In Africa, about 30 million women a year become pregnant in areas where falciparum malaria — the most dangerous kind — is common.
To protect them, health agencies use “intermittent preventive treatment,” or I.P.T., under which all pregnant women in such areas are given doses of anti-malarial drugs at regular intervals, whether or not they are tested for the disease.
But malaria fighters sharply disagree over how to do it, and a recently published by The New England Journal of Medicine adds fuel to the debate.
To cure malaria, virtually everyone in the field uses two-drug cocktails containing, a derivative of the sweet wormwood plant.
But for preventing malaria in pregnant women, the World Health Organization recommends only an older drug combination, Sulfadoxine-pyrimethamime— also known as Fansidar — even though resistance to it is spreading in Africa.
The new study, led by scientists from Uganda and the University of California, San Francisco, found that women who received sulfadoxine-pyrimethamine for prevention were much more likely to develop malaria symptoms during pregnancy and to have parasites in the placenta when their babies were born.
A similar study done in Kenya and published in The Lancet in 2015 had similar results.
Some experts believe the W.H.O. should change its recommendation. “To me, it’s shocking that it’s taking so long,” said Dr. Grant Dorsey, who researches malaria at U.C.S.F. and is an author of the Uganda study.
Other malaria-fighting groups are not endorsing change.
The old method is imperfect but still usually prevents deaths, said Dr. Estrella Lasry, a tropical medicine adviser at Doctors Without Borders. Using artemisinin for prevention could speed the emergence of parasites resistant to it.
“We need artemesinin for treatment, so we don’t want to burn it out,” she said.
The President’s Malaria Initiative, the American government’s global malaria-fighting program, which has paid for 42 million doses of I.P.T. since 2005, still thinks the old method protects fetuses well enough to justify continued use, a spokesman said.
The exception is in a small region of East Africa, where the initiative is backing a trial of new methods.
Source: New York Times