House Hearing on Malaria Highlights Pregnant Women, Children - Women's Congressional Policy Institute

On April 25, the House Foreign Affairs Subcommittee on Africa and Global Health heard testimony on initiatives to combat malaria. Particular attention was given to the deadly effects of the disease on pregnant women and young children.

Chair Donald Payne (D-NJ) stated, “Pregnant women and children are, in fact, the most vulnerable when it comes to malaria. Malaria kills an African child every 30 seconds, causes between 20 percent and 25 percent of all deaths among African children under five-years, and constitutes 10 percent of the continent’s overall disease burden. Malaria has also been cited as a significant indirect cause of death. In sub-Saharan Africa, health experts contend that malaria contributes to anemia in pregnancy, low birth weight, and premature delivery, which, combined, kill from 75,000 to 200,000 infants each year. These statistics are absolutely staggering. They remind us that we simply are not doing enough to fight malaria.”

Admiral Timothy Ziemer, USN, (Retired), coordinator of the President’s Malaria Initiative (PMI) at the U.S. Agency for International Development, detailed PMI’s efforts to fight malaria since 2005. Noting that “infection during pregnancy poses serious health risks for both the mother and her unborn child,” he said, “Malaria may be transmitted from mother to fetus before or during labor and delivery. If a pregnant woman contracts malaria, she is at much greater risk of anemia, premature delivery, and death. In addition, because malaria parasites sequester in the placenta and impair the delivery of nutrients to the growing fetus, a mother’s newborn child is at higher risk of low birth weight a leading cause of poor infant survival in Africa. The prevention and treatment of malaria during pregnancy depends on a combination of malaria control measures, including the use of ITNs [Insecticide Treated Mosquito Nets], laboratory diagnosis for prompt and effective treatment, and intermittent preventive treatment.”

Admiral Ziemer explained that intermittent preventive treatment of pregnant women (IPTp) “is a highly effective means of reducing the risk of malaria in pregnant woman and the adverse consequences to her unborn child. It involves the administration of at least two treatment doses of an antimalarial drug, sulfadoxine-pyrimethamine, to the woman during the second and third trimesters of her pregnancy with at least a one-month interval between doses. IPTp reduces the frequency of maternal anemia, malaria infection of the placenta, and the delivery of low birth weight babies. Because in most African countries more than 70 percent of pregnant women attend antenatal clinics, these clinics serve as an attractive platform for delivering preventive treatments. The wide-scale use of IPTp could prevent up to 75,000-200,000 infant deaths each year in Africa.” He cited the importance of artemisinin-based combination therapies (ACTs), and added, “To prevent malaria in pregnant women and reduce the incidence of life-threatening low birth weight among newborns, PMI has supported IPTp. In total, more than 10,000 health providers have already been trained in these critical interventions with PMI support.”

Outlining the role of ITNs, Admiral Ziemer noted that “ITNs have been shown to reduce all-cause mortality in children under five by about 20 percent and malarial illnesses among children under five and pregnant women by up to 50 percent.” He said that in Tanzania, “beginning in mid-December 2005, PMI distributed 130,000 free long-lasting ITNs (233,000 total with contributions by the GFATM [Global Fund to Fight AIDS, TB, and Malaria]) through local health clinics, more than doubling existing ITN ownership rates among pregnant women and children under age five on Zanzibar and Pemba Islands.” In northern Uganda, where there are “alarming rates of malaria mortality in internally-displaced person camps,” Admiral Ziemer said that “PMI distributed over 300,000 free long-lasting ITNs to children and pregnant women.”

Admiral Ziemer specified PMI goals for “children under age five and pregnant women. These include:

More than 90 percent of households with a pregnant woman and/or children under five will own at least one ITN;
85 percent of children under five will have slept under an ITN the previous night;
85 percent of pregnant women will have slept under an ITN the previous night;
85 percent of houses in geographic areas targeted for IRS [indoor residual spraying] will have been sprayed;
85 percent of pregnant women and children under five will have slept under an ITN the previous night or in a house that has been protected by IRS;
85 percent of women who have completed a pregnancy in the last two years will have received two or more doses of IPTp during that pregnancy; and
85 percent of children under five with suspected malaria will have received treatment with an ACT within 24 hours of onset of their symptoms.”Marathon Oil Corporation Corporate Social Responsibility Director Adel Chaouch described a collaborative “five-year, $12.8 million malaria transmission project,” undertaken by Marathon, business partners, the government of Equatorial Guinea, and leading health specialists. “The main focus is those at highest risk, especially children under five years of age and pregnant women,” Dr. Chaouch said. Begun in October, 2003, in Equatorial Guinea’s Bioko Island, Dr. Chaouch stated that “the project has resulted in a 44 percent reduction in the presence of malaria parasites in children, based on blood smear testing.” She added, “For a population of a quarter million people on the island that has been experiencing an average of one episode of malaria per person per year, the program was able to avert an estimated 150,000 cases in its first year of implementation.”
Susan Lassen, consultant to Episcopal Relief and Development for NetsforlifeSM, told the story of a young Angolan mother who received a net distributed by NetsforlifeSM: “Malita had two small children and was pregnant. She knew that ‘fever’ came but she had no idea what caused it. She was inclined to believe her mother-in-law that it was ‘bad sugar cane.’ When her eldest child about three years old — started feeling feverish the week before, she was utterly powerless to save him. She told me with tears how quickly he had died, in her arms, in less than a day. I met Malita at about 7 o’clock in the evening; she had trekked all day with her mother-in-law and had waited for her net. Not only did she leave with the net, however, but she left with knowledge. She now knows about fever and what to do. She knows about the malaria mosquito, she knows that she and her child must sleep under the net, not just in the rainy season but every night. She knows about puddles, about keeping her compound clean, and about spraying. She knows about treatment with medicine and she knows where to go for help.” Ms. Lasson added, “And, perhaps most important of all, she has become a community malaria volunteer. More nets are on their way to Ondjiva, and Malita will be ready, she has been trained in malaria prevention by the NetsforLifeSM team so that she can educate, support, and teach her own village.”

Also testifying were Stefano Lazzari, senior health advisor for The Global Fund to Fight AIDS, TB and Malaria; Nils Daulaire, president and CEO of the Global Health Council; and Enid Wamani, secretariat coordinator for Uganda for the African Medical & Research Foundation.