WUNRN
The traditional childhood killers - measles, pneumonia and diarrhoea - are all
down; even where malaria is still rife, treated bednets are saving children’s
lives. But as deaths from other causes drop, mortality in the first month of
life looms ever larger.
Statistics
published recently by researchers at
Many of these babies were born too soon, or born too small; others were born
with infections contracted from their mothers. In all these cases it is the
mother’s health during pregnancy which is the key to the babies’ survival, and
now the American Medical Association has published astudy of the incidence
in pregnant women of health problems which are known to affect their unborn
babies, and which can all be treated.
The researchers looked at 171 studies from Sub-Saharan Africa over a 20-year
period, which showed whether women attending ante-natal clinics were infected
with malaria, or with a range of sexually transmitted and reproductive tract
infections - syphilis, gonorrhoea, chlamydia and bacterial and parasitic infections
of the vagina. If left untreated, these can lead to miscarriages, stillbirths,
premature births and low birth-weight babies.
Malaria affects placenta
Matthew Chico, a research fellow at the London School of Hygiene and Tropical
Medicine, who led the team, stresses the far-reaching effects of these
problems. In malaria, for instance, the placenta does not function properly.
“What you end up with,” he told IRIN, “is a low birth-weight baby, and low birth
weight is the single most common factor in neonatal mortality. And it leads to
lifelong consequences. Low birth-weight babies underperform at school and end
up earning less, and curiously they even end up with more cardiovascular
problems later in life.
The good news is that
all these conditions are treatable. It is just a question of finding the best
way to reach these women, many of whom will have no symptoms and be unaware
they are infected |
“There are multiple consequences. Girls are at greater risk, for
instance, of having low birth-weight babies themselves and so it continues into
the next generation. We have to break the cycle.”
What they found was alarming. The incidence of syphilis and gonorrhoea was
relatively low, under 5 percent, and the most recent figures show them on the
decline. But in East and
These figures were a little lower in West and
The averages conceal considerable variations from place to place, with one set
of figures from
So what can be done? Effective treatment could make a major dent in neonatal
mortality. “It’s been established that universal coverage with preventive
treatment for malaria would reduce neonatal mortality by a third,” says
The good news
The good news is that all these conditions are treatable. It is just a question
of finding the best way to reach these women, many of whom will have no
symptoms and be unaware they are infected. The current treatment regime is to
give all pregnant women preventive treatment for malaria using Fansidar (sulfadoxine-pyrimethamine).
But growing resistance to the drug means this is less effective than it used to
be.
One possibility is to do a blood test for malaria at each antenatal visit, and
only give treatment if the test is positive. “The screen and treat approach
minimizes drug use,”
“Or else you could use a preventive combination therapy with an antimalarial
plus azithromycin, which is primarily an antibiotic and will act against the
other infections, but also has some antimalarial properties. Many doctors don’t
like to give a pregnant a woman any drug unless they are sure she needs it, but
in this case the alternative is much more grave.
“What we need now are studies to compare the alternative treatments in similar
populations. Only then will we know what path to follow.”