By Fatima Muraina

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Women become more susceptible to Plasmodium falciparum malaria during pregnancy, and the risk of disease and death is high for both the mother and her foetus. In Africa, an average of 30 million women living in malaria-endemic areas like Nigeria become pregnant each year. For these women, malaria is a threat to them and their babies, with up to 200,000 newborn deaths each year because of malaria in pregnancy. In Nigeria being Africa’s most populous nation, the negative impacts are more devastating and better imagined than experienced.
When malaria infects the placenta during pregnancy, the baby’s future immunity is affected. Pregnant women are particularly vulnerable to malaria as pregnancy reduces a woman’s immunity to malaria, making her more susceptible to malaria infection and increasing the risk of illness, severe anaemia and death. For the unborn child, maternal malaria increases the risk of spontaneous abortion, stillbirth, premature delivery and low birth weight – a leading cause of child mortality.
The problem has long been neglected, but new approaches and commitment offer hope for reducing the burden of malaria in pregnancy and improving the health of mothers and newborns.
Malaria is a mosquito-borne infectious disease that affects humans and other animals. Malaria causes symptoms that typically include fever, tiredness, vomiting, and headaches. In severe cases, it can cause yellow skin, seizures, coma, or death. Symptoms usually begin ten to fifteen days after being bitten by an infected mosquito. If not properly treated, people may have recurrences of the disease months later.
While the disease is rare in temperate climates, malaria is still common in tropical and subtropical countries. Each year, nearly 290 million people are infected with malaria, and more than 400,000 people die of the disease. This mosquito borne protozoan disease is especially dangerous to babies and pregnant women, and thus needs an urgent solution to save our pregnant women, their unborn children as well as toddlers.
To this end, the World Health Organisation declared every April 25th as an internationally recognized day set aside to highlight global efforts in the eradication of malaria, to celebrate the successes recorded in the fight against malaria and recommend possible solution to the menace where need be.
There was a remarkable achievement in Ondo state when the Abiye Safe Motherhood Initiative was operational, until recent global happenings, particularly the challenges of COVID-19 and its attendant global lockdown, the End SARS and others that crumbled the economy across the globe, including Nigeria where Ondo State is not an exception. This has, however, threatened the possibility of reaching world’s effort to eradicate malaria and to meet the zero malaria target set for the year 2030.
As contained in a statement by the Chief Executive Officer of Restoration of the Dignity of Womanhood ROTDOW, Mrs Olabisi Omolona, which was made available to Journalists, in 2019, there was an estimated 229 million malaria cases all over the world, with Africa alone accounting for 94% of these cases. In the same year, about 409,000 malaria deaths were reported globally, with Africa accounting for 94% of the reported deaths.
Despite the emergence of Covid-19 as an additional challenge to the provision of essential health services worldwide, the world experienced a decline in the rate of deaths due to malaria, as about 384,000 lives were lost to malaria in Africa in the year 2020. Malaria still infects about 33.7 million Nigerians, killing no fewer than 81,640 every year.
The Ondo State Malaria Project Manager, Dr Folayan Afolabi, said malaria has remained a major problem despite the fact that it is a highly preventable and curable disease.
According to him, one out of 10 pregnant mothers die from complications caused by malaria annually in Nigeria and, if placed on the general population figure of 200 million people, where about 5 percent is pregnant, then Nigeria loses one in every 10 pregnant women. He said the last indicator showed Nigeria has a prevalence rate of 27 percent and Ondo State had 21 percent, which is still a very high percentage.
Ondo State has adopted different strategic modalities for the vulnerable group through which it gives out long lasting insecticidal nets recommended across board and created a special strategy through which women are given doses of SP, as recommended by WHO to avert spontaneous abortion and premature births due to malaria complications.
Afolabi observed that the pregnancy attendance at clinics has increased, attributing it to the partnership the state Ministry of Health and a company Jhpiego for Optimal Pregnancy where SP doses are being supplied promptly, while also engaging community distributors who have been selected across local government areas to commence Sulfsdoxine Pyrimethamine on pregnant women and referring them to health centres.
CDDs were also trained to re-orientate health workers, which showed a good number of pregnant women at health facilities to benefit other packages like immunization, orientation on breastfeeding and a host of others.
“Ondo State has adequate facilities to attend to pregnant women, but the problem is that something can be adequate and not optimally assessed as some still don’t attend but go to traditional birth attendants.”
A pregnant woman, Mrs Tinuade Komolafe urged government to intensify more effort in safeguarding pregnant women from malaria
“Presently, I am pregnant and I don’t have access to mosquito net. We are not given by the government hospital, but I take malaria drugs every week, as recommended by the doctor in order to prevent malaria during pregnancy,”
In addition, Folasade Bamigboye called for an urgent need for more LLIN coverage, prompt diagnosis and treatment of malaria, and prevention of malaria in pregnancy, especially for women in hard to reach communities.
She said government should discourage commodity stock-out but ensure regular availability of the LLITN and Drugs in the primary health facilities where women can access them.
In addition, there is a need for more collaboration with CBOs to carry out advocacy, communication and social mobilization to make people understand the benefits of using the nets, so they do not misuse them as barricades in their farmlands.
Also, it has become very important to work with advocates and community influencers to change behavioural and social norms with regard to sleeping under long-lasting insecticide treated nets (LLINs), early and correct diagnosis and treatment of malaria, especially in the most vulnerable parts of society, children under five and pregnant women, and early attention to pregnant women, with a focus on preventing and treating malaria.
Despite Nigeria losing about 450 million naira (1.1 million US Dollars) to malaria intervention and treatments, many more children and pregnant women are infected and many are being killed by this disease.
The effort made so far seems more encouraging but there is need for more concerted effort to ensure meeting zero Malaria target being clamoured for.
Speaking further, Mrs Omolona, said that zero Malaria target can be achieved if government creates the political will to make more funds available for malaria programmes and develops strategies to control the disease. While these funds are provided, government must ensure that there is proper accountability to see that the funds are judiciously used.
Funding of Research for the control of malaria is of importance, especially local funding for operational research with the aim of developing domestically tailored approaches for the eradication of malaria.
The Federal government should also construct underground drainage systems across the country, in line with international standard, to reduce breeding spots for mosquitoes and to avoid deaths due to malaria. Again, Federal Government must ensure that the WHO guideline on the management of children with fever, especially those diagnosed to have malaria, is followed strictly by the primary health centres and other health facilities.
In addition, government should ensure that every pregnant woman receives at least three doses of Sulfadoxine-Pyrimethamine (SP), commonly called Fansidar, during pregnancy and to commence in the second trimester with each dose given at least one month apart.
This, she opined, will reduce morbidity and mortality in pregnant women, as well as eradicate complications that follow the disease in pregnancy.
Effective public outreach should be provided to educate the people, particularly the pregnant women to know more about malaria.
If these are put into consideration and many others and commensurate efforts of everyone, as well as the NGOs malaria will be eliminated and we will be able to nail the zero malaria Target in the country.