The Malaria Concept in Pregnancy and the Mechanism of Evading the Immune System by the Malaria Parasite (Review)

Abstract

Malaria during pregnancy is a complex issue when considering the public health and an important contributor to maternal and infant morbidity and mortality in malaria-endemic countries. Malaria can be regarded as one of the leading cause of maternal deaths with regards to the sub-Saharan Africa. A minimum of 6 million women around the world stand the risk of being infected with malaria during pregnancy. Maternal deaths as a result of malaria occur at an approximate figure of 10, 000 per year while a minimum of 200, 00 babies also die on annual basis. Malaria remains a life threatening disease to the mother and her unborn child. The impact of the disease will depend on the strength of the mother, her immune system and the severity of the malaria. The people who are most at risk from malaria are women, who are experiencing their first pregnancies, and who are living in areas where stable malaria infections already exist. The protozoan parasites belong to the genus Plasmodium. Some relevant spp are P. falciparum, P. vivax, P. malariae, P. ovale, and extremely rarely P. knowlesi which causes malaria in macaques but can also infect humans. They are transmitted by the bite of a sporozoite-bearing female anopheline mosquito. After a period of pre-erythrocytic development in the liver, the blood stage infection, which causes the disease, begins. Parasitic invasion of the erythrocyte consumes haemoglobin and alters the red cell membrane. Malaria contributes to complications that can occur during pregnancy and these complications include anaemia, constant abortion, fetal deaths and prematurity. The first and second pregnancies experience the worst of this case. The World Health Organization with governmental support over the years have put in great effort in tackling the menace of malaria in pregnancy. The major objective of the collaborative effort is the public sensitization on the use of insecticide treatedmosquito nets (ITN), Intermittent preventive malaria treatment (IPT) and adequately treating acute mamalia infections that occurs during pregnancy, while the combination of Sulfadoxine-Pyrimethamine as regarding the IPT has proven to be of a great importancein the prevention of chronic malaria cases that can occur during pregnancy. The introduction of the Artemisinin-Combination Therapy (ACT) by the World Health Organization serving as a first-line treatment less complicated cases of malaria occurring during pregnancy has also provent to be of high benefit. Recently, the administration of soluble of chondrointin sulphate A (CSA) to pregnant women has proven to drastically reduce parasite adhesion. The administration of chondroitinase can effectively reduce parasite by 90%, thereby reducing chances of the foetus being exposed to the parasite. It is very important to make confirmations before proceeding to the treatment of malaria and enforcing therapy completions should be encouraged.