The review study consolidated the results of four African trials involving more than 6,000 women. It showed conclusively that using ITNs reduced the number of miscarriages by one third in the most vulnerable women, those in their first pregnancies. The proportion of low-birthweight babies born to this group went down by nearly a quarter and these women also had fewer parasites in their blood compared to those who used no nets.
Although it seems sensible to use ITNs – indeed the World Health Organization recommends that pregnant women use them where malaria is endemic – the nets are widely unpopular. “Women complain that they feel suffocated”, said Dr Thomas Agan, Consultant Obstetrician at Calabar Teaching Hospital in south-eastern Nigeria. Yet there are huge risks to women and their babies, as Dr Agan knows only too well.
Malaria is endemic in Calabar, the mangroves providing perfect conditions for the mosquito vectors to thrive. “A recent study here involving more than 500 pregnant women showed that only 20 had no malaria parasites in their bloodstream”, Dr Agan said. “We need mass education through the media of the benefits of the nets” he said.
Malaria in pregnancy causes anaemia, making women weak, more likely to miscarry or give birth to stillborn or low-birthweight babies. Newborn babies weighing less than 2.5 kg are considered low birthweight; they are more prone to sickness and death than newborns who weigh more than 2.5 kg. Malaria causes most damage in early pregnancy, making it important to get women using the nets long before they first turn up at antenatal clinics.
Paul Garner of the International Health Group at Liverpool School of Tropical Medicine and co-author of the review said it “gives health professionals the ammunition they need to publicise the benefits of ITNs and get pregnant women using them”. The research was supported by the UK Department for International Development’s Effective Health Care Research Programme.
Paul Garner | alfa
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