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Peter Hotez, M.D, Ph.D.

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Saving 7 Million Pregnancies in Africa

Posted: 03/19/2012 8:30 pm

Globally, an estimated 1,000 women die every day from pregnancy and childbirth complications -- the majority of whom live in sub-Saharan Africa and South Asia. Both of these regions have a disproportionally high burden of diseases known as neglected tropical diseases (NTDs). While NTDs affect men, women, and children, one NTD in particular, hookworm, has devastating effects for pregnant women.

Hookworm is an intestinal parasitic infection causes severe blood loss, anemia, and malnutrition. These effects are particularly harmful to pregnant women and their unborn children: long-term blood loss from hookworms increases a mother's risk of dying during childbirth. While hemorrhaging during pregnancy is not uncommon, African women are more likely to die from it because they are severely anemic even before they begin labor. Hemorrhage accounts for roughly one third of the pregnancy-related deaths in Africa.

We're only beginning to understand the full extent of the relationship between hookworm and pregnancy complications in Africa. In a recent analysis published in the Public Library of Science, my colleagues and I conducted a systematic review to estimate the number of hookworm infections in pregnant women living in sub-Saharan Africa.

Our analysis revealed an enormous yet previously hidden burden of the disease: in total, almost 40 million African women of reproductive age are infected with hookworms, and 7 million of these women are pregnant. We also confirmed a clear link between the presence of hookworms in the intestines of these pregnant women and the occurrence of anemia.

Fortunately, we can treat African women and others for hookworm and help to prevent anemia through donated pills from pharmaceutical companies such as GlaxoSmithKline and Johnson & Johnson. These medicines, known as albendazole and mebendazole, can remove hookworms from the intestines long enough for a woman to recover her blood counts and begin labor with corrected or partially corrected anemia. Several studies now confirm the beneficial impact of deworming on reducing maternal morbidity and mortality, as well as improving neonatal birth weights and overall birth outcomes.

Because these pills are donated, the only real expense is transportation and delivery, reducing treatment costs to just a few cents per person per year. This treatment program for hookworm is part of a larger integrated effort to control, and in some cases actually eliminate, other NTDs, such as trachoma, elephantiasis, and river blindness, that disproportionately affect women and girls in developing countries. Integrating the control and/or elimination of the seven most common NTDs in Africa costs around 50 cents per person annually.

Current hookworm treatments are often effective in the short term, but due to elevated re-infection rates in highly endemic regions, a preventive vaccine is the best long-term solution. Through support from the Bill & Melinda Gates Foundation as well as the Dutch Ministry of Foreign Affairs, and in collaboration with FIOCRUZ BioManguinhos, we are developing the first human hookworm vaccine. Clinical trials of this experimental vaccine began this January in Brazil.

Deworming programs and a new hookworm vaccine represent exciting new approaches to improve the lives and health of the poorest women in Africa and other developing countries. They represent a major step in providing a generation of safer pregnancies free of hookworm!

To learn more about how to get involved in the work to end hookworm, please visit www.END7.org. Together we can see the end of these diseases of poverty.