Malaria in pregnancy in the Solomon islands: barriers to prevention and control.

A study of malaria in pregnancy (MIP) was undertaken in Marovo Lagoon, Solomon Islands, to evaluate pregnancy-specific control strategies for malaria. Peripheral parasitemia was present in 18% (19/106) of women: 15 Plasmodium falciparum and 4 P. vivax. Primigravidae were twice as likely to be parasitemic as multigravidae (31% versus 14%; relative risk: 2.24; 95% confidence interval: 1.01-4.96; P = 0.05). Although ante-natal clinic attendance was high, women booked late (mean, 19.7 weeks) and attended irregularly. Free insecticide-treated nets (ITN) were not distributed despite government policy. Primigravidae were less likely to have an ITN in their homes than multigravidae (relative risk: 2.13; 95% confidence interval: 1.03-4.40). Coverage with chloroquine prophylaxis was low. This study revealed barriers to control of MIP at both the health service and client level. To develop an evidence-based malaria control policy in pregnancy for this region, further study of the epidemiology of malaria and its effects, including social and behavioral aspects, is needed.