Oyibo: Pregnant women should sleep under treated mosquito net

Professor Wellington Oyibo is a Consultant Medical Parasitologist and Director, Research and Innovation Office, University of Lagos. He spoke with Paul Adunwoke, on the management, prevention and treatment of malaria during pregnancy.

Could you explain more on malaria?
Malaria is a disease caused by the protozoan parasite plasmodium. Human malaria is caused by four different species of plasmodium, which include plasmodium falciparum, plasmodium malariae, plasmodium ovale and plasmodium vivax.

Essentially, it is a disease caused by plasmodium species, which causes acquit fibril illnesses in a man. It could be a severe condition in pregnant women, because the parasite may not instigate any disease in terms of clinical symptoms, but it could be clinical sequential. The presence of parasite in the placenta of a pregnant woman would cause a lot of issues.

Pregnancy-associated malaria (PAM), or placental malaria is life-threatening to both mother and developing foetus. PAM is caused primarily by infection with plasmodium falciparum, the most dangerous of the four species of malaria parasites. During pregnancy, a woman faces a much higher risk of contracting malaria.

This is why malaria in pregnancy may not present malaria symptoms, though pregnant women may have clinical malaria, such as fever, body rashes, headache and others. Malaria in a broad form may trigger the parasite to enter into the placenta, where they begin to cause several challenges, but the worst among which is an interference with the growth of the foetus.

If malaria happens earlier in pregnancy, it could lead to low birth weight. Children with low birth weight can be exposed to many diseases by the time they grow up. It can lead to delivering of preterm babies, as well as cause unplanned abortion. Malaria can affect the growth, development and death of an unborn baby. This is because once malaria parasite is in the womb, a pregnant woman would begin to have maternal anemia, and of course, all these can lead to the death of the mother. So, if the woman did not have malaria she would live her normal life. All these are consequences of malaria in pregnancy and it affects the foetus, the unborn baby and the mother.

What are the possible treatments and preventions?
Pregnant women living in malaria epidemic settings should follow preventive measures given by government in terms of policy in prevention during pregnancy. Pregnant women have to be careful about the medicines they take during pregnancy. They have to meet healthcare workers, who would tell them the age of the unborn baby and recommend appropriate drugs to clear the parasites.

Health workers should give pregnant women combination medicines after assessing the pregnancy and the drugs would last for months until they put to bed.

Pregnant women are advised to start taking drugs after 16 weeks of the pregnancy, which would help clear the parasites in the placenta. They should sleep under long-lasting insecticide-treated mosquito nets, which means mosquitoes should not be able to bite them to transmit disease. Plasmodium parasite and Plasmodium falciparum are the most dreadful species of malaria parasites. Plasmodium falciparum can go and hide in many parts of the body, including the womb and placenta. This is a major characteristic of the parasite; so at a particular stage after developing in the blood it goes to hide, which is called sequential.

Pregnant women in Africa should be aware of the risk in having malaria during pregnancy. If not, it could result in miscarriage and then she would start to accuse her neighbors of plotting her miscarriage. Every woman is expected to visit antenatal care facility during pregnancy, no matter whether she has put to bed before or not. In their third pregnancy, most women feel they have got experience, but this is not right because there might be new things the woman needs to know.

In some cases, pregnant women go to chemists to buy drugs, which is not right because there are some drugs a pregnant woman takes at the wrong time that are capable of defiling the unborn baby. So, there must be a medical test in antenatal centre, the result of which would determine the particular drugs health workers would recommend.

I would want the media to always educate the public on government policies and strategies because without awareness, malaria cases among women would be higher than expected. So, they have to be aware and the only way is for them to visit healthcare workers, who can teach them how to prevent malaria in pregnancy.

Why are pregnant women always at risk of having malaria?
The risk of having malaria is so high in women at the time of first pregnancy, because the unborn baby and the placenta are in the womb for the first time. Again, the woman has not developed strong immunity, which she would later develop by the time she puts to bed and have her second baby, when the risk would be reduced.

But that notwithstanding, every pregnant woman should visit antenatal care facility to enable health workers teach them the kind of food to eat and the need to stay healthy. The health workers would also give them anti-malaria drugs and they are not allowed to take the drugs at home, but right at the antenatal care centre.

Age is also a risk factor in contracting malaria during pregnancy; the younger the woman, the higher the risk of having malaria. But the more pregnancies, the lesser the risk, because the woman would have begun building protective anti-malaria body around the placenta.

It is very important that pregnant women register early at an antenatal care centre because most pregnant women don’t do this until they are about to put to bed.

Every good antenatal care centre has all that a pregnant woman needs to protect herself and her unborn baby not only against malaria, but also against other diseases and they must be going regularly to the antenatal care centre.

What type of food should a pregnant woman eat?
When women are pregnant, some of them select food, but cases are different from one individual to the other. At antenatal clinics, health workers would give advice on the kind of food to eat for sufficient blood and to keep them healthy.

The antenatal clinic is a discussion centre, where healthcare professionals advise pregnant women and give them opportunity to ask questions.