an altitude of 2300 m. It has low levels of malaria transmission. The population includes non-immune returnees and refugees from the high altitude east Congolese region of Masisi.

Over a period of three years, the researchers found that:

• Heavy rainfall in February 1998 led to a malaria epidemic, which produced a fourfold increase in malaria admissions among pregnant women and a fivefold increase in maternal deaths from malaria.
• In 1998, 38 per cent of pregnancy related admissions in Byumba Hospital were due to malaria. 71 per cent of maternal deaths were malaria-related.
• Assuming pregnant women were as likely to be admitted as non-pregnant adults would lead to a prediction of 34, 40 and 25 malaria-related pregnant admissions in each of the three years studied. Actual admissions were 54, 198 and 67 respectively.
• Pregnant women may be 1.6 – 4.9 times more likely to be admitted for malaria than other adults in low transmission areas.

These results show that malaria is an important cause of maternal illness and death in hospitals. Even in non-epidemic years, it causes a large proportion of maternal deaths. Neither the international Safe Motherhood Initiative nor the Roll Back Malaria Initiative fully address malaria in low transmission areas as a major contributor to maternal death and disease. The researchers recommend that these international initiatives should:

• acknowledge the importance of malaria as a cause of maternal death and a contributor to the disease burden in low transmission areas
• work together to apply the available control measures, such as insecticide-treated bednets, in epidemic situations
• investigate the usefulness of providing preventative anti-malarial drug treatment during pregnancy in low transmission areas.

Source(s):
‘Unstable malaria transmission and maternal mortality – experiences from Rwanda’, Tropical Medicine and International Health 7 (7): 573-576, by A. Hammerich, O. Campbell and D. Chandramohan, 2002

Funded by: German Development Service (DED); UK Department for International Development

id21 Research Highlight: 16 October 2002

Further Information:
Asmus Hammerich
German Techincal Cooperation (GTZ) Technical Assistance Team
Indo-German Basic Health Project
West Bengal
29 GN Block, Sector V
Bidhan Nagar
Calcutta
700 091
India

Tel: +91 33 3574695/6
Fax: +91 33 35746957
Contact the contributor: asmus_hammerich@yahoo.com

London School of Hygiene and Tropical Medicine, UK

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