Malaria is a life-threatening parasitic disease in humans, which is transmitted by female anopheles mosquitoes. It was once thought that the disease came from fetid marshes, hence the name malaria (bad air).
In 1880, scientists discovered the real cause of malaria — a one-cell parasite called plasmodium. Later, they discovered that the parasite is transmitted from person to person through the bite of a female anopheles mosquito, which requires blood to nurture her eggs.
Approximately 40 per cent of the world’s population, mostly those living in the world’s poorest countries, are at risk of malaria. The disease, which was once widespread, has been successfully eliminated from many temperate countries in the mid 20th century. Malaria is endemic throughout the tropical and sub-tropical regions of the world and causes more than 300 million acute illnesses and at least one million deaths annually.
Ninety per cent of deaths due to malaria occur in Africa south of the Sahara mostly among young children. Scientists say malaria kills an African child every 30 seconds. Many children who survive an episode of severe malaria may suffer from learning impairment or brain damage. Pregnant women and their unborn children are also particularly vulnerable to malaria, which is a major cause of perinatal mortality, low birth weight and maternal anaemia.
There are five types of human malaria: Plasmodium vivax P. malariae, P. ovale, P. knowlesi and P. falciparum. P. vivax and P. falciparum are the most common, while falciparum is the most deadly type of malaria infection.
Plasmodium falciparum malaria is most common in Africa, south of the Sahara, accounting in large part for the extremely high mortality in this region. There are also worrying indications of the spread of P. falciparum malaria into new regions of the world and its reappearance in areas where it had been eliminated.
Malaria during pregnancy is a major public health problem in tropical and sub-tropical regions throughout the world. Every year, approximately 300 million people are affected and over one million deaths occur in Africa, Asia, Oceania, Central and South America due to malaria.
Every year, tens of thousands of pregnant women in malaria endemic areas are affected by infection with plasmodium falciparum. Although adults living in endemic areas acquire protective immunity against developing severe malaria, pregnant women remain susceptible to malaria infection, especially in the first pregnancy.
The infection carries an extremely high risk of developing life-threatening pathology for both the mother and the child. The clinical syndrome of what is termed maternal or placental malaria may include premature delivery, intrauterine growth restriction, stillbirth, abortions, maternal anaemia and death of the mother and the newborn.
It is estimated that between 75,000 and 200,000 infants die from pregnancy associated with malaria each year. The reason for the severe pathology associated with maternal malaria is the massive infestation of the placenta with Plasmodium Falciparum.
While the placenta of infected women may be infested with parasitised red blood cell, with parasite densities sometimes exceeding 50 per cent of the total placenta erythrocyte count, the peripheral blood may remain free of parasites. This implies that absence of peripheral malaria parasitaemia may not mean absence of malaria placenta infection. Sequestration of infected red blood cells in the placenta is a virulence factor exclusively displayed by Plasmodium Falciparum infection and not observed for other human malaria parasites.
Regardless of the level of endemicity, the major effects of malaria in pregnancy are maternal anaemia and reduced birth weight. This is known to be commoner in primi gravidae (that is first pregnancy) and to a lesser extent in secondi gravidae (second pregnancy).
Malaria is most frequent in first pregnancy, peaking between 13 and 16 weeks, and declining toward term. Age may be an independent risk factor, as younger pregnant women have been found to be more susceptible to malaria in some settings.
Adolescent and young adult women are more commonly associated with more malaria in pregnancy than older adults, and this may reflect continuing development of malarial immunity.
HIV infection increases susceptibility to malaria, resulting in more prevalent and higher-density infection, and a relative loss of gravidity-dependent immunity.
Clinical presentation of malaria in pregnancy varies from asymptomatic (that is no symptoms at all), while there may be many malaria parasites at the placental bed, to mild symptoms like fever, headache, body pain, or severe presentation like high-grade fever, pulmonary oedema and altered sensorial, up to deep unconsciousness.
Prevention of malaria during pregnancy includes the use of long-lasting insecticide- treated nets. Every pregnant woman is expected to sleep under the insecticide-treated net. Also, the use of Intermittent Preventive Therapy is another preventive measure, whereby Sulfadoxine/Pyrimethamine (the three tablets) are given twice in pregnancy, starting after the first 16 weeks of the pregnancy, and three times during pregnancy for HIV-positive mothers.
Lastly, adequate diagnosis and treatment of malaria infection at any stage of the pregnancy is necessary.
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PORTHARCOURT: Training Schedule for Basic Life Support BLS, Pediatric Advanced Life Support (PALS), Advanced Cardiovascular Life Support ACLS, First Aid, CPR, AED
LAGOS: Training Schedule for Basic Life Support BLS, Pediatric Advanced Life Support (PALS), Advanced Cardiovascular Life Support ACLS, First Aid, CPR, AED
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