Why is malaria in pregnancy still wreaking havoc in Nigeria when there is a control measure?


Malaria is common in Nigeria and everyone, especially pregnant women, in the country is vulnerable to this disease (1–3). With the numerous effective control measures for malaria in pregnancy (MiP), one of which is the use of sulfadoxine-pyrimethamine (SP) (4,5) popularly known as fansidar, one may wonder why MiP still causes problems in the country. In Nigeria, MiP has a prevalence rate of almost 50%, contributes to about 70.5% morbidity, and 11% mortality among pregnant women. Also, 15% maternal anaemia, between 5-14% low birth weight (LBW), and almost 30% of preventable LBW in the country is attributed to it (6–11). 

The World Health Organisation (WHO) recommends 3 or more doses of intermittent preventive therapy with sulfadoxine-pyrimethamine (IPTp-SP) for all pregnant women in  areas where malaria is very common, like Nigeria. As a preventative treatment, fansidar is given to pregnant women whether they have malaria or not, at monthly intervals from the second trimester until delivery (9,12,13).

The effectiveness of fansidar was first demonstrated in Malawi, and its use in pregnancy has been reported to reduce the new occurrence of LBW by 29%, maternal anaemia by 38%, and neonatal death by up to 61.3% (13–15). Despite adopting this highly effective and worthwhile MiP control strategy in Nigeria for over a decade, completion rate of 3 or more rounds of IPTp-SP by pregnant women remains very low. Poor perception regarding pregnancy and the perceived risk-benefit of fansidar use among pregnant women have been documented as some of the reasons for low drug uptake (9,12,16–23).

Pregnancy is considered to be a natural process not requiring any form of medical intervention by many people in Nigeria (23). While one cannot dispute that pregnancy is a natural process, one may argue that biomedical interventions are needed during this phase of a woman’s life. Also,

some malaria symptoms like high fever and general weakness are regarded as normal pregnancy signs which are not meant to be. This is so unfortunate because it influences pregnant women’s care seeking behaviour for the control of MiP (24). Similarly, some pregnant women do not want to take fansidar because they think it can harm them and their babies. They complain about how the drug weakens them, often associating its use with frequent urination and adverse outcomes like skin reactions, abortions, and foetal abnormalities. Some women consider taking fansidar a waste of time because they do not believe it is effective (12,17,19–22). 

While mild and brief side effects like nausea, vomiting, and dizziness may occur on using fansidar the first time, this drug is generally well tolerated. It is important to note that using fansidar of low quality, purchased from unauthorised drug dealers, can exacerbate these symptoms (5). Pregnant women are therefore advised to only use fansidar given to them in the hospital during antenatal visits, and to report to the hospital immediately if the side effects are severe and unbearable.

I do not dispute the fact that pregnancy is a natural process, but please get checked by a midwife or a doctor when your pregnancy is accompanied by a high fever and general weakness. Please, take fansidar as prescribed by your midwife or doctor to protect yourself and your baby from malaria, as there are numerous proofs that attest to the potency and safety of this tablet (13–15). Although you may experience minimal side effects the first time you take the drug, these symptoms are usually brief and reduce in magnitude with repeated drug use (5). My dear preggies, why should you or your baby suffer in the hands of malaria when a potent and cost-effective control measure is available? 

Patricia Ogba is a 2nd year PhD student in Global Health at McMaster University, Canada


1. Jonathan J, Ivoke N, Aguzie I, Nwani C. Effects of climate change on malaria morbidity and mortality in Taraba State, Nigeria. African Zool. 2018;53(4):119–26. 

2. Oyedeji S. Malaria parasites in Nigeria are genetically diverse: a danger but also a useful tool [Internet]. The Conversation. 2020 [cited 2021 Jul 17]. p. 1–5. Available from: https://theconversation.com/malaria-parasites-in-nigeria-are-genetically-diverse-a-danger-but-also-a-useful-tool-147431

3. Boadu I. The changing climate and the changing malaria, the double health challenge. Indian J Community Med. 2019;2(1):5–9. 

4. Thiam S, Kimotho V, Gatonga P. Why are IPTp coverage targets so elusive in sub-Saharan Africa? A systematic review of health system barriers. Malar J. 2013 Oct 3;12(1). 

5. World Health Organization. Policy brief for the implementation of intermittent preventive treatment of malaria in pregnancy using sulfadoxine–pyrimethamine (IPTp-SP) [Internet]. World Health Organization; 2014 [cited 2021 Jan 15]. Available from: https://www.who.int/malaria/publications/atoz/iptp-sp-updated-policy-brief-24jan2014.pdf?ua=1

6. Adeola A, Okwilagwe E. Acceptance and Utilisation of Sulphadoxine-Pyrimethamine and Insecticide-Treated Nets among Pregnant Women in Oyo State, Nigeria. Malar Res Treat. 2015;2015(713987):1–9. 

7. Dawaki S, Al-Mekhlafi H, Ithoi I, Ibrahim J, Atroosh W, Abdulsalam A, et al. Is Nigeria winning the battle against malaria? Prevalence, risk factors and KAP assessment among Hausa communities in Kano State. Malar J. 2016;15(351):1–14. 

8. Chukwuocha U, Dozie N, Chukwuocha A. Malaria and its burden among pregnant women in parts of the Niger Delta area of Nigeria. Asian Pacific J Reprod. 2012;1(2):147–51. 

9. Adeniran A, Mobolaji-Ojibara M, Adesina K, Aboyeji A, Ijaiya M, Balogun O. Intermittent preventive therapy in pregnancy with sulfadoxine/pyrimethamine for malaria prophylaxis among parturients in Ilorin, Nigeria. J Med Trop. 2018;20(1):30–5. 

10. Igboeli N, Ukwe C, Aguwa C. Effect of antimalarial prophylaxis with sulphadoxine-pyrimethamine on pregnancy outcomes in Nsukka, Nigeria. Malar World J. 2017;8(3):1–5. 

11. Ejembi CL, Dahiru T, Aliyu A. Contextual Factors Influencing Modern Contraceptive Use in Nigeria. Vol. 120, DHS Working Papers. Maryland; 2015. 

12. Nyaaba G, Olaleye A, Obiyan M, Walker O, Anumba D. A socio-ecological approach to understanding the factors influencing the uptake of intermittent preventive treatment of malaria in pregnancy (IPTp) in South-Western Nigeria. PLoS One. 2021;16(3):1–26. 

13. Roman E, Andrejko K, Wolf K, Henry M, Youll S, Florey L, et al. Determinants of uptake of intermittent preventive treatment during pregnancy: a review. Malar J. 2019;18(372):1–9. 

14. Thiam S, Kimotho V, Gatonga P. Why are IPTp coverage targets so elusive in sub-Saharan Africa? A systematic review of health system barriers. Malar J. 2013;12(353):1–7. 

15. Olaleye A, Walker O. Impact of Health Systems on the Implementation of Intermittent Preventive Treatment for Malaria in Pregnancy in Sub-Saharan Africa: A Narrative Synthesis. Trop Med Infect Dis. 2020;5(134):1–15. 

16. Orobaton N, Austin A, Abegunde D, Ibrahim M, Mohammed Z, Abdul-Azeez J, et al. Scaling-up the use of sulfadoxine-pyrimethamine for the preventive treatment of malaria in pregnancy: results and lessons on scalability, costs and programme impact from three local government areas in Sokoto State, Nigeria. Malar J. 2016;15(533):1–24. 

17. Akinleye S, Falade C, Ajayi I. Knowledge and utilization of intermittent preventive treatment for malaria among pregnant women attending antenatal clinics in primary health care centers in rural southwest, Nigeria: a cross-sectional study. BMC Pregnancy Childbirthregnancy childbirth. 2009;9(28):1–9. 

18. World Health Organization. The “World malaria report 2019” at a glance [Internet]. The “World malaria report 2019” at a glance. 2019 [cited 2021 Jan 4]. Available from: https://www.who.int/news-room/feature-stories/detail/world-malaria-report-2019

19. Tobin-West C, Asuquo E. Utilization of Intermittent Preventive Treatment of Malaria by Pregnant Women in Rivers State, Nigeria. Int J Prev Med. 2013;4(1):63–71. 

20. Chukwurah J, Idowu E, Adeneye A, Aina O, Agomo P, Otubanjo A. Knowledge , attitude and practice on malaria prevention and sulfadoxine – pyrimethamine utilisation among pregnant women in Badagry , Lagos State , Nigeria. Malar World J. 2016;7(3):1–6. 

21. Ikpeama C, Ikpeama C, Ikpeama O, Ogwuegbu J. Knowledge, attitude and utilization of intermittent preventive treatment for malaria among pregnant women attending antenatal clinic in Usmanu Danfodiyo University Teaching Hospital (UDUTH) Sokoto. Sokoto J Med Lab Sci. 2017;2(1):65–75. 

22. Hill J, Hoyt J, van Eijk A, D’Mello-Guyett L, Kuile F, Steketee R, et al. Factors Affecting the Delivery, Access, and Use of Interventions to Prevent Malaria in Pregnancy in Sub-Saharan Africa: A Systematic Review and Meta-Analysis. PLoS Med. 2013;10(7):1–23. 

23. Diala C, Pennas T, Marin C, Belay K. Perceptions of intermittent preventive treatment of malaria in pregnancy (IPTp) and barriers to adherence in Nasarawa and Cross River States in Nigeria. Malar J. 2013;12(342):1–16. 

24. Onyeneho N, Idemili-Aronu N, Igwe I, Iremeka F. Perception and attitudes towards preventives of malaria infection during pregnancy in Enugu State, Nigeria. J Heal Popul Nutr. 2015;33(22):1–10. 

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