A study published today in The Lancet Infectious Diseases finds that methods to protect pregnant women from malaria are still underutilised in sub-Saharan Africa (SSA). A review of national control strategies by a team of international researchers, led by the Malaria in Pregnancy Consortium and funded by the Consortium and the Wellcome Trust, has concluded that despite major efforts, coverage is still inadequate in many areas and needs to be scaled up.
Malaria infection in pregnancy can lead to devastating consequences for both mother and child. The World Health Organization’s (WHO) recommended policy for malaria prevention and control is a package of intermittent preventive treatment (IPTp) and insecticide treated nets (ITNs). These interventions have the potential to substantially reduce the disease burden and adverse outcomes of malaria in pregnancy. The Roll Back Malaria initiative (RBM) has ambitions to ensure that 100% of pregnant women receive IPTp and at least 80% of people at risk from malaria are using ITNs in areas of high transmission by 2010.
Specific strategies for malaria control in pregnant women were extracted from national malaria policies and the most recent national household cluster-sample surveys recording IPTp and ITN use were reconciled to sub-national administrative units to compute the numbers of protected pregnancies. Malaria maps generated by the Malaria Atlas Project (MAP, www.map.ox.ac.uk) meant these estimates could be stratified against different levels of malaria risk.
The study found that 45 of 47 SSA countries had an ITN policy for pregnant women and that estimated coverage was 17% among the nearly 28 million pregnancies at risk of malaria in the 32 countries with information. Among 39 countries with an IPTp policy, 25% of pregnant women had received some IPTp, despite 77% visiting an antenatal clinic (ANC), the main delivery channel for reaching pregnant women with ITNs and IPTp.
Professor Feiko ter Kuile, MiP Consortium leader and co author said: “Ten years after the Abuja declaration, it is encouraging that the majority of malaria endemic countries in SSA have now adopted ITNs and IPTp and the number of countries with nationally representative coverage data has increased to 40 out of 47. However, very few countries have reached either the Abuja targets or their own policy ambition, and countries are even further away from the more recent RBM targets set for 2010. In addition, coverage was lowest in areas with high malaria transmission, where the need is greatest.
“In general, low coverage with IPTp and ITNs contrasts with correspondingly high ANC attendance, indicating that there are missed opportunities for coverage and the attainment and maintenance of high coverage of ITNs remains challenging.
“In summary, whilst most countries have adopted national policies aimed at reducing and controlling malaria in pregnancy, it is clear that, with some notable exceptions, not enough progress has been made towards the new RBM goals or the policy ambitions of each country.
“With only five years in which to meet the Millennium Development Goals it is sobering that in countries with a national policy for IPT and/or ITN, an estimated 23 million pregnancies remain unprotected by an ITN and 19 million remain unprotected by IPTp. Greater effort to fully understand the reasons why coverage is so low and to develop strategies to combat this is urgently needed to protect the tens of millions of pregnancies in sub-Saharan Africa threatened by malaria every year.”
For further information, please contact:
Alan Hughes, Communications Manager,
Malaria in Pregnancy Consortium,
Liverpool School of Tropical Medicine
Office: +44 (0)151 705 3308
Justa Wawira, Centre for Geographic Medicine,
KEMRI-University of Oxford-Wellcome Trust Collaborative Programme, Kenya
Tel: +254 (0) 733 522063; +254 (0)733 268690; +254 (0) 725 242233
Notes to Editors
The study, entitled ‘Mapping coverage of malaria protection among pregnant women in sub-Saharan Africa: a synthesis and analysis of national surveys’ is published in The Lancet Infectious Diseases and was led by the Malaria in Pregnancy Consortium based at the Liverpool School of Tropical Medicine, in association with the Malaria Public Health and Epidemiology Group at the Kenya Medical Research Institute – University of Oxford - Wellcome Trust Collaborative Programme; the Spatial Ecology and Epidemiology Group, the Department of Zoology, University of Oxford; the Department of Infectious Diseases, Academic Medical Centre, University of Amsterdam; and the Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford.
The Malaria in Pregnancy Consortium consists of 41 partner institutions in 29 countries around the world, joined in the fight against malaria in pregnancy and committed to improving its control and treatment in Africa, Asia and Latin America. The Consortium, led by the Liverpool School of Tropical Medicine, was established with an initial grant of $30 million from the Bill & Melinda Gates Foundation and is also supported by the European Union. The five-year programme will directly benefit the 50 million women globally who face exposure to malaria whilst pregnant every year.
For further information please visit www.mip-consortium.org
The Malaria Atlas Project (MAP) is funded by The Wellcome Trust (UK) to assemble medical intelligence and survey data to provide evidence-based maps on the distribution of malaria risk, human population, disease burdens, mosquito vectors, inherited blood disorders and malaria financing and control worldwide. The maps generated are the results of a collaboration between malaria scientists in the UK, Kenya, Vietnam, Indonesia, Ecuador and the USA. MAP work in the Asia-Pacific region has been additionally supported by a grant from the Li Ka Shing Foundation.
For further information visit www.map.ox.ac.uk
The Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme formally established in 1989, is a partnership between KEMRI, Oxford University and the Wellcome Trust. It conducts basic, epidemiological and clinical research in parallel, with results feeding directly into local and international health policy, and aims to expand the country's capacity to conduct multidisciplinary research that is strong, sustainable and internationally competitive.
Oxford University's Medical Sciences Division is one of the largest biomedical research centres in Europe. It represents almost one-third of Oxford University's income and expenditure, and two-thirds of its external research income. Oxford's world-renowned global health programme is a leader in the fight against infectious diseases (such as malaria, HIV/AIDS, tuberculosis and avian flu). Key to its success is a long-standing network of dedicated Wellcome Trust-funded research units in Kenya, The Gambia, Thailand, Laos and Vietnam. Long-term studies of patients around the world are supported by basic science at Oxford and have led to many exciting developments, including potential vaccines for TB, malaria and HIV, which are in clinical trials.
The Wellcome Trust is the largest charity in the UK. It funds innovative biomedical research, in the UK and internationally, spending over £600 million each year to support the brightest scientists with the best ideas. The Wellcome Trust supports public debate about biomedical research and its impact on health and wellbeing.