By Dr Jorge Caravotta
KEONJHAR, India, 1 February 2011 – Twenty-four -year-old Mamta from Sarasa village in the tribal district of Keonjhar in the Eastern Indian state of Orissa is pregnant for the second time.
Accompanied by the village ASHA (Accredited Social Health Activist), Mamta braves extreme pain and tough terrain to make her way to the hospital, an hour’s drive from her village, to give birth to twins.
The twins are taken to a warmer where they have to be kept for three weeks to help them recover. The babies will require pediatric care, spoon feeding, community support and their mother’s care and affection.
However due to the limited facilities and heavy rush of patients to hospital, Mamta can stay at the hospital for next 48 hours. After which Mamta and her babies will be discharged.
Mamta is one of the hundreds of pregnant women in Keonjhar tribal district, who are fighting the often lonely battle of survival against the combined risks of pregnancy and malaria.
Pregnant women are more vulnerable to developing malaria related complications due to lowered immunity. Malaria infection of the placenta and maternal anaemia contribute to the low birth weight of babies, one of the major causes of death and impaired child development among new borns.
Babies born to mothers who have survived malarial attack, may also suffer from anaemia, fetal growth retardation, premature birth and in some cases deaths inside the womb.
During her pregnancy, Mamta survived two malarial attacks. The last one being just four weeks before the delivery.
Orissa is a malaria endemic area with the disease more predominant in the tribal districts of the state which are also the most deprived regions of the state. In India, Malaria is one of the largest public health problems in India. The World Health Organisation estimates that there were about 10.65 million malaria cases in India in 2006, responsible for 15,000 deaths.
In the neighbouring state of Chattisgarh, Malaria is believed to be the second largest cause of maternal death in the state.
Globally WHO and UNICEF recommend a two pronged approach: The use of Insecticide-Treated Nets (ITN) to reduce the burden of malaria infection among all pregnant women in high transmission areas and the early diagnosis and case management of malaria illness as well as the use of Intermittent Preventive Treatment (IPT) in high transmission areas.
But, not all pregnant women are sleeping under Insecticide-Treated Nets and chloroquine, a drug used to protect from malaria was withdrawn due to drug resistance. This leaves only the mosquito nets to protect against Malaria.
To bridge this policy gap, UNICEF is partnering with the National Vector Borne Disease Programme and National Institute of Malaria Research, to study the effectiveness of two doses of Sulpha Pyrimetamine(SP) drug during pregnancy as preventive treatment to reduce severe anaemia, low birth weight and malaria prevalence during pregnancy.
‘The positive outcome of this confirmatory study will make SP widely available as preventive treatment against Malaria in pregnancy as part of the National Drug Policy, and ensure safety of mother and foetus against the adverse consequences of this disease, especially in hard core malaria endemic areas of India” according to the National Institute on Malaria Research.