Let's redouble efforts to protect pregnant women from malaria

A healthcare worker demonstrates how to set up a treated mosquito net. [Joseph Muchiri, Standard]

With the onset of the rainy season this month, the spectre of malaria is set to return to communities, bringing with it an upsurge in disease cases, hospital admissions, school and work absenteeism, household costs and in some cases death.

Malaria is one of humankind's oldest and deadliest diseases, stealing young futures and diminishing both national and individual potential. Fighting it has led to some of the greatest strides in global health in history and yet, today, a child still dies from malaria every minute, and over half of the world's population remains at risk from this treatable and preventable disease.

With the international communities' attention focussed on Covid-19 in recent years, combined with rising biological and environmental threats and reduced malaria prevention and treatment funding, progress in the malaria fight has not only plateaued, but is at risk of reversal.

Indeed, the WHO's latest World Malaria Report illustrated how Africa continues to shoulder a vastly disproportionate burden of malaria with 94.5 per cent of global malaria cases at 234 million, and 95.9 per cent of all global malaria deaths at 593,000. A new and innovative approach is needed if a Zero Malaria world is to become a reality within our lifetimes.

Tragically, pregnant women and infants represent the largest vulnerable group of those impacted by the disease, which poses substantial risks to both the mother and unborn child, including maternal anaemia, stillbirth, miscarriage, problems with child growth and cognitive development, and low birth weight - a leading cause of child mortality.

Indeed, pregnancy-related malaria causes around 200,000 infant deaths every year and is responsible for 20 per cent of stillbirths and 11 per cent of all new-born deaths across the WHO's Africa region. In 2021 alone, in 38 moderate to high transmission countries across Africa, there were an estimated 40 million pregnancies, of which close to one in three were exposed to malaria infection.

Although many malaria-endemic countries, donors, and other organisations have taken steps to increase delivery of life-saving interventions for malaria in pregnancy - intermittent preventive treatment with quality-assured sulfadoxine-pyrimethamine (IPTp-SP) - more than two-thirds of eligible women still do not receive the full triple-dose course today, with access and coverage remaining precariously low across many areas of sub-Saharan Africa.

The Kenya National Malaria Strategy targets IPTp interventions to pregnant women living in malaria-endemic areas. Among these, 49 per cent in the Lake endemic zone and 46 per cent in the Coast endemic zone received triple doses of IPTp, whereas urban women and those from the most vulnerable households in these zones are least likely to receive the correct course of treatment.

However, the Speed Up Scale Up campaign through the RBM Partnership is assisting to ensure that every eligible pregnant woman and her unborn child is protected against malaria by 2025. Launched in 2020, the campaign has called on leaders and policymakers to ensure provision of three doses of IPTp-SP in pregnancy and commit to increasing their efforts to safeguard more pregnant women from malaria.

The drug has been effective, safe and has proven safeguard against malaria for pregnant women and it is an excellent example of targeted delivery and improving supply chains on the continent. Medicines for Malaria Venture is currently leading a Unitaid-funded project to enable pharmaceutical companies in Kenya and Nigeria to manufacture quality SP for both domestic use and other countries in Africa.

In fact, Universal Corporation Ltd in Kenya became the first African manufacturer to gain WHO prequalification of high-quality sulfadoxine-pyrimethamine. This achievement directly feeds into the need for local production of quality medicines for use in Africa - a major gap that was critically highlighted when the Covid-19 pandemic left the continent with limited access to vital health products in 2020.

From IPTp-SP to next generation bed nets and malaria vaccine development, it is important to remember that a combination of tools to fight the disease is critical to saving millions of lives and unlocking the economic potential of endemic countries, helping us on the road towards malaria elimination and Universal Health Coverage.

Ending malaria and improving women and adolescent girls' access to treatment is an unrealised opportunity for advancing gender equality in health and achieving crucial WHO malaria targets and SDG Goals.

With public and political commitment, strong leadership, and increased investment in creative solutions, we can achieve Zero Malaria within our lifetimes and take back our futures.

-Dr Bonfield is the CEO of Malaria No More UK. Ms Mburu is the Executive Director of WACI Health Kenya, part of the Zero Malaria Campaign Coalition