A study recently carried out in Zambia found that a drug recommended for the prevention of malaria in pregnant women also reduces the risk of contracting sexually transmitted infections and reproductive tract infections including gonorrhea, chlamydia, trichomoniasis and bacterial vaginosis.
The study, carried out in Zambia’s Luapula province by researchers from the London School of Hygiene and Tropical Medicine, also found that the drug, sulfadoxine-pyrimethamine (S.P.), can lead to improved birth outcomes. Women who received two or more doses of the drug saw their risk of experiencing stillbirth, low birth weight, preterm delivery or intrauterine growth retardation cut by 45 percent.
The study also found that women who received two or more doses of S.P. saw their risk of getting malaria reduced by 76 percent, while their risk of getting gonorrhea or chlamydia was reduced by 92 percent.
Enesia Chaponda, the lead researcher, said that the study was prompted by an overlapping presence of malaria and STIs/RTIs in the region.
“These STIs and RTIs are prevalent in most places in Africa, so you find that in the areas that are hard-hit with malaria there is overlapping prevalence, and this has important public health implications, especially in pregnant women,” Chaponda said.
Nearly 39 percent of women in the study tested positive for both malaria parasites and at least one STI/RTI.
Treatable STIs/RTIs have been known to cause various complications in pregnancy. According to the World Health Organization (WHO), syphilis remains a leading cause of stillbirth and infant mortality in many parts of the world, while bacterial vaginosis and trichomoniasis cause complications such as prelabour rupture of membranes and preterm delivery.
Chaponda said that in Zambia, many STIs and RTIs remain untreated, since pregnant women are tested only for syphilis during their antenatal checkups.
“You find that a considerable burden of STIs in pregnancy remain undetected and untreated as you can have women with chlamydia or gonorrhea showing no symptoms, but this will impact on the birth outcome,” she said.
In addition, untreated malaria during pregnancy can cause infected red blood cells to gather in the placenta and block the exchange of nutrients between the mother and the fetus, resulting in miscarriage, stillbirth and low birth weight.
The good news, however, is that the proportion of pregnant women who receive malaria prevention treatment is on the rise.
Samantha Jiri, a 27-year-old social worker and mother of two who lives in the province where the research was undertaken, attributes this improvement largely to the persistence of health workers.
“They now insist on giving you at least three [doses of] treatment for malaria prevention,” she said. “They also give you a mosquito net during your first antenatal visit and insist that you come back for at least two more preventative treatments.”
Persistent malaria infections in pregnant women in the region may be attributed to a failure to attend all recommended antenatal checkups. Chaponda said that though the malaria prevention drug S.P. is given for free and is readily available in Zambia, some women in their study failed to get the recommended minimum of two treatments because they skipped antenatal checkups.
“They took the first dose and disappeared, and only showed up again at delivery,” she said.
She encourages women to attend their antenatal checkups and take S.P.
“At the moment there is no better alternative for improving birth outcomes,” she said.