Special Report: Why Covid-19 Disruption In Malaria Treatment Poses Grave Risk To Pregnant Women In Nigeria

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  • Pregnant Mothers Hard-hit As Pandemic Rages On

By Akanimo Kufre (The New Diplomat’s A/Ibom|C/River Correspondent)

Amid the uncertainties that occasionally come with child-birth, pregnant Magdalene Effiong was hoping to scale the hurdle when she was rushed to a nearby primary health centre on the outskirt of Uyo, Akwa Ibom state capital in Nigeria’s Niger Delta region.

She had suffered heavy bleeding in May 2020 and needed urgent medical attention during the peak of the Covid-19 lockdown. The treatment she required was beyond what the primary health center could offer.

She was immediately referred to a tertiary health facility where the timely intervention of health workers narrowly saved her life, but her baby was not lucky as she had a miscarriage.

Magdalene was diagnosed with acute malaria complications. The staff in-charge of the health center said Magdalene had avoided medical facilities for fear of the Covid-19 stigma. But when her ailment got worse, her husband rushed her to the local clinic where she had registered for antenatal before the outbreak of Covid-19 in February 2020.

Magdalene’s experience proved how malarial infection during pregnancy is a major public health concern in endemic country like Nigeria as it is one of the most common complications during pregnancy, especially in Sub-Saharan Africa. It is an important preventable cause of significant maternal morbidity and mortality with associated fetal and perinatal wastage. Yet the Covid-19 outbreak came with its attendant effects on people’s culture and finances, on the back of an already overburdened and near-comatose healthcare system in the country.

According to the United Nations Development Programme, (UNDP) Sustainable Development Goals on Good Health and Well Being, “before the pandemic, major progress was made in improving the health of millions of people. Significant strides were made in increasing life expectancy and reducing some of the common killers associated with child and maternal mortality. But more efforts are needed to fully eradicate a wide range of diseases and address many different persistent and emerging health issues.”

While speaking on 25th April, 2020 on the occasion of World Malaria Day celebration, the National Ambassador for the Elimination of Malaria in Nigeria, Aliko Dangote encouraged sustenance of the gains in the fight against Malaria in the country.

“This is the reason we must not allow the giant strides made in reducing the burden of malaria in our community and nation at large to slide even in the face of this pandemic.” Dangote said.

The New Diplomat‘s findings showed that some healthcare centers in Uyo reported significant reduction in the number of visits by pregnant mothers between April and August 2020.

The reasons include fear of contracting Covid-19 as health workers were among earlier cases and death recorded. Other reasons include the stigma of being isolated as possible Covid-19 patient once care seekers manifest common symptoms of the contagion like fever and cold which are same as malaria symptoms.

One medical staff at an Uyo health centre, who spoke in confidence said some pregnant women preferred patronizing traditional birth attendant for checks and traditional treatment. She said it’s worrisome to think that some pregnant women believe the traditional birth attendants did not pose Covid-19 threat to them like medical staff in hospitals do. Before now, centuries-old tradition in Africa has led to pregnant women flocking to traditional birth attendants especially in the rural parts, mostly because Africans see them as people with some sorts of mystical powers who can offer prayers and spiritual support as they take on the role of a spiritualist. But it has ended in sad tales for many pregnant mothers.

For city dwellers and educated pregnant moms like Mrs. Deborah Iwang, receiving care for her pregnancy during the Covid-19 lockdown was costly. Some pregnant mothers consulted doctors via phone calls, Zoom, WhatsApp and other social media platforms. To many, getting airtime and data to keep up with medical consultations came as an extra financial burden. Beside, the epileptic power situation in the country forces many to regularly turn to generators to power their phones and other internet gadgets, another luxury for many who had already been stretched to their financial breaking point due to the Covid-19 crisis.

Iwang said she had to patronize a private clinic where she was charged twice the amount she would have spent receiving care at a public health facility near her home.

“It wasn’t really panic for me because it was not my first pregnancy but second. I had to consult with an expensive private clinic near my house as I couldn’t bear the risk of going to the University of Uyo Teaching Hospital (UUTH) where cases of Covid-19 were reported and police had once embarrassed a cab driver meant to pick me to the antenatal clinic.” Iwang said.

Also, in Calabar, capital of Cross River State, a twin state to Akwa Ibom, pregnant women experienced a hard time treating malaria, while the Covid-19 lockdown lasted in the country.

Calabar, which yearly hosts the Africa’s largest street party — the Calabar Carnival had similar interruption and fear among pregnant women visiting hospitals for malaria treatment since the pandemic struck Nigeria in late February.

“Definitely Covid-19 has had effect on malaria as people were unable to seek care during the period. Furthermore, some of the Covid symptoms are similar to malaria and persons who suffered from malaria will be scared of showing up at facilities to take proper care so they won’t be branded Covid-19 patients.

“However, the use of LLITNs (Long-lasting Insecticide-treated Nets) which was already distributed to every house hold in the state was still on and was not affected by COVID.” Commissioner for Health in Cross River State, Dr Betta Edu told The New Diplomat.

Checks by The New Diplomat revealed that during Covid-19 lookdown months, there was no immunization; no new ITNs were received. Though malaria test kits were still available in some of the health centres, in a number of centres the drugs were out of stock with the closure of international borders and logistics challenges.

According to UN, health emergencies such as Covid-19 poses a global risk and have shown the critical need for preparedness.

The UNDP highlighted huge disparities in countries’ abilities to cope with the Covid-19 crisis and recover from it. The pandemic provides a watershed moment for health emergency preparedness and for investment in critical 21st century public services.

A Consultant Obstetrician and Gynaecologist at the University of Uyo Teaching Hospital (UUTH), Dr. Idorenyin Udoh stressed the lack of adequate data collation by relevant authority in Nigeria to properly assess the Covid-19 disruption with respect to WHO prediction on malaria mortality.

However, Dr. Udoh argued that the social impact of Covid-19 on pregnancy was more than clinical impact as the region is already endemic to malaria.

“Malaria is endemic here, meaning Malaria is on ground 24/7, its always there. Covid-19 now came and hamper the logistics and modalities of treatment and malaria prevention. The question is, did it hamper the availability of ITNs, IPTp drugs etc.? It’s obvious because of problem with transportation, again do we have statistics? If we have the number of women that use nets before and now one can evaluate. Yes, because of Covid-19 there is going to be a significant decline in the utilization of ITNs and indirectly affect the number of exposure to mosquito bites. If there’s exposure, it is expected that there will increase or upsurge of people coming down with malaria. By extrapolation, the number of pregnant people that succumb to malaria, were there complications, like problems with miscarriages, preterm labour, low weight birth. Unfortunately, since we don’t have statistics, means of record keeping here it will be difficult to evaluate.” He said.

Dr. Udoh also emphasized the need to have marked cargo vehicles to convey medical supplies, noting that during lockdown, it was difficult to move with popular commercial vehicles who encounter problems with security personnel on return trips.

Concerned with the dangers of losing the strides recorded against malaria in Africa, Thomson Reuters Foundation (TRF) recently selected and trained some African journalists to focus their search light on malaria reporting.

The nearly one-month remote training exposed selected journalists to expert coaching and glaring facts about malaria. The essence of the training was useful in understanding the role of journalist in covering health issues like malaria challenges and new tools to fight the disease.

Also, participants’ understanding of scientific reporting and health statistics including visualizing health data was improved upon.

Participants at the TRF course were lectured on how to maximize the use of social media platforms to effectively boost malaria reporting. The need for a solution-based journalism in the society was also stressed at the training.

The effect of Covid-19 disruption on pregnant women seeking malaria treatment is worrisome but more frightening is the WHO projections on mortality rate if the malaria campaigns are relaxed.

“When all sub-Saharan Africa countries are combined and analyzed under a scenario in which Insecticide Treated Nets (ITN) campaigns are not implemented and continuous distributions and access to effective antimalarial treatment are reduced by up to 75% (worst scenario), the results suggest that by the end of 2020, there could be an estimated 769,000 malaria deaths; of these, approximately 70% would be among children under the age of 5. This would represent a 100% increase in deaths relative to the 2018 baseline estimates,” WHO said in its recent report on malaria mortality in Africa.

The report also revealed that over 12 sub-Saharan countries were estimated to have an increase of more than 100 per cent to 150 per cent of malaria deaths.

Analyzing the seasonality of malaria, out of 42 African countries analyzed in the report, 22 have spikes in malaria cases between August to September, 12 countries have spikes in cases between February to March, while 8 other countries have spikes in other months.

Among the countries that have scheduled Insecticide Treatment Net Campaigns in 2020, the report revealed that Eritrea has the least cases of deaths with 235 deaths while Nigeria has the highest cases of deaths being 193,358.

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