Postpartum severe malaria in Tanzania; outcomes of gaps in antenatal screening and prevention: A Case Report

Background: Malaria in pregnancy exposes both the woman and the foetus to a high risk of morbidity and mortality. Good antenatal care services can prevent malaria in pregnancy, but inappropriate ones like late booking and incomplete uptake of malaria preventive interventions, such as Intermittent Preventive Treatment for malaria in pregnancy with sulphadoxine–pyrimethamine (IPTp-SP), are common in many countries with ongoing efforts to prevent malaria in pregnancy and increase the risk of severe infection. Most infections may be asymptomatic during pregnancy and only become symptomatic after delivery when they pose a life-threatening risk. 
Case presentation: A 22-year-old woman was admitted two days after giving birth presenting with fever, jaundice, haemodynamic instability, heavy parasitaemia (850 trophozoites per 200 white blood cells), and pancytopaenia. She had attended antenatal care only once at 31 weeks of gestation and had received a single dose of IPTp-SP prophylaxis for malaria. She was managed with intravenous artesunate, broad-spectrum antibiotics, and blood transfusion. The patient was treatment-responsive with parasite clearance, and clinical symptoms as well as haematological recovery were achieved within seven days of treatment. She remained symptom-free during the follow-up period.
Conclusion: The antenatal malarial preventive measures which include antenatal screening and intake of Intermittent Preventive Treatment for malaria in pregnancy with sulphadoxine–pyrimethamine (IPTp-SP), must be strengthened to avert severe postpartum malaria and its associated maternal and perinatal morbidity and mortality.