Protecting pregnant women and their babies

Dr Elizabeth Juma, National Malaria Control Programme, Kenya

When a pregnant woman contracts malaria two lives are at stake, not just one. Pregnancy lowers a woman’s immune response to infections and so she is four-times more likely to get malaria and twice as likely to die from it than another adult. It can also lead to complications for the baby such as low birth weight and even death.

Together with Pfizer, MMV is developing a new regimen for intermittent preventive treatment in pregnancy (IPTp), of azithromycinchloroquine (AZ-CQ) that will help to improve overall birth outcomes. IPTp is administered during the second and third trimester at antenatal clinics – regardless of whether the mother-to-be has malaria symptoms. The development programme started in October 2010 and the goal is to submit the medicine for regulatory approval in 2014.

1. What is the impact of malaria in Kenya, particularly for pregnant women?

Malaria is the single leading cause of illness and death in my country, particularly for children. For pregnant women and their unborn babies it’s also a big problem. Every year around 600,000- 700,000 pregnant women live at high risk of malaria in Kenya alone. What is the approach in Kenya to protect pregnant women from malaria?

We have a three-pronged approach: first, and one of the most important, is health education for mothers. They need to be aware of the threat malaria poses to them and their unborn babies and how to protect themselves. Second, we focus on prevention using a combination of bed-nets and IPTp using sulfadoxinepyrimethamine (SP), which are given to the mothers in antenatal clinics all around Kenya, even in the most remote areas. Third, we try to encourage prompt treatment-seeking behaviour, as malaria can progress rapidly and be dangerous.

2. What are the flaws in this approach?

IPTp was introduced in the late 1990s after being recommended by the WHO and it relies on only one medicine – SP. The problem is that we are now seeing resistance emerging to it. We cannot assume SP will be effective forever, its efficacy will continue to decline. We know that the pipeline for new medicines to replace it is narrow if not empty.

3. What is your view on the combination of azithromycin and chloroquine as an alternative?

Azithromycin (AZ) and chloroquine (CQ) have been used for a number of years and so we know they are well-tolerated in pregnancy. The combination, therefore, comes with a head start. In Kenya we stopped using CQ for treatment a number of years ago, as the parasite had become resistant to it. Thankfully, AZ is able to improve parasite sensitivity to CQ and the combination is in fact more efficacious than the sum of its parts. As an antibiotic, AZ is also able to treat sexually transmitted infections, which unfortunately are prevalent in pregnant women. This means the combination would be dual-acting: protecting against malaria and treating other infections that can lead to reduced pregnancy outcomes.

Here in Kenya we are excited about the clinical testing of this drug for IPTp. We are all hopeful that the AZ-CQ development programme will generate positive results as we really need more commodities in our armoury to fight malaria, especially in pregnancy.

Dr Elizabeth Juma is the Former Progamme Manager, of the National Malaria Control Programme, Kenya.

Note: The AZCQ programme has been discontinued. Read more.