Pregnant Women: An Overlooked Asset to Plasmodium falciparum Malaria Elimination Campaigns?

Community chemotherapy campaigns to reduce malaria transmission often exclude pregnant women due to safety concerns related to the drugs. However, pregnant women might represent an important source of human-to-mosquito infection due to frequent parasite carriage with higher densities of parasites (often detectable by microscopy), attractiveness to mosquitoes, and modified sleeping behaviour. Accumulating evidence of the safety of artemisinin-based combination therapies for the treatment of malaria during gestation suggests that malaria elimination programmes should reconsider this exclusion. Including pregnant women will increase intervention coverage and impact, and may thereby accelerate progress towards the desired endpoint (e.g., elimination) or increase the chances of success. Studies assessing infectiousness of pregnant women and gametocyte dynamics during different trimesters of pregnancy will be valuable to support the planning of community treatment campaigns.