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
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