Aims: Pregnant women are usually excluded from mass drug administration programs due to lack of recommendation for artemisinin-based combination therapy (ACTs) in 1st trimester and because primaquine is contraindicated. However in areas where routine screening is part of antenatal programs data on malaria incidence can support malaria eradication programs.
Methods: Pregnant women enrolled at SMRU antenatal clinics for refugee and migrant population living along the Thailand-Myanmar border have been continuously monitored for malaria by microscopy examination of blood smears from first attendance until pregnancy outcome. Annual changes in falciparum malaria incidence were calculated separately for refugee (1986-2016) and migrant (1998-2016) pregnant women.
Results: 72661 pregnant women were enrolled in antenatal clinics between January 1986 and December 2016. 10785/72661 (14.8%) women had at least one malaria episode in pregnancy.
The incidence of falciparum malaria in the migrant population was 25.2/100 pregnant-woman-year in 1998; from 2008 when expansion of malaria village posts started to 2014 when the malaria elimination program was implemented the incidence dropped to 0.5/100 pregnant-woman-year and was at zero in 2016 when the program was fully operational. The incidence of falciparum malaria in the refugee population followed a very similar trend: it decreased steadily from 46.1 to 22.5/100 pregnant-woman-year between 1986 and 1995, but as soon as ACTs were systematically used in the non-pregnant population living in the camps, the incidence dropped from 22.5/100 to 3.9/100 pregnant-woman-year in 2008 and by 2014 reached zero.
Conclusion: Pregnant women are usually a stable and regular part of the community and antenatal care is a universal practice. In malarious areas active rather than passive screening may take place on a regular basis in pregnant women providing ideal incidence surveillance data on falciparum malaria in the community, despite pregnant women being non-participatory to elimination efforts by the malaria control programs.