MALARIA IN PREGNANCY

Pregnancy

Malaria is a disease which is prevalent in Africa and many other third world nations in the world. It has caused great strain on the resources of affected nations as it usually has a very high morbidity and mortality on the societies affected.

In pregnancy, it gets worse as the woman’s physiological state is already somewhat compromised due to the presence of the unborn foetus. As a result, a pregnant woman infected with the malaria parasite has a higher chance of showing more severe symptoms, and possibly dying, than her non-pregnant counterpart. Pregnant women are also susceptible to repeated infections, particularly for women experiencing their first pregnancies, and women in their second trimester.

In order to increase the chances of a pregnancy being malaria free (or reducing the frequency of infections), certain basic understanding of the disease process, as well as steps towards prevention will be necessary.

HOW DO I CONTACT MALARIA?

This usually happens when an infected female anopheles mosquito bites a human. The mosquito is usually infected with a parasite called Plasmodium. There are five (5) different types of Plasmodium. Of all of them, Plasmodium falciparum is by far the most common, and the deadliest in West Africa. Once bitten by the mosquito, the parasite multiplies in the blood and causes all the symptoms of malaria within a few hours to a few days.

The female anopheles mosquito which is responsible for spreading malaria breeds mostly in stagnant water. This is a very important fact to note as once sources of stagnant water is eliminated, chances of contacting malaria is drastically reduced.

Sources of stagnant water include:

  1. Open gutters
  2. Ponds
  3. Storage containers including open overhead tanks
  4. Generally any environment where the water does not flow.

WHAT ARE THE USUAL SYMPTOMS?

Symptoms of malaria are basically the same as that found in other non-pregnant members of the population. They may however, be more severe as the woman has less reserve to withstand the physiological assault from the parasite.

  1. Fever
  2. Headaches
  3. Weakness and tiredness
  4. Generalised body pains which may be worse at the joints.
  5. Sometimes, a patient with very mild symptoms above can begin to loose consciousness or start behaving in a very odd manner. When this happens, it becomes a medical emergency as the patient has probably developed a more severe form of malaria known as Cerebral Malaria. Death can quickly ensue if prompt treatment is not started.
Image: Intechpen

WHAT TESTS DO I EXPECT?

  1. The most precise way to find out if an individual has malaria is through the test called the BLOOD FILM. No other test comes close in being reliable. So many other tests that are done may not be as reliable. This is because a large number of the healthy population may actually test positive to some of the other tests, even when they have no symptoms. But a patient with positive blood film is very likely to be showing symptoms of sickness.
  2. In addition to (1) above, a low blood count (low haemoglobin count), may also be seen, as the parasite is known to destroy the red blood cells in the sick patient.

If the test in (1) above is positive, treatment should be commenced immediately as delay may be dangerous. Please do not self medicate as not all drugs are safe in pregnancy. Let your medical professional be the one to decide which medications to give.

In some places that do not have the luxury of a laboratory, treatment can be commenced if there is strong suspicion of malaria when the patient is exhibiting the common symptoms mentioned above. This is done in areas where malaria infection is common.

HOW CAN I AVOID BEING INFECTED?

Prevention has always been the best, most convenient and cheapest form of treatment. While there is no fool-proof method for preventing malaria at the individual level, especially in the third world, some steps contribute in no little way towards drastically reducing risks of transmission.

  1. Eliminate all sources of stagnant water: We all learnt above how stagnant water is a very necessary link in the breeding of the mosquito. Many cities with open sewers and gutters have provided an endless source for the Mosquito to keep multiplying. While we cannot work on city drains, it is certainly possible to clean our immediate gutters and ensure that the drains are free flowing. Clean water kept in storage should be covered when not in use, as this also serves as breeding ground for the mosquito.
  2. Sleeping Under Insecticide Treated Nets: We are usually the least aware of mosquito bites when we are asleep. Insecticide treated nets usually minimise the chances of a mosquito bite during sleep, while also ensuring you sleep soundly as the woman doesn’t spend the better part of the night warding off mosquitoes.
  3. Intermittent Prevention Therapy: This is a method of administering anti-malaria drugs to healthy pregnant mothers as a form of prevention. It involves giving the drugs at intervals during the pregnancy. This is usually helpful in areas that have an unusually very high rate of transmission.
  4. Fumigating Immediate Living Environment: This involves the use of insecticides to fumigate one’s immediate living environment (living room, toilets, bedroom etc). It can be expensive, and may need repetition as doors and windows to the outside are occasionally opened, but can guarantee freedom of internal movement while its effects last. Occupants are advised to vacate the environment or room while fumigation is going on, and can only go in once the scents of the fumigating agent can no longer be detected by smelling.
  5. Sleeping in Well Ventilated Environment: Insects find it particularly difficult to anchor themselves onto human skin for a bite in a windy environment. It is for this reason that mosquito bites are less common in air-conditioned and well ventilated rooms. It is advised to sleep with fans and air-conditions on if there is no other overwhelming reason to do other-wise. In areas where there is epileptic power supply, those who can afford alternative source of power are advised to use them at night and for sleep when mosquito activities are at their highest.

WHAT ARE THE COMPLICATIONS OF MALARIA?

Malaria if not properly treated can have severe consequences  for both Mother and baby. Below are some of the more common ones:

  1. Spontaneous Miscarriage: The woman just simply looses the pregnancy due to excess load of parasite on the baby.
  2. Premature Delivery: The mother can go into pre-mature labour and deliver prematurely with all the attendant problems of premature babies.
  3. Still Birth: The woman may succeed in carrying the baby to term, but due to excess physiological assault to the baby’s system, it may not withstand the rigours of delivery. It therefore dies shortly before, during or shortly after birth.
  4. Low Birth Weight: If the mother is lucky to carry the baby to term, and the baby is lucky enough to live through child birth, the baby may have a low birth weight.
  5. The Mother may actually develop cerebral malaria as a complication. Death my ensue if proper treatment is not commenced.

CONCLUSION

As earlier said, there is no fool-proof method towards preventing malaria in the thirld world, especially as eradication in first world countries decades ago had a very strong input from Government. But there are enough individual prevention methods that have been proven to drastically reduce transmission even in areas where malaria is endemic. Adopting these measures will increase the chances of a malaria-free pregnancy.

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