Parasites in Pregnancy Debated at Symposium

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Concern about parasitical diseases and pregnant women affected by them was the focus of the Parasites in Pregnancy Symposium hosted by the Discipline of Public Health Medicine at UKZN’s Nelson R Mandela School of Medicine.

The Symposium, funded by the Southern African-Nordic Centre (SANORD) sought to bring attention to the burden and impact of various parasitic diseases affecting countries all over the African continent, but more importantly it shed light on how little information and awareness of parasitic diseases exist in South Africa.

Soil-transmitted helminths, a term used to refer to worm-like organisms which live in and feed off living hosts, are the cause of many parasitic diseases in Africa, usually contracted through contaminated water, food, soil and mosquito bites.  Poorly washed plants, vegetables and undercooked meat which contain the eggs of nematodes are also causes of parasitic infections and diseases.

Ms Tsakani Furumele of the National Department of Health provided an overview of the burden of parasites in South Africa, explaining that parasitic diseases are an increased threat to human health welfare in underdeveloped areas of South Africa.

‘Malaria, which occurs in the lowveld areas, is now a cause of morbidity and mortality over the last 10 years.  We’ve had to sharpen our strategies, since the problem areas were mainly in Limpopo, Mpumalanga and KwaZulu-Natal. These areas have now been categorised as moderate risk areas,’ said Furumele.

Schistosomiasis, also known as bilharzia, is a disease caused by parasitic worms. ‘In South Africa, 4.7 million people are infected with bilharzia,’ said Furumele.

Soil transmitted helminths (STHs), hookworms and roundworms aggravated malnutrition and impeded growth and development. ‘Four and a half billion people are at risk of STH. Species of STH are found among schoolchildren and individuals attending Public Health Facilities. It was found in a recent study that 51% of 268 school children in KwaZulu-Natal had STH and at least 75% of school aged children needed to be treated for Schisto. There is a need for regular treatment of school going children for STH infections and bilharzias.’

Furumele said the only statutory parasite control programme in South Africa was for malaria. ‘It is notifiable, but schistosomiasis isn’t. There is poor surveillance of parasitic diseases. There is a lack of political commitment. The burden of parasitic diseases is under-estimated or unknown.’

Professor Ayola Adegnika of Gabon spoke about the Global burden of Parasites in Pregnancy in West Central Africa and East Africa. He said that while pregnancy results in major hormonal and nutritional change, ‘there are certain aspects of a parasitic disease that can cause great harm to a foetus. Parasites with higher risk infection like malaria and toxoplasmosis can result in abortion or serious consequences after birth. Geographically, 23 million are in high transmission areas of Africa (West, Central and East Africa) where there is heavy torrential rain for malaria to be prevalent.

‘Three to 15 percent of mothers are severely anaemic, with up to 10 000 malaria anaemia related deaths. Malaria infections contribute to bad pregnancy outcomes. For the foetus, there is a high chance of spontaneous abortion, prematurity, miscarriage and congenital infection,’ said Adegnika. ‘If the baby is born, there is risk of low birth weight, anaemia, risk of malaria infection at an early age and death. Malaria associated pregnancy is a public health problem. The symptoms and complications depend on geographical areas. If malaria is prevalent, it can affect any pregnant women.’

Adegnika said morbidity was caused by anaemia and malnutrition. ‘This affects those of a young age, from a low socio-economic standing and low education levels. The geographical distribution of helminths is just like malaria. Pregnant women have a higher risk of being infected by helminths while those pregnant with HIV and helminths, experience CD4 count decreases. Treatment is seen to increase the CD4 count. Having helminths can increase the chances of HIV being transferred to the child seven fold. Yet, while malaria is intensely reported, there is a scarcity of data regarding helminths.’

Dr Mwele-Ntuli Malecela of Tanzania said ‘the poorest of the poor are affected by these parasitic diseases. The government and policy makers are not getting to the issues of how these diseases affect people, therefore making this an area of advocacy.’

Malecela explained that placental malaria parasites accumulate and thrive in the placenta of pregnant women making them highly susceptible since there is no pre-existing immunity. ‘A lot of the time, there are people living in areas with little or no access to clean water. In certain areas of Tanzania, there are zones with four diseases or more that people can contract. If there is better sanitation, the prevalence of these diseases can be decreased, along with a sanitation intervention to control helminths.’

-           Zakia Jeewa