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A new study shows malaria’s often neglected toll on a vulnerable population: Pregnant women

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Malaria kills hundreds of thousands of people every year, especially young children. It’s also exceptionally dangerous to another at-risk group: pregnant women.

Researchers have estimated that 10 to 20 percent of maternal mortality in countries where malaria is endemic is malaria-related. That’s almost 30,000 women every year. Pregnancy loss, and long-term disability caused by exposure to malaria in utero, are even more common. And many drugs that are used to save people dying of malaria are not safe to use during pregnancy, or are not widely used even though they are safe.

A new study published in The Lancet: Child and Adolescent Health offers a comprehensive account of just how much this deadly disease affects pregnant women — and suggests that changing treatment options could significantly improve the situation.

Malaria’s effects on pregnancy, explained

Malaria is caused by parasites that are transmitted to people from mosquito bites. Last year, there were more than 200 million cases of malaria, and at least 400,000 deaths, mostly among young children. It is still one of the world’s deadliest killers.

The good news is that public health efforts have made a big difference in reducing malaria deaths: Insecticide-treated bednets and seasonal preventative malaria treatment both have a strong, well-supported track record, and have saved hundreds of thousands of lives. Addressing malaria is one of the world’s most cost-effective giving opportunities, and one we’ve often recommended here at Vox.

But the official numbers may underestimate malaria’s toll, because they mostly do not include stillbirths, neonatal deaths from low birth weight, and late-term pregnancy loss. Malaria causes all of these problems, the Lancet study argues.

“[Malaria] infection at delivery is associated with some 200,000 stillbirths per year in sub-Saharan Africa,” the paper says. It adds, “Up to 100,000 infant deaths each year are attributable to low birthweight caused by maternal infection with P falciparum during pregnancy in Africa.”

Malaria during pregnancy is overwhelmingly common in parts of Africa where malaria is endemic: One modeling study estimates that in 2010, 40 percent “of women in malaria endemic areas in Africa in 2010 had placental malaria at some stage during pregnancy.” That’s an astonishingly large number.

And while most people who live in malaria-endemic areas have acquired immunity to malaria by the time they are adults, this immunity doesn’t fully transfer to the fetus. The result is that when women contract malaria while pregnant, they face a significantly elevated risk of miscarriage (which, the paper notes, in low-income countries is often defined as any pregnancy loss before 28 weeks, well past the cutoff to be considered a stillbirth in high-income countries) and an elevated risk of stillbirth or neonatal death due to preterm birth or low birth weight.

The complications of treating pregnant women for malaria

There are a lot of difficulties in delivering good malarial treatments to pregnant women. Many of the infections that cause miscarriages, stillbirths, low birth weight, and premature birth are asymptomatic; it can be hard to persuade people to take medications they don’t notice they need when they don’t feel sick, especially when the medications have substantial side effects. Additionally, most malaria-endemic areas are very low-income and don’t have adequate prenatal care of any kind.

But there is reason to prioritize malaria treatments for pregnant women, despite these complications. Pregnancy loss is devastating, and preventing it is an important public health priority. When babies are born prematurely or with low birth weight, they’re at a much-elevated risk of death and lifelong problems, which can be solved by protecting their mothers from malaria. And we’re learning more about which treatments are effective.

In malaria-affected areas, the World Health Organization (WHO) recommends chemoprophylaxis — taking antimalarial drugs while healthy to avoid becoming sick — for pregnant women.

However, the paper argues, the existing recommendations have some problems. First, they aren’t widely adhered to: In many at-risk areas, women don’t have access to the drugs. Second, the drugs might interfere with fetal development if taken in the first trimester, so they don’t provide full coverage throughout pregnancy. Even worse, resistance to the drugs is developing among malaria parasites.

Overall, the paper argues, “Intermittent preventive treatment of malaria in pregnancy with sulfadoxine–pyrimethamine is not providing the expected reduction in the risk of malaria infection and the subsequent impact of malaria, despite efforts to improve uptake of this strategy.” In other words, giving pregnant women occasional doses of the standard antimalarial just isn’t getting the job done.

There are other drug regimens that might work better. In particular, the WHO has not historically recommended artemisinin-based combination therapies for women to take throughout pregnancy. (Those are a different, more effective set of antimalarial drugs.) This, the paper argues, is a mistake; at first we didn’t know if those drugs caused any pregnancy complications, but recent research suggests those drugs are safe even in the first trimester and last longer in the body, making it less likely that people will catch malaria during gaps in coverage once the drugs wear off.

Such therapies, the paper argues, “should be recommended for pregnant women in the first trimester without further delay.”

The headline numbers for malaria — hundreds of thousands of children dead every year — are bad enough. It’s sobering to realize that in many ways, those numbers don’t capture the scale of the losses, because they don’t count hundreds of thousands more children who are stillborn or die because of low birth weight or premature birth that is ultimately attributable to malaria.


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‘Ignition of new war:’ Sudan political parties reject Israel deal

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Sudanese political parties have rejected the government’s decision to normalise relations with Israel, with officials saying they will form an opposition front against the agreement.

Dozens of Sudanese people demonstrated in the capital Khartoum on Friday following the joint statement from Israel, Sudan and the United States on Friday saying that the two countries agreed to “end the state of belligerence between their nations”.

A statement from Sudan’s Popular Congress Party, the second most prominent component of the Forces of Freedom and Change (FFC) political coalition, said Sudanese people are not obligated to accept the normalisation deal.

“We see that our people, who are being systematically isolated and marginalised from secret deals, are not bound by the normalisation agreement,” the statement said.

“Our people will abide by their historical positions and work through a broad front to resist normalisation and maintain our support for the Palestinian people in order for them to obtain all their legitimate rights.”

Sudan’s former Prime Minister Sadiq al-Mahdi also slammed the announcement, adding that he withdrew from a government-organised religious conference on Saturday in Khartoum in protest.

Al-Mahdi, who is the country’s last democratically elected premier and heads the country’s largest political party, said: “This statement contradicts the Sudanese national law … and contributes to the elimination of the peace project in the Middle East and to preparing for the ignition of a new war.”

Kamal Omar, a leader in the Popular Congress Party, said in a separate statement that Sudan’s transitional government is not elected and therefore not authorised to normalise relations with Israel.

“This transitional government hijacked the Sudanese position to satisfy regional and international intelligence agencies,” he said.

Protesters in Khartoum took to the streets and chanted “no peace, no negotiation, no reconciliation with the occupying entity” and “we will not surrender, we will always stand with Palestine”.

Muhammad Wadaa, a leader in the Sudanese Baath Party, which is part of the FFC, said the anti-normalisation front includes a civil force and influential parties from within and outside the forces of freedom and change.

Wadaa said there are a number of parties within the FFC that warned the transitional government they will withdraw their support if normalisation with Israel was agreed to.

“Normalisation with Israel is a move that is rejected. The government is not authorised to take such a decision with a racist state that practises religious discrimination,” he said.

Wadaa told Al Jazeera that “the government made a big mistake and it is a step that will not achieve economic abundance”.

Palestinian officials reacted with dismay as Sudan became the third country to normalise relations recently, after the United Arab Emirates and Bahrain.

Palestinian Authority (PA) President Mahmoud Abbas denounced the deal and said the only path towards peace is by resorting to international law to make Israel end its occupation of Palestinian territories.

However, according to Al Jazeera’s Nida Ibrahim, many Palestinians believe the PA does not have much to offer other than condemnation.

“For many political analysts here, Palestinians have their backs against the wall and really don’t have much to hope for, other than Trump would not get a second term in office,” she said, speaking from the occupied West Bank city of Ramallah.

“Many Palestinians on social media say the Sudanese people’s hearts are with the Palestinian people but they were dragged into this by their military rulers.”

On Saturday, Iran’s foreign ministry slammed Sudan’s move, saying: “Pay enough ransom, close your eyes on the crimes against Palestinians, then you’ll be taken off the so-called ‘terrorism’ blacklist.”

“Obviously the list is as phoney as the US fight against terrorism. Shameful!” it added.

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EU border agency ‘involved in illegal pushbacks’ of migrant boats

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Media investigation reveals ‘senior Frontex officials know about illegal practices by Greek border guards’.

Europe’s border security agency Frontex has been involved in several illegal “pushbacks” of migrants and refugees crossing the Aegean Sea from Turkey to Greece, a media investigation has revealed.

The investigation shows “senior Frontex officials know about illegal practices by Greek border guards – and that some of them are themselves implicated in pushbacks”, Germany’s Der Spiegel said on its website.

Also known as refoulements, “pushbacks” are incidents where refugees or migrants are illegally returned across a border to a country where they could face persecution.

Journalists say they have uncovered six cases since April when Frontex units did nothing to stop refugee boats in Greek waters being returned towards Turkey.

A video from a June incident shows a Frontex boat blocking one with refugees on it. A later shot from the same encounter shows it racing across the bow of the boat before leaving the area.

German public broadcaster ARD, journalist collective Lighthouse Reports, investigative platform Bellingcat and Japanese broadcaster TV Asahi were involved in the investigation alongside Der Spiegel.

The journalists say they compared “dozens” of videos, also checking satellite imagery and eyewitness accounts from refugees, migrants and Frontex workers.

Der Spiegel reported that more than 600 people from the European border agency equipped with boats, drones and aircraft are deployed in Greece, where many migrants first enter the European Union.

It added that Frontex would not comment on the individual cases uncovered by the investigation, but referred to a human rights and non-refoulement code of conduct supposed to bind staff.

On Friday, it posted on Twitter that its actions in support of Greek authorities were “in full respect of fundamental rights and international law”, adding that it “has been in contact with the Greek authorities about some incidents at sea in recent months”.

Athens had launched an “internal inquiry”, it added.

Greece’s conservative government has always rejected claims of illegal pushbacks taking place at its borders, regularly alleged by several charities.

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NASA probe leaking asteroid samples due to jammed door

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Images beamed back to ground control revealed it caught more material than scientists anticipated and was spewing excess of flaky asteroid rocks into space.

A US probe that collected a sample from an asteroid earlier this week retrieved so much material that a rock is wedged in the container door, allowing rocks to spill back out into space.

On Tuesday, the robotic arm of the probe, OSIRIS-REx, kicked up a debris cloud of rocks on Bennu, a skyscraper-sized asteroid some 320 million kilometres (200 million miles) from Earth and trapped the material in a collection device for the return to Earth.

But images of the spacecraft’s collection head beamed back to ground control revealed it had caught more material than scientists anticipated and was spewing an excess of flaky asteroid rocks into space.

The leakage had the OSIRIS-REx mission team scrambling to stow the collection device to prevent additional spillage.

“Time is of the essence,” Thomas Zurbuchen, NASA’s associate administrator for science, told reporters on Friday.

Zurbuchen said mission teams will skip their chance to measure how much material they collected as originally planned and proceed to the stow phase, a fragile process of tucking the sample collection container in a safe position within the spacecraft without jostling out more valuable material.

NASA will not know how much material it collected until the sample capsule returns in 2023.

The troubleshooting also led mission leaders to forgo any more chances of redoing a collection attempt and instead commit to begin next March the spacecraft’s return to Earth.

“Quite honestly, we could not have performed a better collection experiment,” OSIRIS-REx’s principal investigator Dante Lauretta said.

But with the door lodged open by a rock and the “concerning” images of sample spillage, “we’re almost the victim of our own success here”, he added.

The roughly $800m, minivan-sized OSIRIS-REx spacecraft, built by Lockheed Martin, launched in 2016 to grab and return the first US sample of pristine asteroid materials.

Asteroids are among the leftover debris from the solar system’s formation some 4.5 billion years ago.

A sample could hold clues to the origins of life on Earth, scientists say.

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