Congenital and Neonatal Malaria – Afrab Chem’s Intervention in the Treatment

An estimated 219 million cases of clinical malaria was recorded globally according to the W.H.0 2018 World Malaria Report and Nigeria has the highest country share of total malaria cases in the world (25% of global malaria burden). Between 2010 and 2017, there has been a steady decline in the number of malaria deaths, dropping from 555,000 to 435,000 globally.  Africa accounts for 403,000 of these deaths, with under-5 mortality at a staggering 266,000 in 2017.

Malaria is an acute febrile illness with an incubation period of 7days or longer, caused by the protozoan parasite Plasmodium, which is transmitted by female Anopheles mosquitoes. In addressing the burden of malaria, interventions should take a closer look at three situations namely:

1. Malaria in pregnancy
2. Malaria in Under-5
3. As a sub-group of the under-5, is congenital and neonatal malaria.

The high burden of childhood malaria in endemic regions of the world has been associated with malaria during pregnancy¹. In sub-Saharan Africa for instance, malaria affects an estimated 24 million pregnant women² and each year between 75,000 and 200,000 infant deaths are attributed to malaria infection in pregnancy globally³. Pregnant women residing in malaria endemic areas often experience a high frequency and density of parasitemia, resulting to high rates of maternal morbidity including fever and severe anemia, with abortion and stillbirth, and with high rates of placental parasitisation⁴. Severe parasitization of the placenta by malaria parasites particularly P. falciparum and P. vivax which is known as placental malaria can result in transplacental transmission of the parasite to the fetus and consequently to congenital malaria⁵.

Congenital malaria, defined as the presence of malaria parasites through maternal transmission in the erythrocytes of newborns aged less than 7 days. Symptoms usually occur 10 to 30 days postpartum. However, the disease can be seen in a day-old baby or be delayed for weeks or months.

Neonatal malaria on the other hand is the development of malaria (not transmitted from maternal source) in a neonate (a child under 28 days of age). In the early 1950’s the prevalence of congenital malaria has been thought to be extremely rare^6,7.

However in about the last three decades, cross-sectional studies conducted in sub-Sahara Africa (Nigeria playing a major role) clearly indicates that congenital malaria is not as uncommon as previously thought, with prevalence ranging from 10.8% to as high as 54.2%. Newer studies have confirmed that transplacental transmission of infected erythrocytes in endemic region is high and that the placental barrier is not very effective when infected with malaria parasites.^8,9

It is important to therefore have an effective treatment option that serves the two groups of people. LA-TESEN® (a brand of Artemether lumefantrine) in different formulations helps in the treatment of malaria in pregnancy, from the second trimester as well as provide an effective treatment for neonates. W.H.O has expressed the great concern of lack of pharmaceutical formulations of antimalaria in treating neonates.

LA-TESEN Drops is the appropriate intervention for neonates. The first of its kind and only existing, LA-TESEN Drops offers a treatment option for neonates of different birth weight, even neonates at less than 5kg body weight at a dose equivalent to the same mg/kg body weight dose as 5kg neonates. LA-TESEN Suspension serves under-5 older babies, while LA-TESEN Tablets is positioned for treating malaria in pregnancy from the 2^nd trimester.

REFERENCES:

1. Murphy, S.C. & Breman, J.G. (2001) Gaps in the childhood malaria burden in Africa: cerebral malaria, neurological sequelae, anemia, respiratory distress, hypoglycemia, and complications of pregnancy. American Journal of Tropical Medicine Hygiene 64, 57-67.

2. Steketee, R.W., Nahlen, B.L., Parise, M.E. & Menendez, C. (2001) The burden of malaria in pregnancy in malaria-endemic areas. American Journal of Tropical Medicine Hygiene 64, 28- 35.

3. Brabin, B.J., Romagosa, C., Abdelgalil, S., Menéndez, C., Verhoeff, F.H., McGready, R., Fletcher, K.A., Owens, S., D’Alessandro, U., Nosten, F., Fischer, P.R. & Ordi, J. (2004) The sick placenta-the role of malaria. Placenta 25, 359-378.

4. Menendez, C. & Mayor, A. (2007) Congenital malaria: the least known consequence of malaria in pregnancy. Seminars in Fetal and Neonatal Medicine 12, 207-213.

5. Uneke, C.J. (2007b) Congenital Plasmodium falciparum malaria in sub-Saharan Africa: a rarity or frequent occurrence? Parasitology Research 101, 835-842.

6. Lamikanra, O.T. (1993) A study of malaria parasitaemia in pregnant women, placentae, cord blood and newborn babies in Lagos, Nigeria. West African Journal of Medicine 12, 213-217.

7. Djibo, A. & Cenac, A. (2000) Congenital malaria. Parasitological and serological studies in Niamey (Niger). Sante 10, 183-187.