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Malaria in Pregnancy in the Solomon Islands: Barriers to Prevention and Control

A study of malaria in pregnancy (MIP) was undertaken in Marovo Lagoon, Solomon Islands, to evaluate pregnancy-specific control strategies for malaria. Peripheral parasitemia was present in 18% (19/106) of women: 15 Plasmodium falciparum and 4 P. vivax. Primigravidae were twice as likely to be parasitemic as multigravidae (31% versus 14%; relative risk: 2.24; 95% confidence interval: 1.01–4.96; P = 0.05). Although ante-natal clinic attendance was high, women booked late (mean, 19.7 weeks) and attended irregularly. Free insecticide-treated nets (ITN) were not distributed despite government policy. Primigravidae were less likely to have an ITN in their homes than multigravidae (relative risk: 2.13; 95% confidence interval: 1.03–4.40). Coverage with chloroquine prophylaxis was low. This study revealed barriers to control of MIP at both the health service and client level. To develop an evidence-based malaria control policy in pregnancy for this region, further study of the epidemiology of malaria and its effects, including social and behavioral aspects, is needed.

Received May 11, 2007. Accepted for publication October 21, 2007.

Acknowledgments: The authors thank community leaders, health service staff, interview assistants, translators, funders, and especially, the participants involved with this study. Dr. T. Eggelte supplied the chloroquine kit, for which we are very grateful.

Financial support: This study was supported by the Australian Centre for International and Tropical Health, the World Bank’s Solomon Island Health Sector Development Project, and Ministry of Health, Solomon Islands.

^* Address correspondence to James S. McCarthy, Queensland Institute of Medical Research, Herston Rd., Herston, QLD 4006, Australia. E-mail: j.mccarthy{at}qimr.edu.au

Authors’ addresses: Bridget Appleyard and James S. McCarthy, Queensland Institute of Medical Research, Herston Rd., Herston, QLD 4006, Australia, Telephone: 61-7-3845-3796, Fax: 61-7-3362-0104, E-mail: j.mccarthy{at}qimr.edu.au. Makiva Tuni, Ministry of Health, PO Box 349, Honiara, Solomon Islands. Joan Bryan, School of Population Health, The University of Queensland, Herston Rd., Herston, QLD 4006, Australia. Qin Cheng and Nanhua Chen, Department of Drug Diagnostics, Australian Amry Malaria Institute, Weary Dunlop Drive, Gallipoli Barracks, Enoggera, QLD 4051, Australia.