A maternal health perspective on malaria 

Pregnant lady with cloth around belly
Posted on March 11, 2025
By Dr. Alexandre Quach

Stakeholder Engagement Officer, Imperial College London
Target Malaria UK

A maternal health perspective on Malaria

As we celebrate International Women’s Day, it is important to emphasise the central role of women in the malaria issue, in view of the impact of the disease on their health and also as caregivers for affected children. They are also in active contributors to the co-development of tools against this disease through their deep knowledge of preventive or risk factors, economic and social impacts.

Pregnancy in particular, a determinant factor to overall gender equity, creates a time of increased vulnerability of women to malaria with potentially lethal consequences, such as miscarriage, intrauterine demise, low-birth weight, and severe maternal anemia[1]. Key routine prevention measures include the provision of intermittent treatment in pregnancy (IPTp) and the use of bed nets. The WHO recommends IPTp, in the form of Suphadoxine-Pyrimethamine (SP), is provided monthly from 13 weeks during antenatal care, with the aim to have at least 3 doses received during the pregnancy[2]. As an illustration, 2018 malaria indicator surveys (MIS) showed 58%[3] and 41%[4] of pregnant women received 3 IPTp doses in Burkina Faso and Uganda respectively.

The efficacy of this measure is conditioned by the timelines and number of antenatal care contacts with pregnant women. Recent studies in East Africa showed most pregnant women receive their first prenatal visit between 4 to 7 months of pregnancy, meaning a substantial proportion of women covered[5][6]. Access to prenatal visits varies greatly across geographies countries and is dependent on the geographic and financial accessibility of healthcare facilities, or social barriers at domestic and community level[7], indirect costs and the quality of care received at the facility[8]. As such, pregnant women face both the overall challenges that affect the fight against malaria (e.g. emerging resistance to insecticides and drugs, funding and supply chains gaps…) and the ones that impede maternal and child health.

The Global Fund plays a pivotal role, helping countries build stronger and more inclusive health systems. In 2023, over 15 million pregnant women attending antenatal clinics received intermittent preventive treatment for malaria through a Global Fund program. The Global Fund also supports the quality of care of maternal health through its Resilient and Sustainable Systems for Health (RSSH) grants. The organization reported the distribution of 1.28 million mosquito nets in Burkina Faso and 28.2 million in Uganda. Globally, the percentage of the population with access to a long-lasting insecticide-treated net reached 57% in 2022, up from 30% in 2010. However, there is still more to do to significantly cut malaria transmission.

To continue to maintain this progress, it is essential to maintain investment in organisations such as the Global Fund, but also to focus on innovation and research for complementary tools that will strengthen current malaria interventions. We are hopeful that gene drive will, one day, be one of those new means of control, offering hope to reduce the burden of malaria on women, and stay on course with the objectives that the world has set for health and gender equity.

[1]Schantz-Dunn J, Nour NM. Malaria and pregnancy: a global health perspective. Rev Obstet Gynecol. 2009 Summer;2(3):186-92. PMID: 19826576; PMCID: PMC2760896.
[2] WHO. Guidelines for the treatment of malaria. Third edition. 2015
[3] Institut National de la Statistique et de la Démographie (INSD), Programme d’Appui au Développement Sanitaire (PADS), Programme National de Lutte contre le Paludisme (PNLP), and ICF. 2018. Burkina Faso Malaria Indicator Survey 2017-2018. Ouagadougou, Burkina Faso: INSD, Burkina Faso, PADS, PNLP, and ICF. Available at http://dhsprogram.com/pubs/pdf/MIS32/MIS32.pdf.
[4] Ministry of Health National Malaria Control Division – NMCD, Uganda Bureau of Statistics – UBOS, and ICF. 2020. Uganda Malaria Indicator Survey 2018-19. Kampala, Uganda: NMCD/UBOS/ICF. Available at https://www.dhsprogram.com/pubs/pdf/MIS34/MIS34.pdf
[5] Oyato BT, Abasimel HZ, Tufa DG, Gesisa HI, Tsegaye TG, Awol M. Time to initiation of antenatal care and its predictors among pregnant women in Ethiopia: a multilevel mixed-effects acceleration failure time model. BMJ Open. 2024 Apr 19;14(4):e075965. doi: 10.1136/bmjopen-2023-075965. PMID: 38642996; PMCID: PMC11033649.
[6] Endawkie A, Kebede SD, Abera KM, Abeje ET, Enyew EB, Daba C, Asmare L, Bayou FD, Arefaynie M, Mohammed A, Tareke AA, Keleb A, Kebede N, Tsega Y. Time to antenatal care booking and its predictors among pregnant women in East Africa: a Weibull gamma shared frailty model using a recent demographic and health survey. Front Glob Womens Health. 2024 Nov 27;5:1457350. doi: 10.3389/fgwh.2024.1457350. PMID: 39664654; PMCID: PMC11631944.
[7] Dahab R, Sakellariou D. Barriers to Accessing Maternal Care in Low Income Countries in Africa: A Systematic Review. Int J Environ Res Public Health. 2020 Jun 16;17(12):4292. doi: 10.3390/ijerph17124292. PMID: 32560132; PMCID: PMC7344902.
[8]   Uldbjerg CS, Schramm S, Kaducu FO, Ovuga E, Sodemann M. Perceived barriers to utilization of antenatal care services in northern Uganda: A qualitative study. Sex Reprod Healthc. 2020 Mar;23:100464. doi: 10.1016/j.srhc.2019.100464. Epub 2019 Oct 25. PMID: 31710878.