Saturday, 25 April 2015

Maternal malaria: what it means for Indonesian children

By Maria Endang Sumiwi, Health Specialist Malaria

Dr Jeanne Rini Poespoprodjo* in the Mimika District Hospital in Papua. ©UNICEFIndonesia/2015

There has been much progress in the fight against malaria around Indonesia – the disease is gradually being eliminated district by district. But it still remains in many areas throughout the country. The Eastern Provinces continue to suffer disproportionately from the disease. In the worst-affected districts, one in three people will experience malaria each year.

Pregnant women are particularly vulnerable to malaria. They have an increased risk of infection and greater risk to suffer from severe malaria compared to non-pregnant women. What does this mean for Indonesian children? UNICEF asked a clinician that deals with malaria on a daily basis. Dr. Jeanne Rini Poespoprodjo is a paediatrician who has worked in Papua for the last 15 years:

Q : How would you describe the malaria situation in your hospital – especially regarding malaria in pregnancy?

A : Each month, there are about 100 to 150 malaria-associated outpatient visits to the hospital and at least two malaria admissions per day. Malaria in pregnancy occurs in 10 to 15 percent of pregnant mothers who are admitted to the maternity ward. About 30  percent of infant hospital admissions are due to malaria. My youngest patient was a one-day-old baby suffering from falciparum malaria with anaemia, most likely a congenital infection.

Q : If a woman suffered from malaria during pregnancy, what does this mean for her and the baby?

A : The most detrimental effect of malaria to pregnant women is anaemia. Maternal malaria and anaemia will increase the risk of having adverse pregnancy outcomes. Malaria during pregnancy can affect foetal growth and can result in a birth weight of less than 2,500 grams :  a condition that is associated with high risk of mortality during the first year of life. Pre-term delivery can also be precipitated by fever resulting from malaria. Malaria in early pregnancy can even cause a miscarriage.

Q : How does malaria affect Indonesian children?

A : The risk of having the adverse effect of malaria starts in utero and the risk of having malaria starts at birth. I have seen quite a lot of infants suffering from severe anaemia associated with vivax and falciparum malaria. Having anaemia in such an early age would certainly affect the growth and development of a children. This will prevent children from reaching their full potential as a future generation. It is a very serious issue.

Q : How do we address this situation?

A : Providing treatment and intermittent prophylaxis therapy (IPT) with an effective anti-malarial drug, together with insecticide treated nets (ITN) are currently the main strategies in preventing malaria during pregnancy and infants in moderate to high malaria-endemic settings.
The majority of evidence for malaria prevention in pregnant women and infants comes from experience in combating P. falciparum malaria. The significance of P. vivax malaria in this vulnerable group has only recently been appreciated and therefore would require a modified approach.

Q : How can we make sure that this is happening?

A : Ensuring universal coverage of early detection and treatment, insecticide-treated nets use and - where applicable - intermittent preventive treatment with an effective antimalarial drug would certainly reduce the burden of malaria in pregnant women and their infants. This is not an easy task and would need concerted efforts of all parties involved in malaria control.

UNICEF supports the Indonesian Ministry of Health on the Malaria in Pregnancy programme, in reducing malaria burden in Eastern Indonesia and in malaria elimination programme.

*Dr Jeanne Rini Poespoprodjo, SpA, Msc, PhD is a paediatrician in the Mimika District Hospital (Papua, Indonesia), a mother and child health consultant for UNICEF and WHO Indonesia and The Health Authority in Papua-Indonesia, and malaria researcher at the Timika Research Facility in collaboration with the Faculty of Medicine at Gadjah Mada University and Menzies School of Health Research, Darwin. She could be contacted at