In 2018 alone, 11 million pregnancies in sub-Saharan Africa were exposed to malaria, resulting in high levels of maternal anaemia and 872,000 low-birthweight babies.1
For several years, MMV has been committed to providing informed therapeutic choices for malaria prevention across all genders and age categories, including pregnant women.
Bringing SP to all eligible pregnant women
To protect pregnant women, the WHO recommends intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP), starting as early as possible in the second trimester.
Despite increased mobilisation from the global malaria community in recent years, only 31% of eligible pregnant women receive the recommended three doses of SP in 2018. This is partly due to the low availability of this medicine. Almost 30 years ago, SP was a recommended treatment for acute uncomplicated malaria, but drug resistance undermined its curative efficacy in the 1990s. Hence some healthcare providers do not necessarily trust it as a medicine for preventive treatment during pregnancy, despite its established benefits.
So far, IPTp has been delivered primarily in healthcare facilities, during antenatal care visits. However, because these visits happen in health centers, pregnant women from rural areas who do not have access to transportation often skip them, missing out on the opportunity to receive the three doses of SP. The TIPTOP project, to which MMV collaborates, is looking at establishing new delivery channels in the community to increase the coverage of IPTp and protect as many pregnant women as possible
In the context of the COVID-19 pandemic, sustained mobilization and effort are critical. In October 2020, 5 years after the first IPTp call to action, MMV and the RBM MiP working group launched the ‘Speed-up, Scale-up’ renewed call to action to bring SP to all eligible pregnant women in sub-Saharan Africa.
Filling the data gap in the use of antimalarial medicines
Pregnant women are generally excluded from research and clinical trials for fear of causing harm. As a result, when a new drug is registered, its safety and efficacy profiles in pregnancy are unknown. As additional data is required, most drugs become available to pregnant women 5–10 years later.
MMV is collaborating with the Liverpool School of Tropical Medicine (LSTM) to establish a pregnancy registry in malaria-endemic countries in Africa to help fill the data gap on the use of antimalarial medicines during pregnancy. The registry will be supported by MMV donors including a grant received from the Swiss Agency for Development and Cooperation.
The aim of this registry is to provide a rich and reliable source of safety data on the use of ACTs in second and third trimesters but also in first trimester pregnancy. A network of sites will be established to collect safety data on all antimalarials used in endemic regions, in partnership with researchers and local regulatory authorities responsible for pharmacovigilance. MMV and its partners will promote the development of standard protocols and build capacity for pharmacovigilance.