PEDIATRICS Vol. 96 No. 1 July 1995, pp. 117
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WOMEN AND MALARIA—SPECIAL RISK AND APPROPRIATE CONTROL STRATEGY

R. Rueben

The factors that make pregnant women particularly vulnerable to morbidity and mortality with falciparum malaria and their relationship to current control strategies are reviewed. Pregnant women, particularly during their first pregnancy, are at greatest risk of severe falciparum malaria in areas of high and continuous malaria transmission and under conditions of unstable malaria in which they do not develop protective immunity. The author recommends chemoprophylaxis with chloroquine for pregnant women living in holoendemic and hyperendemic areas of Africa and Papua, New Guinea. Chloroquine is safe, but drug resistance has increasingly limited its utility, distribution is a formidable problem. In rural areas where poorly developed health care system are better developed and malaria transmission is less intense, the emphasis should be on early diagnosis and treatment. Women are potentially the key to the implementation of malaria control programs, yet recent studies indicate that underprivileged women frequently do not attend malaria clinics and are often missed in projects with passive surveillance. Additional research and community interventions are needed to enable women with malaria to obtain treatment and to involve them in malaria control measures at the village level.