Clinical Management & Clinical Observations of Malaria in Pregnant Women

Summary description of the project

Malaria – a Tiny Enemy

Malaria, today, is by far the most widespread tropical parasitic disease, threatening at least four out of every ten persons in the world.

Plasmodium falciparum causes the most serious form of the disease which can be fatal and Anopheles mosquito is its vector.

Malaria is a major and increasing cause of disease burden globally and is estimated to be responsible for more than 2.7 million deaths and almost 300 million clinical cases annually worldwide (WHO World Health Report, 1999).

The disease has its greatest impact in sub-Saharan Africa where an estimated 90% of the world’s cases and deaths occur especially in high-risk groups, often in young children and pregnant women. The economic impact of malaria in Africa is substantial: US$ 12 billion annually in lost income. Despite successes in controlling malaria in the 1950s and 1960s, recent years have seen a resurgence due to a combination of factors. There is growing resistance to current antimalarial drugs in many areas, including multidrug - resistance. Increasing insecticide resistance, environmental changes and human migration, often the result of political instability and wars, are further contributory factors.    

Malaria & Research Policy

“Despite nearly a century of research, malaria has yet to be conquered in its bastion, Africa south of the Sahara, where the majority of the world’s cases are to be found” said (or wrote) Richard Lane, Head of the Wellcome Trust’s International Programmes.

The WHO Expert Committee on Malaria in Geneva (18th Report) in his introduction asserted “… during the last 15 years very little progress had been made towards the control of malaria in the world …”.

Public investment in R&D (research and development) by developing countries is the lowest in the world.

By comparison, the contribution of African countries to overall research in health and biomedicine, stands at just 1.2 % of the world’s output.

The highest contributing individual countries in malaria research are the USA, UK and France.

However, the absolute level of malaria research activity is low compared to other areas of biomedical research and in relation to the global burden of malaria disease: publications numbered approximately 1.000 a year and accounted for just 0.3% of all outputs. By comparison, cardiology accounted for 10.2%. The low publishing activity in international malaria research reflects the relatively small global investment, which stood at about US$ 100 million in 1998.

The global investment in health research and development (about US$ 55 billion annually), only 5 – 10% is thought to be devoted to health problems in low- and middle-income countries.

The research bases in many developing countries are currently heavily dependent on coordinated foreign long term investments by high-income countries.

Why Malaria is considered a “Priority Health Problem

In endemic countries this disease must be brought under control because it undermines the general health conditions and welfare of families, debilitating the population and straining the countries’ and peoples’ economic resources.

Malaria must be considered a priority health problem and requires special attention, more than other health problems due to the following factors:

  • the population groups most at risk or affected by the disease are children, pregnant women, rural populations, low-income populations,
  • the disease impedes social and economic recovery and development,
  • the disease is of major concern to the population,
  • the disease causes complications, disability, and death,
  • the disease causes personal and family expenses,
  • the disease causes public expenses,
  • the incidence of the disease is worsening worldwide.

The Place of Malaria among other Health Problems

The most straightforward way of comparing malaria with other health problems is probably by examining hospital - based proportional mortality rates and “proportional hospitalization rates” of malaria with those of other diseases.

Certain donors are exclusively interested in deaths in childhood, while national authorities and other agencies normally place at least as much emphasis on death in productive age groups.

Objectives and Key Elements of the Project

The major objective of this initiative is to strengthen and sustain long-term malaria research capability in African countries through international partnerships with scientists.

A major component of the research effort against malaria is the capacity of scientists based in Africa to study the disease on the ground.

In addition, the project is intended to raise awareness amongst African scientists about current research opportunities and the characteristics of leading malaria research centres across sub-Saharan Africa.

This project is devoted to the development of national programme plans for the control of malaria throughout a whole country.

The same process can however be applied to a state or province if the country is very large.

The key points of the project are summarized here together with some examples:

  1. Early diagnosis and prompt treatment of the disease especially in the population groups most at risk such as children and pregnant women
  2. Planning and implementation of sustainable preventive measures (larval and vector control)
  3. Prevention and treatment of main complications in pregnancy (maternal severe anaemia, percentage of abortions, still births, premature deliveries, retarded intrauterine growth, low birth weights, placental malaria & HIV)
  4. Training of local health professionals at all levels
  5. Implementation of local infrastructures and health care within affected districts taking into account not only technical aspects but also social, behavioural, and economic factors as well
  6. A network linking operational infrastructures in Africa and overseas University centres to study severe malaria in children and pregnant women and particularly evaluate the epidemiology of antimalarial drug resistance, evaluate novel treatments and develop new interventions.

Parallel Research

This multidisciplinary malaria control programme offers the opportunity to develop some essential information without any financial or logistic support (except n° 14).

The proposed items are:   

  1. Extensive Demographic Surveillance System
  2. Economic impact of malaria morbidity & mortality on communities
  3. Morbidity & Mortality due to malaria in pregnancy
  4. Antimalarials use during pregnancy and its effect on birth weight (and / or anaemia in  pregnancy)
  5. Human genetic susceptibility to malaria in pregnancy (host immune system)
  6. Interactions between malaria & EPH gestosis and its variants (HELLP)
  7. Economic analysis of the market for antimalarials in rural Africa
  8. Impact of HIV on P. falciparum malaria infection in pregnancy
  9. Epidemiological studies of genetic factors influencing the prevalence of malaria, including sickle cell genes, thalassemia, HLA type etc.
  10. Studies of antimalarial drug side-effects
  11. Interactions between malaria & other concurrent infections (HIV, etc.)
  12. Histopathology of malaria (placenta, CNS)
  13. STD
  14. Computed Tomography (CT) and MRI research of the CNS in “severe malaria”.

The Aim of this Project is

  • To reduce the impact of the disease on the health of the population to the lowest possible level that can be achieved within the available financial and human resources according to existing technology and feasibility
  • To improve malaria research activities and develop policies for disease control and treatment
  • To improve the therapeutic strategies of different clinical aspects of malaria, particularly severe malaria.
  • Collaboration involving researches from different Universities
  • To provide training (indigenous staff) linked to ongoing research programmes
  • To concentrate resources at a limited number of centres avoiding wasteful dispersion of resources across unproductive sites.

 

INDICE

Summary description of the project

  • Malaria – a tiny enemy
  • Malaria and research policy
  • Why malaria is considered a Priority health problem
  • The place of malaria among other health problems
  • Objectives and key elements of the project
  • Parallel research
  • The aim of this project is

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