Malaria in pregnancy
Malaria in pregnancy is associated with a range of negative pregnancy and birth outcomes including anaemia, pre-term delivery and low birthweight and remains a substantial and often overlooked contributor to global malaria burden. Due to the unique immunological interactions between the parasite and pregnant women during gestation, this burden is primarily concentrated in young, first-time mothers and their babies representing a particularly vulnerable time in life in which women typically have least access to protective measures such as LLINs.
Prevention programs targeted at pregnancy in Africa currently combine treatment (case-management) and the distribution of LLINs with Intermittent Preventative Therapy (IPTp) and are amongst the most cost-effective approaches to tackling malaria burden. However, slow progress in the scale-up of IPTp precipitated a global call to action by Roll Back Malaria in 2015, subsequently renewed in 2020. We aim to support this call by collaborating with WHO and the Malaria Atlas Project to provide estimates of the level of exposure to malaria in pregnancy across Africa and its associated impact upon the risk of low birthweight, as well as estimates of the impact of closing existing gaps in intervention coverage towards reducing this burden. These estimates are then featured within WHO’s annual World Malaria Report. Our current research aims to expand this work to reflect the impact of malaria upon anaemia and maternal health.
In addition to supporting the roll-out of existing tools, our research also involves assessing the potential impact of additional preventative measures, in particular the extent to which prevention can be better optimised at both the individual and population-level by screening for malaria routinely within antenatal care.
In a new collaboration with the Malawi-Liverpool Wellcome Trust Clinical Research Programme, we are also modelling to what extent IPTp exerts additional selective pressure for drug resistance relative to ongoing treatment for symptomatic malaria.
Walker P, Cairns M, Slater H, Gutman J, Kayentao K, Williams J, Coulibaly S, Khairallah C, Taylor S, Meshnick S, Hill J, Mwapasa V, Kalilani-Phiri L, Bojang K, Kariuki S, Tagbor H, Griffin J, Madanitsa M, Ghani A, Desai M, ter Kuile Fet al., 2020, Modelling the incremental benefit of introducing malaria screening strategies to antenatal care in Africa, Nature Communications, Vol: 11, Pages: 1-12, ISSN: 2041-1723
Kitojo C, Gutman JR, Chacky F, Kigadye E, Mkude S, Mandike R, Mohamed A, Reaves EJ, Walker P, Ishengoma DSet al., 2019, Estimating malaria burden among pregnant women using data from antenatal care centres in Tanzania: a population-based study, The Lancet Global Health, Vol: 7, Pages: e1695-e1705, ISSN: 2214-109X
Walker PGT, Floyd J, ter Kuile F, et al., Estimated Impact on Birth Weight of Scaling-up Intermittent Preventive Treatment for Malaria in Pregnancy Given Sulphadoxine-Pyrimethamine Resistance in Africa: a Mathematical Model, Plos Medicine, ISSN:1549-1277 Publishers link.
Walker, PGT, ter Kuile, FO, Garske, T, Menendez, C, Ghani, AC, (2014). Estimated risk of placental infection and low birthweight attributable to Plasmodium falciparum malaria in Africa in 2010: a modelling study. The Lancet Global Health, 2(8): e460 - e467. Publisher’s link.