For Dr Folake Adurogbola, working in the community to ensure healthy mothers and babies was a priority. The reality is that the consequential effects of malaria on pregnant women are lost to many, even though malaria testing and medications are free in many health facilities.
Pregnant women are particularly vulnerable to malaria when they become infected because pregnancy reduces a woman’s immunity, increasing the risk of illness, severe anemia, and death. Malaria in pregnancy increases the risk of miscarriage, stillbirth, premature delivery, and low birth weight — a leading cause of child mortality.
For many pregnant women, ignorance about the effect of malaria, poverty and traditional beliefs of mothers on when a pregnant woman goes to the health facility for antenatal care continues to be a hindrance to the prevention and treatment of malaria, even though treatment for these are free in many government-owned health facilities.
“A lot of people believe that when they go to the hospital, they will spend a lot. They had forgotten that most of these tests, especially malaria tests are free. Also, malaria treatment is free. Some organizations support free malaria drugs in the community,” Dr Adurogbola, Oyo State team lead, APIN Public Health initiatives, said.
An increase in the number of contacts between health care providers and pregnant women creates opportunities to expand coverage of both quality-assured “intermittent preventive treatment (IPT) in pregnancy” and antenatal care.
Generally, across different communities, perceptions of pregnant women regarding malaria and the recommended malaria prevention interventions, which are an integral component of maternal and newborn health services, are low.
In some communities, people misinterpret symptoms of malaria in pregnancy. “Once a woman misses her period, confirms that she’s pregnant and then falls ill, they don’t even think alongside malaria. They associate the symptoms with pregnancy. They will stay at home, maybe go to chemist shops to get some medications, which affects the pregnancy negatively,” said Dr Adurogbola.
According to her, body pains, headaches or high body temperature require tests to be sure it is not malaria in pregnant women, especially in malaria-endemic areas like Nigeria.
She added, “It is not in all cases that high body temperature or feeling unwell is confirmed to be malaria. That is why the test is important to confirm it is malaria to get proper treatment. For instance, they might have a headache that could just have been due to stress.”
World Health Organisation’s recommendation of IPT- sulfadoxine-pyrimethamine (SP) as a safe and highly effective strategy for preventing malaria in pregnancy is underpinned by a wide body of evidence. However, access to preventive therapy throughout pregnancy remains low.
In 2019, there were around 373 thousand pregnant women with malaria in Nigeria. Compared to the previous two years, the number of pregnant women with malaria experienced a decrease. In 2017, they amounted to over 480 thousand.
Even so, only 57 per cent of pregnant women had four or more antenatal care visits in 2018. The states in Nigeria where over 90 per cent of women had at least four antenatal visits were Osun and Ogun. On the contrary, in Zamfara and Bayelsa this percentage was around 26 per cent.
A 2008 baseline household survey conducted by the Society for Family Health in 21 states of Nigeria on perceptions of risk of malaria in pregnancy as it influences receiving of Intermittent Preventive Therapy among pregnant women indicated that respondents who perceived malaria to be a risk during pregnancy were nearly twice as likely to receive IPT.
Sleeping under an insecticide-treated net the night before the survey was associated with receiving IPT, as was registering for antenatal care (ANC) services. Also, women who had registered for ANC were six times as likely to receive IPT as those who had not registered.
Dr Adurogbola, however, stated that pregnant women shouldn’t joke about malaria because it breaks down red blood cells in the body; they may not be able to eat and could cause vomiting, all together lowering blood volume or anaemia and increasing the chance of losing their unborn baby.
“That is exactly why a pregnant woman who refuses to treat malaria stands to lose her baby. We sensitize every pregnant woman to register ingovernment hospital or hospital where she can have quality-assured Intermittent Preventive Treatment in pregnancy and antenatal care.”
Dr Monday Famakin, Chief Medical Officer and Director, Primary Health Care in Ibadan North Local Government said that malaria is an issue during pregnancy because the parasite can cause the death of her baby. It can cause other complications in the baby yet unborn.
He stated that pregnant women, especially in the early stages of pregnancy, should not avoid the use of malaria medicine if prescribed because it cannot lead to miscarriage as many thought in the community.
Dr Famakin added: “Rather it is malaria that leads commonly to abortion in pregnancy, particularly if a pregnant woman has malaria in the first trimester. Malaria medicines are safe in pregnancy, be it first, second or third trimester. Also, there are malaria preventive measures like the use of insecticide-treated nets or the use of IPT that will help to reduce their chances of coming down with malaria.”
Studies on the acceptability of malaria preventive interventions often examine them in isolation from other interventions. There is a need to better understand women’s perceptions, acceptability and adherence to these interventions that are integrated with other health services offered to women, such as ANC services. It will increase uptake of these services and ensure safe mothers and healthy babies.