By Kalu Okoronkwo
Malaria is a life-threatening disease caused by parasites that are transmitted to people through the bites of infected female Anopheles mosquitoes. It is one of the major causes of death in developing countries especially Africa.
In 2017, there were about 219million cases of malaria in 87 countries with estimated deaths standing at about 435,000. Malaria in pregnancy is the cause of 10,000 maternal deaths per annum in Nigeria and accounts for about 200,000 deaths in new born babies according to statistics.
Pregnancy reduces a woman’s immunity to malaria, making her more susceptible to infection and increasing the risk of illness, severe anaemia and death. In Nigeria, there are estimated 100 million malaria cases with over 300,000 deaths per annum. About 11% of maternal death is attributed to malaria while over 70% of deaths in children under five years is linked to malaria.
Adolescent girls are particularly vulnerable to malaria. In many sub Saharan villages and urban centres, adolescents are often parasitaemic and anaemic when they first become pregnant. Moreover, societal stigma results in pregnant adolescents being least likely to access antenatal care.
According to Dr. Motunrayo Shittu, a medical doctor practising in Lagos, to achieve universal health coverage, women’s primary health care needs, including addressing malaria in pregnancy, must be at the forefront of comprehensive country wide policies and strategies that reach all women at risk of malaria- no matter where they live.
Shittu advocated proper equipping of primary health centres to tackle malaria in pregnancy as they are closer to the people.
Several efforts have been made at global and national levels to combat the spread of malaria and reduce mortality especially among pregnant women and infants. In 2005, Nigeria adopted artemisinin based combination therapies (ACTs) as first line therapy for uncomplicated malaria. Majority of the malaria drugs are in tablets, caplets, powder and injections.
However, a new technology in malaria drug has emerged to effectively tackle malaria resistance and stop complications associated with treatment. It is the soft gel technology. Some of the malaria drugs in Nigeria with the softgel technology are Amatem Forte manufactured by Olive Healthcare, India and marketed in Nigeria by Elbe Pharma, Lagos and Coatal-Forte Softgel, a product of Geneith Pharmaceuticals Company Limited, Lagos. It is a combination of Artemether and Lumefantrine which acts as a blood schizonticide and is indicated for the treatment of adults and children with acute uncomplicated infections due to both sensitive and multi-drug resistant strains of P.falciparam.
A softgel is an oral dosage form similar to capsules. It consists of a gelation-based shell surrounding a liquid fill. It is a combination of gelatin, water, opacifier and a plasticizer. According to Mr. Emeka Nwachukwu, General Manager, Marketing of Geneith Pharmaceutical Company Limited, a poorly soluble tablets face absorption challenges and, as such, best formulated as gelatins. Coatal-Forte Softgel eliminates multiple processes of disintegration into granules dissolution and absorption.
Nwachukwu enumerated the advantages of softgel regular tablets or caplets to include that wide variety of compounds in the form of semi-solid filling, liquid gel or paste can be delivered in soft gelation form; formulated into various colours, shapes and sizes and helps to mask odours and unpleasant taste as it is tasteless, odourless and easy to swallow. This is key according to him because most pregnant women are sensitive to smell and taste, hence most of them don’t like to take drugs.
According to reports, softgel has faster disintegration and absorption due to the oily nature of the gelation most suitable for Lumefantrine absorption. It also readily dissolves in the gastric juices of the digestive tract. In addition, the opacity of the softgel provides protection against ultra violet radiation and light thus providing stability to the product and minimizes the formation of free radicals and prevents rancidity.
Because of the need to safeguard the baby and mother during pregnancy, medical experts caution that pregnant women should not take malaria drugs without the recommendation of a qualified medical practitioner. This is against the backdrop of the abuse in Nigeria in the treatment of malaria. Because over the counter drugs are readily available in pharmacies, people just purchase and take these drugs at the slightest headache, body weakness or anything that appears to be a symptom of malaria. According to Dr. Uche Ajuzinam, an obstetrics and gynaecology expert in Magboro, Ogun State, administering malaria drugs and indeed any other drugs in pregnant women should be done with caution to avoid adverse side effects that may affect the health of unborn babies. According to him, some of the postnatal health issues with newly born babies are traced to wrong use of medication, alcohol abuse and cigarette smoking during pregnancy.
Early and accurate diagnosis of malaria is essential for both rapid and effective disease management and surveillance.
WHO recommends prompt malaria diagnosis either by microscopy or malaria rapid diagnostic test in patients before treatment commences.
Diagnostic testing improves the overall management of patients with febrile illnesses and may also help to reduce the emergence and spread of drug resistance by reserving antimalarial to those who actually have the disease.
In sum, there is need to promote early and comprehensive antenatal care where eligible pregnant women can access long-lasting insecticidal nets which are highly effective in preventing malaria infection and reducing associated morbidity and mortality. WHO also recommends intermittent preventive treatment in pregnancy (IPTp) – a full therapeutic course of antimalarial medicine given to pregnant women at routine antenatal care visits, regardless of whether the recipient is infected with malaria. According to WHO, “IPTp reduces maternal malaria episodes, maternal and foetal anaemia, placental parasitaemia, low birth weight and neonatal mortality”.