Malaria remains a significant burden in sub-Saharan Africa as it continues to be the leading cause of infant morbidity and mortality in Africa. It is believed that malaria contributes up to about 25% of infant mortality in Nigeria [
Congenital malaria is defined as malaria in a newborn or infant, transmitted from the mother [
Congenital malaria was thought to be rare in developing countries [
Literature providing information on the prevalence, burden, diagnosis, prevention, and control of congenital malaria, published between 2000 and 2010 was reviewed. Search terms included “congenital,” “Malaria,” “burden,” “diagnosis,” “prevention”, “control,” and “sub-Saharan Africa.” These literatures were accessed from Pubmed (MEDLINE), Biomed central, Google Scholar, and Cochrane Database of Systematic Reviews. Searches were also supplemented with recommendations from outside experts, reviews of bibliographies of other relevant articles, and systematic reviews.
Congenital malaria is rare in developed countries such as the United States of America, where only three infants out of 4.1 million live births were reported to have congenital malaria [
Furthermore, while a study in Kenya reported a prevalence of malarial parasitaemia in <0.5% of neonatal admissions [
It is estimated that placental malaria is responsible for 35% of preventable low birth weight in developing countries [
The detection of malaria parasites in the infant’s blood is essential for diagnosis, although blood smears can be negative if there are low parasite counts (50 parasites/
Cord malaria can also be detected by polymerase chain reaction (PCR). The use of PCR has suggested that congenital malaria may be more frequent, although it is unclear if a positive PCR represents an active infection [
Apart from the laboratory constraints, low antenatal care attendance and skilled delivery rates in African countries will also affect detection and prevention of congenital malaria. Antenatal care utilization in the developing countries is about 65%; this is low compared to that of the developed countries, which is 97% [
The clinical diagnosis of congenital malaria usually poses a challenge. This is because its clinical findings may be indistinguishable from those of neonatal sepsis [
Thus, the clinical distinction from other congenital infections rests primarily on maternal history of exposure to malaria and absence of a skin rash [
Prevention of any disease condition requires the availability of methods for prediction of those at high risk of the disorder. If there were tests which are adequately sensitive for detecting placenta malaria in the antenatal period, it would have helped in assessing the efficacy of antimalarial drug during pregnancy and identifying the infants at risk of congenital malaria [
Therefore, malaria preventive measures in pregnancy still remain as priority interventions required to protect the foetus and the newborn against the adverse effects of congenital malaria. The World Health Organization (WHO) has recommended a three-pronged strategic framework in areas of high or moderate (stable) malaria transmission of sub-Saharan Africa: intermittent preventive therapy (IPT), insecticide-treated nets (ITNs), and case management of malaria illness and anaemia [
Intermittent preventive therapy (IPT), also known as chemoprophylaxis for pregnant women, especially those in their first pregnancies, has been widely used in sub-Saharan Africa. In line with WHO recommendation, most national guidelines stipulate that all pregnant women should receive at least two doses of IPT given as sulphadoxine-pyrimethamine (SP) combination after quickening as part of preventive treatments at antenatal care [
Despite the beneficial impact of sulphadoxine-pyrimethamine on maternal and infant health, its utilization is threatened by weak health systems and sociocultural issues in sub-Saharan Africa. Studies have shown that a substantial proportion (20% to 80%) of pregnant women in this setting make their first antenatal visit in their third trimester [
Within the sociocultural context, it is thought that noninitiation of care in the first trimester seems to be a widespread cultural practice in sub-Saharan Africa. In rural Gambia, women do not usually “announce” pregnancy but wait for other family members to discover it, thereby presenting for care well into the third trimester [
Randomized control trials in sub-Saharan Africa have consistently shown the effectiveness of insecticide-treated nets (ITNs) in the prevention of malaria in pregnancy. Studies in Ghana and Kenya have documented reduced placental malaria, low birth weight, and fetal loss resulting from use of ITNs [
Access to ITNs by vulnerable populations including pregnant women continues to increase due to the efforts of national governments and supporting development agencies through multiple approaches such as stand-alone campaigns, health facilities, and antenatal clinic [
Despite these efforts, recent findings revealed low utilization of ITNs among pregnant women. Though increasing trends in ownership and use of ITNs by households were reported in national demographic surveys, the reports indicated that 5% to 57% of pregnant women aged 15–49 years slept under an ITN the past night. Furthermore, gaps between ownership and use of an ITN continue to exist as about 50% or less of pregnant women aged 15–49 years in households with an ITN slept under the net the past night [
Supporting and promoting access to correct, affordable, and appropriate treatment within 24 hours of the onset of symptoms of malaria is the third essential component of malaria prevention and control during pregnancy in malarious endemic countries of sub-Saharan Africa [
However, prompt and effective case management of malaria illness is hinged on early and correct diagnosis of the condition. As noted above, this is seriously hindered by lack of capacity to conduct quality malaria diagnostic tests by local health facilities in sub-Saharan African countries [
The World Health Organization (WHO) recently recommended prompt parasitologic confirmation by microscopy or alternatively by rapid diagnostic tests (RDTs) in all patients suspected of malaria before treatment is commenced unless parasitological diagnosis is not accessible [
On the other hand, malaria rapid diagnostic testing (RDT) has been found useful as an attractive alternative to routine microscopy with good sensitivity and specificity profiles [
From the foregoing, utilization of RDTs in resource-poor settings would seem to be an appropriate technology as it has the potential of improving the quality of malaria diagnosis and treatment services provided to all cases of malaria, including pregnant women and newborns. Therefore, it is suggested that national governments and development partners in sub-Saharan Africa should support widespread use of rapid diagnostic tests (RDTs) for malaria diagnosis. The capacity of local health facilities providing maternal and child health services should be strengthened with the provision of adequate supplies of equipment and consumables required to provide the diagnostic services. In addition, targeted trainings and supportive supervision of local health staff are highly desirable in order to meet up with the challenges of newly-assigned task.
In order to increase uptake of IPTs and facilitate prompt diagnosis and treatment of malaria in pregnancy, national governments and development partners in sub-Saharan African countries should also consider improving the poor maternal health service indicators—nonbooking, late antenatal visits and low antenatal service rate—as an essential task to be concertedly pursued. To achieve this task, strategies aimed at improving maternal health service should be implemented. For example, proven-specific interventions such as the World Health Organization (WHO) training on Life Saving Skills [
In addition, health staffs’ familiarization and adherence to WHO guidelines on provision of effective, efficient, safe, and culturally appropriate services to pregnant women and newborn under the Integrated Management of Pregnancy and Childbirth (IMPAC) would assist to ensure best practices [
On a long term basis, strategies which would bring about over 80% antenatal service utilization rate should be pursued vigorously. Therefore, it is suggested that redirecting and repackaging health education and service content of antenatal care service using a social marketing approach acceptable within the sociocultural context would be found useful. Therefore, placing the antenatal care service content and its benefits on public agenda through different media and matrices may be helpful in the study setting as opposed to the current practice of restricting information to women who make antenatal visits.
Despite male economic dominance and decision making power in developing countries, their involvement in reproductive health issues is reportedly low [
With regard to closing the gap between ownership and use of an ITN, a carefully designed qualitative research may be useful in eliciting the factors responsible or reasons for not sleeping under an ITN despite its availability in the household. While it is suggested that national governments and development partners should not relent on their efforts in making ITNs universally accessible to pregnant women either free of charge or at a subsidized price, experiences of other researchers on factors which promote or inhibit ITN usage may be found useful in packaging educational messages aimed at promoting its usage. ITN usage promoting factors such as high perception on the seriousness of malaria and its effect on pregnant women and children, high perceived benefit of ITNs in protecting children and pregnant women against malaria, and high awareness of the prevention of malaria as a better and cheaper option compared with treatment should be intensified. Whereas inhibitory factors such as fear of the chemical that is used to treat nets and unsupportive spouses should be demystified [
Evidence abound that congenital malaria constitutes a public health burden in sub-Saharan Africa. However, efforts of the national governments and development partners at instituting the recommended cost-effective interventions are continuously thwarted by challenges brought about by weak health systems and sociocultural factors among others, thereby, militating against the progress towards attainment of Millennium Development Goal (MDG) 6 (Indicator 22, Target 8). Health system strengthening and appropriate public health promoting and educating messages delivered through a social marketing approach may be found useful in putting back on track the race towards 2015 with respect to attainment of MDG 6.