Description
Introduction - objectives
Pregnancy involves a heightened biological susceptibility to malaria, recognized as a significant contributor to adverse birth outcomes. However, it accounted for a significant proportion of maternal deaths in Sri Lanka in the first half of the 20th century. Following the subsequent control of malaria, there was a dramatic decline of maternal mortality ratio.
The last indigenous malaria case in Sri Lanka was reported in November 2012. Consequently, Sri Lanka was certified as having eliminated malaria in 2016 and is currently in the prevention of re-establishment (POR) phase.
There is no published literature on prevention of malaria during pregnancy (MDP) during POR phase, although pregnant women are highly susceptible to the infection.
This review is aimed at exploring the measures implemented in Sri Lanka to ensure the safety of pregnant women in POR phase.
Methodology
Sri Lanka is an island with a population of 22 million, divided into 25 administrative districts. The Medical Officer of Health (MOH) oversees preventive healthcare in a defined area averaging 60,000 population and the Public Health Midwife (PHM) has a defined area averaging 3,000 population. This preventive health system covers the entire country.
In Sri Lanka, all pregnant women receive clinic care by MOOH and domically care by PHMM, and for identified morbidities, they are referred to specialist hospitals.
In addition to the Anti-Malaria Campaign (AMC) Headquarters, Anti-Malaria Offices (AMOO) at district level cover the entire country for malaria prevention and control services.
The measures to prevent MDP in Sri Lanka was reviewed through a literature search and inputs from key informants. Only the interventions specific for pregnant women were selected.
Results and Discussions
Malaria preventive measures are well integrated into the routine maternal care services in Sri Lanka.
Similar to the broader population, passive case detection (PCD) is the main strategy in preventing MDP in Sri Lanka.
At registration of pregnant women, PHMM take a comprehensive history, including information on malaria, from them.
Pregnant women receive inputs from preventive healthcare staffs, which directly and indirectly strengthen PCD. They are advised to seek hospital care on day one of a febrile illness, primarily aimed at preventing maternal mortality from seasonal influenza, but also aiding in early detection of malaria. However, a challenge exists due to the clinicians being less vigilant about malaria given the extremely low number of cases reported.
Pregnant women travelling to endemic countries are referred to the AMC Headquarters/RMOO for advice and prophylactic medications, provided free of charge. However, in the current economic scenario, out-of-pocket expenditure is a concern.
Relevant health staff receive inputs on MDP in their basic and in-service training programmes.
Conclusions
The above low-cost interventions, together with general preventive measures, have successfully prevented malaria in Sri Lankan pregnant women. As more and more resource poor countries enter the elimination phase, the above measures would provide guidance for them to prevent this highly susceptible population getting affected by malaria.
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