Malaria in pregnancy

"Pregnant women are particularly vulnerable to malaria"

Malaria is a parasitic infection transmitted to humans by the bite of Anopheles mosquitoes. Most infections are due to four species:

  • Plasmodium falciparum,
  • P.vivax,
  • P.ovale and
  • P.malariae.

All species may cause uncomplicated malaria but severe malaria is almost always due to P.falciparum. Staff need to react quickly when a diagnosis has been made as even uncomplicated malaria can progress rapidly to severe malaria, and severe malaria may cause death within a few hours if left untreated.

The WHO state that in Africa, 30 million women living in malaria-endemic areas become pregnant each year. For these women, malaria is a threat both to themselves and to their babies, with up to 200,000 newborn deaths each year as a result of malaria in pregnancy.
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 miscarriage, stillbirth, premature delivery and low birth weight - a leading cause of child mortality. Since I arrived in camp in October, 40% of our miscarriages/stillbirths have been linked to malaria.
In Batil camp we have our own lab which has the ability to screen for malaria and specifically P.falciparum. When women come to us with any symptoms such as fever, confusion, or diarrhoea we can test and have the results within 15 minutes.  Last month 20% of our admissions were due to malaria. I'm quickly learning which medication is appropriate for the stage of pregnancy and the importance of donating the mosquito net. That being said however, quite a few of our nets have been seen on the market to make beds or dresses.
Mosquito net beds © Laura Bridle
I developed malaria my second month here, despite being on prophylactics. I was exhausted, had fever, and didn't want to be too far from the latrine. I was cared for well by our doctor and the threat of a large grey cannula from the nurse kept me drinking lots of water and focused on getting better. I returned to work within 72 hours, thinking I was pretty tough... but my first admission that day was a Mabanese pregnant woman who had walked for seven hours, in 40oC heat, at seven months pregnant, as she wasn't feeling well. She tested positive for malaria and I quickly stopped telling people how brave I was ;) After one night of treatment and rest she was requesting discharge as she needed to return to cook and care for her other nine children. I reluctantly discharged her with some health education, a mosquito net and medication.
Blood transfusion © Laura Bridle
Another consequence of malaria is the effect it has on haemoglobin (Hb) in your blood which carries oxygen around your body. Pregnancy can already reduce the haemoglobin and women in the area are given iron tablets to help combat this.
During an admission of a first time mother for a miscarriage at 16 weeks, we discovered she had malaria. With all investigation screenings undertaken in maternity we also screen for Hb. This lady's Hb was dangerously low at 4.5 - the normal range is over twice this amount - and she would need a blood transfusion. But unlike the UK, with regular blood donors and easy access to blood, we had to find a family member who was willing to donate and more importantly was a match.
This lady's family were over an hour's drive away, and with communities here walking to access any care, could cause a huge delay in getting the message out and getting volunteers to our health centre. Luckily this lady's caretaker was her sister and also even more importantly was a match and cleared safe to donate after being screened by our lab technician. The whole process took about four hours from start to finish and she was discharged three days later with iron tablets.

The dry season is here now. And with cooler evenings and no rain we are seeing a decline in malaria and the overpowering smell of deet.