Source: Times of Zambia
MANY, if not most, readers are familiar with malaria. It is one of those diseases the general populace takes for granted, not least of all because it is a disease of antiquity.

The day is long past when malaria took the light of day out of many Zambians to a point where it is slowly but surely becoming a neglected,

if not an entirely forgotten disease.

Headlines come from elsewhere in spite of the fact that malaria is still one of the leading causes of morbidity and mortality in Zambia across all age brackets. It ranks next to the HIV/AIDS shoulders.

The majority of readers of this column can recite, without any effort at all, the symptoms and clinical features of malaria. Those among the readers who are old enough to look back at the days of chloroquine will do so with nostalgia.

Those days where untoward effects of the treatment were worse than the malaria itself are now paled into oblivion for good.

The hellish days of scratching and sleepless nights are thankfully over as newer medications have alighted upon the scene and banished the use of chloroquine in Zambia to the dustbin of history. Just to be sure there are places on earth where chloroquine is still in use and to good effect.

Thanks to a four-pronged approach of employing residue spraying, insecticide treated bed-nets, managing of cases with coartem and clearing homes and surroundings of tall grass and water-pools, success has come the way of Zambia like a windfall of first fruits.

The transmission lines of malaria have been cut by as much as 67 per cent in many places. Lusaka and Copperbelt provinces, for instance, are low-transmission malarial areas to a point where the residents are beginning to forget what it was like to contract malaria.

That said, it is a grim fact that malaria, certainly malaria in pregnancy, the subject of the presentation this week, is still alive and well and claiming its thousands in its wake. Malaria is commonly associated with poverty and may also be a major hindrance to economic development.

Malaria in pregnancy carries with it certain risks that, in a manner of speaking, the non-pregnant woman and the general population do not shoulder. Malaria in a pregnant woman can complicate the pregnancy unless dealt with diligently.
Malaria in pregnancy affects the placenta or the after-birth tissue. It is thus alternatively called placental malaria. Informed readers know that there are a number of subspecies of malaria.

Five species of plasmodium can infect and be transmitted by humans. The vast majority of deaths are caused by P. falciparum and P. vivax, while P. ovale and P. malariae cause a generally milder form of malaria that is rarely fatal.

The most dangerous is called plasmodium falciparum, which species is also found in India and most of Africa, including Zambia. Plasmodium malaria is transmitted via a certain infected female anopheles mosquito with special features.

In a word it is not every mosquito bite that will eventuate into malaria. All other mosquitoes do not transmit malaria. The science of the whys and wherefores is outside the bounds of this discussion.

Malaria in pregnancy is particularly problematic in a women's first pregnancy. Prevention and treatment of malaria, therefore, is of utmost importance during this time for first mothers.

Although human beings develop immunity to malaria in malaria-endemic areas yet pregnancy causes complications that leave the woman and the baby she is carrying extremely vulnerable.

There are a number of reasons for this. For starters, pregnancy suppresses the immune system in a way that the non-pregnant women is exempt from.

The second reason is that the parasite enters the placenta and interferes with the transportation of vital life-supporting substances that enter the fetal placenta.

The common untoward effects include anaemia in the mother, stillbirth, spontaneous abortion, low birth weight and even death. Severe untreated malaria in pregnancy can abbreviate the lives of both the mother and child as indicated above.

Women experiencing malaria in pregnancy may exhibit normal symptoms of malaria, but may also be asymptomatic or present with more mild symptoms, including a lack of the characteristic fever. This may prevent a woman from seeking treatment despite the danger to herself and her unborn child.

The disease results from the aggregation of blood cells infected by plasmodium falciparum which have been shown to adhere to the placenta causing the blocking of the crucial flow of nutrients from mother to the growing baby as well as removal of toxic products from the foetus.
The typical picture of malaria infection is joint pains, general malaise, fever, headaches, vomiting some yellow stuff, chills and rigors and loss of appetite.

It is also not uncommon for a sufferer of malaria to develop diarrhoea, vomiting and at times respiratory challenges. Cerebral malaria may present with most of the above symptoms, with fits or convulsions in tow. Anaemia, dizziness and mild jaundice are regular accompaniments too.

Malaria is typically diagnosed by the microscopic examination of blood using blood films, or with special tests that pick the actual antigen or offending agent.

Malaria in pregnancy is dangerous for both the mother and the foetus. Therefore, pregnant women with malaria must be treated promptly with an effective anti-malarial agent to clear parasites rapidly.

In general, the newer the drug, the more likely it is to be effective (in part because there has been insufficient time for resistance to emerge). Clinicians, therefore, have to make treatment decisions based on the clinical severity of infection, resistance patterns and available data regarding safety of the drug or class of drug in pregnancy.

Despite a crying need for it, no effective vaccine currently exists, although efforts to develop one are ongoing. Several medications are available to prevent and treat malaria.

Pregnant women are encouraged to attend antenatal clinics. Preventative measures are used where an anti-malarial, commonly called fansidar is intermittently given to the woman.

A variety of anti-malarial medications are available. Usually artemisinin derivative artesunate, also called coartem, a combination therapy in both children and adults is available for use. Quinine is still the reserve drug for severe forms of malaria such as cerebral malaria.

It is a crying shame that many pregnant women, especially in rural areas are still dying in their numbers when help is available.

Government outreach programmes to these folks, the use of mobile clinics and construction of health centres as close to the family as possible, mass health education, use and promotion of the use of insecticide-impregnated mosquito nets are great ways of fighting and rolling back malaria in pregnancy.

Well readers this is all for now. Your columnist felt this reminder was timely as female anopheles mosquitoes are still prowling around with bad intentions.

Feel free to connect with the columnist by directing your emails to: This email address is being protected from spambots. You need JavaScript enabled to view it. or simply sending the old-fashioned letter to: The Sunday Doctor, C/O Sunday Times of Zambia, P.O Box 30394, Lusaka.

May the God of Heaven bless you and keep you, may He make His face to shine upon you and grant you peace through His Son Jesus Christ to whom all, who may come, can apply for salvation through faith in Him, upon renouncing their sins and believing upon Him.

• Zambia