By Eshani Goradia ‘19

A problem in many parts of the world, particularly sub-Saharan Africa, is low birth weight (LBW). LBW could result in neonatal mortality/morbidity, childhood stunting, a lack of cognitive development, and more. Often times, diseases like malaria can be the cause of LBW. Dr. James G. Beeson and Dr. Julie A. Simpson conducted a mathematical study that suggests incidences of LBW can be significantly reduced in sub-Saharan Africa by increasing intermittent preventive treatment in pregnancy (IPTp), a preventive treatment for women visiting antenatal clinics. It requires them to ingest doses of sulphadoxine-pyrimethamine (SP), an antimalarial drug. Another important technique to decrease the incidence of malaria during pregnancies is using an insecticide-treated bed net (ITN).

In order to monitor the effectiveness of IPTp, ITNs, disease resistance, and coverage, the research team conducted a study based on a mathematical model that provided statistics and estimates on the relationship between LBW and IPTp coverage. The researchers collected data regarding attendance at clinics from recent Demographic Health Surveys and Malaria Indicator Surveys. Other data were gathered from the Malaria Atlas Project and Worldwide Antimalarial Resistance Network molecular database.

The researchers found that despite resistance to SP, increased coverage of IPTp has been immensely beneficial. According to the model, 215,000 LBW births could be averted annually if properly administered to all women who visit an antenatal clinic at least three times per year. Their model also found that IPTp would benefit from increased coverage of ITNs. But because some of the data suggest that using SP to treat populations with high level of SP-resistance can be injurious, the findings also received a great deal of criticism. The researchers, however, argued that this is not a consistent finding and can be overlooked when considering the overall benefits.

Because of drug-resistant malaria, researchers and policy makers are also looking into alternative drugs that may be effective. Challenges in improving coverage, as the study suggests, include having well funded/staffed antenatal clinics that can properly and conveniently administer treatments. Community engagement and health care governance are also issues that must be well managed in order to make any kind of service to the general population effective. However, the scientists hope that this study illuminates the need for future interventions and a global plan to fight various strains of malaria.

References:

1. J.G. Beeson, J.A. Simpson, The potential benefit of scaling up malaria prevention to reduce low birth weight in Africa. PLoS Medicine 14, (2017). doi: 10.1371/journal.pmed.1002244.
2. Image retrieved from: https://upload.wikimedia.org/wikipedia/commons/3/39/A_malnourished_child_in_an_MSF_treatment_tent_in_Dolo_Ado.jpg