Pregnant mums matter, especially when at risk of malaria

WWARN Published Date

Poor women in remote areas are the least likely to receive adequate health care. This is particularly true for regions with insufficient skilled health workers, such as in sub-Saharan Africa and South Asia. 

When you combine poverty, rural locations and poor health systems it is no surprise that pregnant women are a very vulnerable population group. More than half of the estimated 303,000 women that die each year during and following pregnancy live in sub-Saharan Africa. One of the causes of morbidity for both mother and child is malaria*.

To respond to these unacceptably high mortality rates, the Malaria in Pregnancy (MiP) Consortium is working with WWARN to build a partnership focused on developing the evidence base of how drug resistance affects the performance of antimalarials used to treat and prevent malaria in pregnancy. Prevention strategies include intermittent preventive treatment (IPTp), recommended by WHO in all countries with medium to high malaria transmission, and intermittent screening and treatment (ISTp) recently evaluated in clinical trials.

What are intermittent ‘preventive treatment’ or ‘screen and treat’ strategies?

IPTp strategies are treatment doses of antimalarials given presumptively (i.e. without a malaria test/parasite detection) to mothers at appropriate intervals during pregnancy starting early in the second trimester through to delivery to help protect mother and baby from the harmful effects of malaria infection in the blood and placenta. ISTp on the other hand provides pregnant women with a malaria rapid diagnostic test (RDT) at predefined intervals during the second and third trimester, and treatment of infected women with an efficacious antimalarial.

Malaria in Pregnancy Scientific Group

To understand the relationship between drug resistance and treatment outcomes, the Malaria in Pregnancy Scientific Group is gathering data on the efficacy, tolerability, safety and pharmacokinetic properties of antimalarial medicines used both for treatment and prevention of malaria during pregnancy.

The first of two MiP Study Groups, The Alternative MiP Prevention Strategies (AMPS) Study Group, is underway and focused on determining the safety and efficacy of intermittent screening and treatment (ISTp) with an artemisinin combination therapy (ACT) in non-African settings.

Have you got ISTp-data from outside Africa?

Read the inclusion criteria and get in contact with us to find out how you can join the AMPS Study Group. We’re planning to combine the findings from multiple trials in India, Indonesia, and any other trials in similar settings, to determine if ISTp has any role to play in the control of malaria in pregnancy with the current generation of RDTs, and if so, under which epidemiological settings, and / or if alternative strategies are required.

Malaria in Pregnancy Treatment Efficacy Study Group

Assessment of antimalarial efficacy in non-pregnant patients is standardised by the WHO guideline, yet there is no consensus on how this should be done in pregnancy after 28 days of treatment.

To respond to this knowledge gap, the Malaria in Pregnancy Treatment Efficacy Study Group Scientific Group will conduct IPD meta-analyses to measure the effectiveness of the majority of antimalarial treatments used for the treatment of P. falciparum caused malaria in pregnancy, during all trimesters. The MiP Treatment Efficacy Study Group will look at pooled data from Africa and Asia to outline long-term maternal and fetal outcomes after single and repetitive malaria P. falciparum infection and treatment in pregnancy.

Are you working in malaria advocacy? WWARN supports the Malaria in Pregnancy Working Group (MIPWG) led by the Roll Back Malaria Partnership – find out more.

To ask further questions, or join our MiP Study Groups, please contact Jenny Hill, Senior Scientific Coordinator for the MiP Scientific Group

Read a news article on two other recent studies published in the New England Journal of Medicine on malaria treatment safety and efficacy during pregnancy.

* Source: WHO website November 2016