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Kenya: Pregnant? Malaria is Your Greatest Enemy
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The Nation (Nairobi)
25 April 2008
Posted to the web 25 April 2008
Dorothy Kweyu
Nairobi
When a community nurse in a Kisumu neighbourhood received a phone call from a friend asking her to attend to a very sick sister-in-law, little did she know what awaited.
The patient, Mrs Agnes Oloo*, 23, who had lived in a childless marriage for five years, had all the clinical symptoms of malaria.
"She was running high fever, a temperature of 40 degrees Celsius, and was vomiting a lot," says the nurse, who requested anonymity because of the drastic decisions she had to make to save the patient's life.
"I wanted to refer her to the general hospital, but when she told me that she had earlier been admitted to a private hospital for five days with no improvement, I decided to handle the case as best I knew," said the 52-year-old nurse.
Mrs Oloo then said she had missed her periods for one month. This prompted the nurse to do a pregnancy test even as she sent a blood sample to the lab for a malaria test.
The pregnancy test turned out positive, as did the malaria test, which showed a parasite load of three plus - very high.
The nurse decided to put Mrs Oloo on a quinine drip, a procedure that should normally be administered in a hospital.
Happily, Mrs Oloo responded well to the treatment. "She is now very pregnant," says the nurse with a chuckle.
At Kiboswa Medical Clinic, Lucy Wayodi, a clinical officer, describes malaria among pregnant women as "very bad; it can result in miscarriage."
"When (malaria) parasites fill the placenta, they make the mother anaemic and can kill the baby," says Ms Wayodi.
She advises that serious cases of malaria, especially in pregnancy, be referred to a hospital, because of the high risk of miscarriage or premature birth.
Both Ms Wayodi and the nurse, are part of a Government initiative known as the National Malaria Strategy 2001-2010, which is aimed at fighting malaria as part of the UN decade to roll back malaria.
The initiative targets pregnant women who are at the greatest risk of dying from malaria. It involves distribution of insecticide-treated mosquito nets to mothers at a highly subsidised cost of Sh50 each.
The division of malaria control in the Public Health Ministry describes malaria as the leading cause of illness and death in Kenya.
According to officials from the division, 25 million out of the 34 million Kenyans are at risk of contracting malaria. It is estimated that 170 million working days are lost to the disease each year.
The disease is also responsible for 20 per cent of all deaths of children aged five years and below. The division describes this age group and pregnant women as most vulnerable to malaria.
The management of malaria and anaemia in pregnancy is one of the Government's key strategies in bringing down the prevalence of the disease, which is endemic in the Lake Victoria region.
In this region, the disease occurs throughout the year unlike in Nairobi, Nyeri and Nakuru which are considered to be malaria-free.
Malaria, which is prevalent across Africa, is caused by Plasmodium falciparum. Africa accounts for 90 per cent of malaria cases globally.
Although people around the lake region and Coast Province live within areas where malaria is prevalent, women in low malaria transmission areas are at greatest risk of contracting malaria in pregnancy.
Immunity level
This is because such women have not acquired any significant level of immunity and usually become ill when infected with Plasmodium falciparum.
Accordingly, they are at a two-or-three times greater risk of developing severe infection than are the non-pregnant women in the same regions.
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Malaria kills either directly or indirectly because of the anaemia that the parasite causes in pregnant women. The high fever that an infected woman suffers can result in convulsions, which unless attended to promptly, can result in death.
Miscarriage, death of the newborn and low birth weight are some of the effects of malaria in pregnancy.
The reason why women in low malaria prevalence areas are at higher risk of dying from the disease is that they are most likely to suffer the full symptoms of the disease, including convulsions.
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