Spotlight on vulnerable populations
Spotlight on vulnerable populations
Malaria caused by plasmodium, a parasite transmitted by certain types of mosquitoes, is an infectious disease that killed about 627,000 people in 85 countries in 2020 according to the WHO.
Pregnant women and children under five are most at risk due to weaker immune systems
The WHO African Region bears a significant and disproportionate share of the global burden of malaria. In 2020, 95% of malaria cases and 96% of malaria-related deaths were recorded in this region. Children under five accounted for 80% of all malaria deaths in the region.
BENIN | Gaining a greater understanding of barriers to malaria control strategies among pregnant women on the ground
The malaria prevention during pregnancy approach used in Africa has a particular focus on the use of the long-lasting insecticidal nets (LLINs). The incidence of P. falciparum infections during pregnancy can be as high as about 20 per 100 person-months (1), resulting in maternal anemia and low birth weights associated with a high risk of maternal and infant mortality. These indicators raise questions about the effectiveness of control strategies. Since 2015, the NMCP in Benin has been engaging expertise from the Institut de Recherche pour le Développement (IRD) and the Entomological Research Center of Cotonou at the University of Abomey-Calavi (CREC-UAC) through support from L’Initiative to carry out an evaluation with a view to optimizing the approach to combating malaria among pregnant women in Benin. This study has been carried out in several phases.
The second phase of the evaluation was completed in June 2021 and was conducted with 720 women across 12 health centers. The objective of this phase was to assess the distribution, use and physical and chemical efficacy of LLINs. The results show that 93% of pregnant women recruited during their first antenatal visit already own and use a mosquito net. However, only 13% of pregnant women surveyed use a new LLIN received during this first antenatal consultation. The laboratory evaluation of nets used by these pregnant women showed that only 61% of the nets used were in good physical condition and 39% had full bio-efficacy.
Therefore, despite the fact that LLINs are widely used by these pregnant women, only a minority of women are effectively protected. These results demonstrate a highly sub-optimal level of implementation on the ground of the approach to combat malaria among pregnant women in Benin.
The third phase of the evaluation will begin in summer 2022 and will interview a sample of pregnant women, their families and health personnel to gain a better understanding of the socio-anthropological barriers to using mosquito nets and the use of intermittent preventive treatment during pregnancy. This will feed into the national malaria response strategy.
- Hounkonnou CP, Briand V, Fievet N, Accrombessi M, Yovo E, Mama A, et al. Dynamics of submicroscopic Plasmodium falciparum infections throughout pregnancy: a preconception cohort study in Benin. Clin Infect Dis. 2020. https://doi.org/10.1093/cid/ciz748.
CAMBODIA | Understanding the epidemiology of malaria in forest areas
In countries of the Greater Mekong region there has been considerable progress in recent years in the response to malaria: elimination is within reach. However, to achieve this, it is still necessary to target certain areas which are “reservoirs” for the disease: forest areas. In Cambodia, Institut Pasteur is carrying out research to document malaria transmission in forest areas with a view to improving prevention. Expertise France, through L'Initiative, supports this operational research project to end the malaria epidemic in the Greater Mekong region.
BURKINA FASO | Increasing the impact of seasonal malaria prophylaxis in children under five
Children under five are most at risk of dying from malaria. Since 2012, the World Health Organization (WHO) has recommended providing them with prophylactic treatment once a month during the rainy season (when the risk of malaria is high) in order to reduce mortality in this particularly vulnerable population group.
In Burkina Faso, seasonal malaria chemoprevention (SMC) has achieved good coverage, yet mortality remains high among children. This suggests that as yet unknown factors may negatively affect the effectiveness of SMC.
The Institut de recherche en sciences de la santé (IRSS) in Burkina Faso is currently conducting a research project to identify and treat all family members (symptomatic and asymptomatic) who share a home with children taking preventive treatment. By removing the parasite reservoir, researchers hope to break the parasite's transmission cycle and increase the efficiency of SMC. If successful, this intervention will significantly strengthen the arsenal of preventive strategies to protect children from severe forms of malaria.
MALI | Improving prophylaxis approaches for pregnant women
In Mali, malaria-related mortality during pregnancy accounts for 15% of maternal mortality. Severe malaria also poses a significant threat to newborns, increasing the risk of miscarriage, premature delivery, low birth weight and neonatal mortality.
The WHO's recommended preventive interventions against malaria in pregnant women include intermittent preventive treatment with three doses of sulfadoxine-pyrimethamine (TPI/SP) in areas of moderate to high transmission of Plasmodium falciparum. The first dose should be administered as early as possible in the second trimester, with subsequent doses at each contact with a trained health care professional up to the time of delivery, ensuring that doses of TPI-SP are administered at least one month apart.
Unfortunately, in Mali the rate of coverage of TPI-SP is only 28% of pregnant women. In order to increase the coverage of this prophylaxis treatment during pregnancy, an operational research project under the scientific supervision of the gynecological society SOMAGO aims to implement and evaluate a new model of antenatal monitoring through eight contacts, as recommended by the WHO since 2016. This increase in the number of antenatal consultations is expected to enhance opportunities to improve the coverage of preventive treatment for pregnant women.