Women and malaria--special risks and appropriate control strategy.

This paper reviews the factors which make non-immune pregnant women particularly vulnerable to falciparum malaria and examines the problems of adequately protecting them in relation to current control strategies. Women are most at risk in areas of high and continuous transmission, particularly during their first pregnancy, and also under conditions of unstable malaria which do not permit immunity to develop. Chemoprophylaxis is recommended for pregnant women in holoendemic and hyperendemic areas in Africa and Papua New Guinea. Chloroquine is safe, but drug resistance problems are beginning to limit its utility. Distribution is a formidable problem in rural areas with a poorly developed health care infrastructure, and research studies reveal widespread ignorance and lack of motivation. In countries in which primary health care systems are fairly well developed, and where malaria transmission is relatively less intense, the emphasis is on early diagnosis and treatment of cases. The assumption is made that women and men have equal access to medical facilities. The preponderance of reported cases among adolescent and adult males in some areas has been attributed solely to the well-known greater occupational risks in some traditionally male activities. Two recent studies, however, suggest that underprivileged women, weighed down by domestic chores, do not readily attend clinics at some distance from home, and therefore are liable to be missed in passive surveillance. It is essential that services within the village should be strengthened, but there are problems in implementation. Lacunae in existing knowledge are discussed.