When I worked in admissions in our on board hospital a couple of years ago I remember that asking patients when they last had malaria was routine, not if they had ever had it but when, it is a given here that everyone has malaria from time to time. Before I came here the issue of how malaria affects pregnancy had not really entered my radar, it is just not something I ever needed to worry about. Every day at work here malaria is mentioned - women are given preventative treatment, sleep under nets and we are there to diagnose and treat active cases as part of the much wider antenatal care we give. But why is it such a big deal?
Malaria in pregnancy increases the likelihood of the woman becoming anaemic (or more anaemic), there is a large increase in low birthweight infants (which is the greatest single risk factor for neonatal and early infant mortality and also a risk factor for developmental delay, so you can see why we prefer bigger babies), it accounts for about 5% of infant deaths (in this part of the world), it also increases the likelihood of the mother dying, of sponatneous abortion (miscarriage), stillbirth, growth restricted babies and pre-term births.
I know that all sounds very depressing - the good news is it can largely be prevented with just a couple of simple measures. The WHO approach which we follow is to recommend all pregnant women sleep under Insecticide Treated Nets and be given Intermittent Preventative Treatment. Women who present with symptoms should be treated aggressively, although often malaria during pregnancy has no symptoms (besides possibly anaemia) because of the woman's acquired immunity so the other two measures are vital. So the next time you get one of those alternative gift charity forms where you can buy a mosquito net for someone in Africa just remember it might actually save some lives. It is the simple things that can make a difference, but here not everyone can afford something so simple.