Vivax malaria in pregnancy and lactation: a long way to health equity

• Published in: Malaria journal Vol. 19; no. 1; p. 40
• Main Authors: Brummaier, Tobias, Gilder, Mary Ellen, Gornsawun, Gornpan, Chu, Cindy S, Bancone, Germana, Pimanpanarak, Mupawjay, Chotivanich, Kesinee, Nosten, François, McGready, Rose
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 22-01-2020; BioMed Central; BMC
• Subjects: Adolescent; Age; Aminoquinolines - therapeutic use; Anaemia; Anemia; Anemia - drug therapy; Anemia - etiology; Antimalarials - therapeutic use; Artemether, Lumefantrine Drug Combination - therapeutic use; Care and treatment; Case Report; Complications and side effects; Diseases; Drug dosages; Drug therapy; Equity; Female; Females; Fetal Growth Retardation - etiology; Fetal Growth Retardation - therapy; Fetuses; G6PD deficiency; Gender; Gender equity; Genotype & phenotype; Genotypes; Gestation; Glucosephosphate dehydrogenase; Glucosephosphate Dehydrogenase Deficiency - diagnosis; Health aspects; Health Equity - statistics & numerical data; Hematocrit; Hemoglobin; Human diseases; Humans; Infant, Small for Gestational Age; Infections; Laboratories; Lactation; Lactation Disorders - etiology; Lactation Disorders - parasitology; Malaria; Malaria, Vivax - drug therapy; Malaria, Vivax - epidemiology; Malaria, Vivax - mortality; Morbidity; Pain; Phosphates; Plasmodium vivax; Postpartum; Pregnancy; Pregnancy Complications, Parasitic - drug therapy; Pregnancy Complications, Parasitic - epidemiology; Pregnancy Complications, Parasitic - mortality; Pregnancy Outcome; Pregnant women; Primaquine; Primaquine - therapeutic use; Radical cure; Risk reduction; Sex differences (Biology); Sustainable development; Sustainable Development Goals; Ultrasonic imaging; Uterus; Vector-borne diseases; Women; Womens health; Thailand; Southeast Asia; Myanmar (Burma); Equity; Plasmodium vivax; Primaquine; Radical cure; G6PD deficiency
• ISSN: 1475-2875; 1475-2875
• DOI: 10.1186/s12936-020-3123-1

The Sustainable Development Goals (SDG) call for increased gender equity and reduction in malaria-related mortality and morbidity. Plasmodium vivax infections in pregnancy are associated with maternal anaemia and increased adverse perinatal outcomes. Providing radical cure for women with 8-aminoquinolines (e.g., primaquine) is hindered by gender-specific complexities.
A symptomatic episode of vivax malaria at 18 weeks of gestation in a primigravid woman was associated with maternal anaemia, a recurrent asymptomatic P. vivax episode, severe intra-uterine growth restriction with no other identifiable cause and induction to reduce the risk of stillbirth. At 5 months postpartum a qualitative glucose-6-phosphate dehydrogenase (G6PD) point-of-care test was normal and radical cure with primaquine was prescribed to the mother. A 33% fractional decrease in haematocrit on day 7 of primaquine led to further testing which showed intermediate phenotypic G6PD activity; the G6PD genotype could not be identified. Her infant daughter was well throughout maternal treatment and found to be heterozygous for Mahidol variant.
Adverse effects of vivax malaria in pregnancy, ineligibility of radical cure for pregnant and postpartum women, and difficulties in diagnosing intermediate levels of G6PD activity multiplied morbidity in this woman. Steps towards meeting the SDG include prevention of malaria in pregnancy, reducing unnecessary exclusion of women from radical cure, and accessible quantitative G6PD screening in P. vivax-endemic settings.