Why malaria in pregnancy is often mistaken for routine fatigue

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Malaria remains one of the most dangerous yet preventable threats facing pregnant women across sub-Saharan Africa. In regions where it is endemic, pregnancy carries not only hope and expectation, but also a silent risk that can endanger both mother and unborn child.

Yet the danger often hides in plain sight. Early signs — fever, fatigue, headaches, and body aches — are easily dismissed as normal pregnancy discomfort, allowing the illness to advance unnoticed.

This overlap often leads to delays in seeking treatment, giving the infection time to progress and cause serious complications.

According to Dr Fredrick Kairithia, a consultant obstetrician and gynaecologist at Calgary Health Care in Nairobi, malaria in pregnancy behaves differently from typical infections.

“When a woman becomes pregnant, her immunity naturally goes down; it makes it easier for malaria parasites to thrive in her body, especially for first-time mothers who have not built enough resistance,” he explains.

One of the most serious complications is maternal anaemia. Malaria destroys red blood cells, leaving a woman weak, dizzy, and at risk of life-threatening complications. “Severe anaemia can lead to heart strain, complications during delivery, and even maternal death if not managed early,” Dr Kairithia warns.

Malaria in pregnancy can also harm the baby, as parasites build up in the placenta and reduce oxygen and nutrients, leading to low birth weight—a major cause of infant illness and death.

Dr Josephine Okwoyo explains that placental malaria is especially dangerous because it often shows no symptoms in the mother, yet silently affects foetal growth, resulting in premature or underweight babies.

In high-risk areas like Kisumu County, where mosquito breeding is common due to water bodies like Lake Victoria, many cases go unnoticed. Colleta Achieng’ recalls mistaking malaria symptoms for normal pregnancy fatigue until a routine check-up revealed the infection.

For some mothers, the experience is painfully real. Naliaka, a 27-year-old from Trans Nzoia County, recalls how malaria nearly cost her baby’s life. She delayed going to the clinic due to distance and transport costs, thinking it was normal pregnancy fatigue.

“By the time I went to the hospital, I was very weak. My blood levels were low, and my baby was not growing well,” she says.

She later received treatment and delivered safely, but her baby was born underweight and spent time in special care.

In some cases, the consequences are even more devastating. Malaria during pregnancy can lead to miscarriage, stillbirth, or premature delivery. These outcomes are not just medical statistics; they are deeply emotional losses for families.

Most regions in Kenya are free from malaria apart from 14 regions in the lake and coastal endemic regions: Kisumu, Siaya, Homabay, Migori, Busia, Vihiga, Bungoma, Kakamega, Lamu, Taita Taveta, Kilifi, Tana River, Mombasa and Kwale counties.

Prevention remains the strongest line of defence.

The use of insecticide-treated mosquito nets is one of the simplest and most effective measures.

Dr Okwoyo stresses that every pregnant woman should sleep under a treated mosquito net nightly, calling it a simple habit that can save two lives. She also highlights intermittent preventive treatment (IPTp), given during antenatal visits to clear and prevent malaria infections.

However, many women miss clinics due to distance, cost, or fear of side effects, while others arrive only when already very ill. Environmental factors like stagnant water and poor drainage further fuel infections.

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