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HEALTH: Treat the mother - save the baby
LONDON, 16 May 2012 (IRIN) - The past decade has seen great advances in
child survival, but while toddlers and small children are benefiting,
the death rate for new-born babies remains stubbornly high. Now a new
report suggests that paying more attention to their mothers' health,
and focusing on certain damaging but treatable diseases, could be one
key to tackling neonatal mortality.
The traditional childhood killers - measles, pneumonia and diarrhoea -
are all down; even where malaria is still rife, treated bednets are
saving children's lives. But as deaths from other causes drop,
mortality in the first month of life looms ever larger.
-1/abstract> published recently by researchers at Johns Hopkins
University in Baltimore show that, worldwide, around 40 percent of
children who die below the age of five die in the first month of life,
and that rises to 50 percent or more in regions like Europe and South
East Asia where other causes of childhood death have been reduced.
Many of these babies were born too soon, or born too small; others were
born with infections contracted from their mothers. In all these cases
it is the mother's health during pregnancy which is the key to the
babies' survival, and now the American Medical Association has
of the incidence in pregnant women of health problems which are known
to affect their unborn babies, and which can all be treated.
The researchers looked at 171 studies from Sub-Saharan Africa over a
20-year period, which showed whether women attending ante-natal clinics
were infected with malaria, or with a range of sexually transmitted and
reproductive tract infections - syphilis, gonorrhoea, chlamydia and
bacterial and parasitic infections of the vagina. If left untreated,
these can lead to miscarriages, stillbirths, premature births and low
Malaria affects placenta
Matthew Chico, a research fellow at the London School of Hygiene and
Tropical Medicine, who led the team, stresses the far-reaching effects
of these problems. In malaria, for instance, the placenta does not
function properly. "What you end up with," he told IRIN, "is a low
birth-weight baby, and low birth weight is the single most common
factor in neonatal mortality. And it leads to lifelong consequences.
Low birth-weight babies underperform at school and end up earning less,
and curiously they even end up with more cardiovascular problems later
'' The good news
is that all these conditions are treatable. It is just a question of
finding the best way to reach these women, many of whom will have no
symptoms and be unaware they are infected
"There are multiple consequences. Girls are at greater risk, for
instance, of having low birth-weight babies themselves and so it
continues into the next generation. We have to break the cycle."
Chico and his colleagues divided the continent into two regions - East
and Southern Africa, and West and Central Africa, because of the way
the higher incidence of HIV/AIDS in Southern Africa might affect the
results. They also excluded South Africa, because malaria was a major
part of the study, and malaria there has been reduced to the point
where it is no longer an issue.
What they found was alarming. The incidence of syphilis and gonorrhoea
was relatively low, under 5 percent, and the most recent figures show
them on the decline. But in East and Southern Africa more than half the
women attending antenatal clinics tested positive for bacterial vaginal
infection and more than a quarter had the parasitic infection,
These figures were a little lower in West and Central Africa, but those
areas had a higher rate of malaria infection, around 40 percent,
although this had reduced a little in more recent studies, an
indication perhaps that the promotion of bednets for pregnant women has
had an effect.
The averages conceal considerable variations from place to place, with
one set of figures from Blantyre, Malawi, showing more than 85 percent
of women had a bacterial vaginal infection and another, from Ngali in
Cameroon, reporting that almost 95 percent of women there were infected
So what can be done? Effective treatment could make a major dent in
neonatal mortality. "It's been established that universal coverage with
preventive treatment for malaria would reduce neonatal mortality by a
third," says Chico. "So add to that an STI [sexually transmitted
infection] and RTI [reproductive tract infection] component and the
reduction could certainly be more than that."
The good news
The good news is that all these conditions are treatable. It is just a
question of finding the best way to reach these women, many of whom
will have no symptoms and be unaware they are infected. The current
treatment regime is to give all pregnant women preventive treatment for
malaria using Fansidar (sulfadoxine-pyrimethamine). But growing
resistance to the drug means this is less effective than it used to be.
One possibility is to do a blood test for malaria at each antenatal
visit, and only give treatment if the test is positive. "The screen and
treat approach minimizes drug use," Chico told IRIN, "and that would
minimize drug resistance. But the test doesn't show if the placenta is
infected, which is what affects the unborn baby, and this approach
doesn't give protection against sexually transmitted infections.
"Or else you could use a preventive combination therapy with an
antimalarial plus azithromycin, which is primarily an antibiotic and
will act against the other infections, but also has some antimalarial
properties. Many doctors don't like to give a pregnant a woman any drug
unless they are sure she needs it, but in this case the alternative is
much more grave.
"What we need now are studies to compare the alternative treatments in
similar populations. Only then will we know what path to follow."
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