Nairobi — DESPITE SLEEPING UNDER insecticide treated nets, pregnant women still face serious threat from malaria, according to a study published in PLoS Medicine, a medical journal.

Since 2000, the World Health Organisation has recommended a package of interventions to prevent malaria, including the promotion of the use of treated nets, intermittent preventive treatment in pregnancy and effective case management of malaria.

The study recommends that pregnant women in malaria-endemic areas receive at least two doses of sulphadoxine-pyrimethamine in the second and third trimesters of pregnancy.

Many countries have adopted the WHO recommendations, but implementation has often been hampered by constraints within health service delivery systems or individual perceptions of preventive treatment. These factors include health service delivery systems burdened by poor drugs supply, poor health worker practices and low attendance or late presentation to antenatal clinics.

Malaria infection during pregnancy poses substantial risks to the mother, foetus and the newborn.

Consequences of malaria infection during pregnancy include severe anaemia, placental parasitaemia (presence of malaria parasites in the placenta) and intra-uterine growth retardation.

These factors contribute to low birth weight, one of the principal causes of infant mortality in Africa. First time mothers and women in their second pregnancy are at a higher risk for placental malaria than women with multiple prior pregnancies.

A STUDY CARRIED OUT IN Ifakara town and the surrounding villages in the rice growing plains of the Kilombero River Valley in Tanzania, assessed the prevalence of placental malaria at delivery in women during first or second pregnancy, who did not receive preventative treatment in a malaria-endemic area with high bed net coverage.

Women who presented to the labour ward and who reported not using preventive treatment were included in the study. Self-report data were collected by questionnaire; whereas neo-natal birth weight and placenta parasitaemia were measured directly at the time of delivery.

The Kilombero region receives monsoon tropical rains from December to May and malaria transmission ranges from intense to moderate. Transmission is perennial, peaking after the long rains.

The hospital-based study was carried out for a period of one year, from December 2003 to December 2004. The study targeted women in their first or second pregnancy and had not received preventative treatment from an antenatal care provider.

Overall, 413 pregnant women were enrolled of which 91 per cent reported to have slept under a bed net at home the previous night, while 43 per cent reported history of fever. Fifteen per cent of newborns weighed less than 2.5kg at delivery.

According to the findings, the observed incidence of low birth weight and prevalence of placental parasitaemia at delivery suggests that malaria remains a problem in pregnancy in this area despite high bed net coverage, when eligible women do not receive preventive treatment.

Accordingly, the study showed that in the absence of effective preventive treatment, some risk from malaria during pregnancy persisted.

The researchers say preventive treatment through the use of treated nets should be emphasised at all levels to achieve maximum community coverage.

Due to a wave of renewed awareness of and investment in malaria prevention and treatment, it is tempting to believe that malaria has not been neglected. Although malaria's comparatively high profile excludes it from the WHO's list of "neglected tropical diseases," this technicality should not deceive the world into thinking that malaria receives sufficient attention.

As a new study published in PLoS Medicine finds the neglect of malaria persists, as uncovered by an analysis of malaria spending.

The study, "Divergent goals and commitments in global malaria intervention, tells" of the alarming gap between the funds needed to meet internationally agreed goals and the resources so far allocated.

A comprehensive audit of malaria funding shows that the world invests only about $1 billion per year, billions short of what several independent estimates suggest is necessary to achieve basic international goals for reducing malaria burdens.

Because need estimates may undershoot actual needs, the true gap may be far wider.

IN A CLIMATE RIFE WITH CALLS to revisit the goal of global malaria elimination and eradication, the magnitude of this gap is worrying. Target 8 of Goal 6 of the Millennium Development Goals is to "Have halted by 2015 and begun to reverse the incidence of malaria and other major diseases."

It is unlikely that Target 8 will be met unless malaria resource commitments can be made," the study says.

To reach global malaria control goals, the researchers argue that more international funding is needed but that it must be targeted at specific countries most at risk.

While the Republic of the Congo, Côte d'Ivoire, and Pakistan apply only $0.11 annually per person against malaria, Suriname spends about 1,500 times more at $167 per person per annum," says the study.