A global team of researchers has called for a review of drug-based strategies used to prevent malaria infections in pregnant women particularly in areas where there is widespread resistance to existing antimalarial medicines.
The most comprehensive study on the impact of sulphadoxine-pyrimethamine (SP) widely known as Fansidar, a combination medication used to treat malaria shows that in areas with the highest grade of resistance, alternative approaches to the prevention of malaria in pregnancy are urgently needed to achieve better birth outcomes for pregnant women.
Professor Feiko ter Kuile, an expert in malaria in pregnancy worked with a multi-disciplinary team including the US Centres for Disease Control and Prevention, the WorldWide Antimalarial Resistance Network (WWARN) and Duke University.
Professor ter Kuile said, “We reviewed more than 100,000 birth outcomes across Sub-Saharan Africa, our results suggest that the widely used antimalarial SP for preventive therapy remains very effective in many parts of Africa, but that there is a clear trend toward reduced effectiveness with increasing levels of resistance by the malaria parasite to SP.”
Published yesterday in Lancet Infectious Diseases, the results demonstrate that the clinical effectiveness of SP in protection of pregnant women against malaria is compromised in certain areas. The experts call for further urgent investigation into alternative strategies or drugs to prepare for further growing resistance to this mainstay of preventive therapy.
The World Health Organisation recommends intermittent preventive treatment (IPTp) in malaria endemic areas. The only antimalarial currently recommended for this treatment is the SP drug. To date this form of treatment using SP has effectively resulted in reductions in maternal anaemia, low birth weight and neonatal mortality. However, with the growing threat of drug resistance emerging or spreading in sub-Saharan Africa, this protection is now at risk.
It is estimated that without protection during pregnancy, 45% of 32 million pregnancies in malaria endemic sub-Saharan Africa are exposed to Plasmodium falciparum malaria- this according to WHO is most severe form of the disease whose variable clinical features include fever, chills, headache, muscular aching and weakness, vomiting, cough, diarrhoea and abdominal pain. The impact is 900,000 malaria-associated low birthweight deliveries, low birth weight, anaemia and other serious adverse birth outcomes result in numerous longer-term health issues for infants.
Carol Sibley, WWARN’s Senior Scientific Advisor from the University of Washington said molecular monitoring of parasites in humans is a valuable tool for policy makers to monitor the spread of antimalarial resistance and assess the impact on this valuable prevention strategy for malaria in pregnancy and therewith on the lives of new-borns in low income settings across Africa.
The team however said they are calling for further analysis into the potential additional benefits that SP may continue to have even in areas where it is no longer able to kill malaria parasites.
“We hope that by examining the risks, outcomes and alternative strategies available we will ensure that vulnerable babies born in low resource settings are given the best possible chance of good health, by receiving the most effective antimalarial prevention approaches and medicines available to us today, and in the future,” said Anna Maria van Eijk, first author.
In 2018, Researchers at the Kenya Medical Research Institute (Kemri) had identified an anti-malarial drug, dihydroartemisinin-piperaquine (DP), as a viable option to replace fansidar. Trials done in Siaya County and Uganda showed that when DP is administered during pregnancy, it is well-tolerated and more effective than Fansidar.