**3. Complications of malaria**

*P*. *falciparium* causes severe complications as cerebral malaria, severe anaemia, acute renal failure, hypoglycemia and pulmonary infection. The two features that actually separate *P*. *falciparium* from the other human malaria are the ability to attack erythrocytes of all ages, causing high parasitaemia and enhanced growth and the capability to adhere to vascular endothelium through sequestration [2].

*P*. *falciparium* is a threat because of high level of mortality and spreading drug resistance. Cerebral malaria caused by *P*. *falciparium* is when infected blood cells obstruct blood vessels in the brain; other vital organs can also be damaged often leading to death of patient.

Malaria in pregnancy is widespread. Pregnant women are especially vulnerable because of iron deficiency, a special problem in malaria endemic areas .It endangers the health of women and prospects for the new born. Malaria causes anaemia and low birth weight babies. This is due to the loss of previously existing immunity. *P*. *falciparium* infects the Red Blood cells (RBC) that adheres to and accumulates in the placenta in pregnant women. Pregnancy exacerbates malaria through a nonspecific hormone-dependent depression of the Immune system. The protective antiplasmodial activity is suppressed at pregnancy, which has clinical consequences with important public health implications on pregnant women [2]. Malaria accounts for 6.5% of abortions, 15% of premature deliveries and 0.7% death in utero [3].

Malaria infection leads to increased morbidity and mortality and the delivery of premature infants with low birth weights due to intrauterine growth retardation (IUGR) that may have been as a result of placental parasitisation [2]. Malaria infection in pregnancy is significant in sub -Saharan Africa where its fatality as a result of virulent *P. falciparium* is a far greater problem than in most parts of the world [4].

Anaemia is another malaria complication that can lead to death. It occurs when *P*. *falciparium* disrupts the erythrocytes and so decreases the production of erythrocytes. The pathology associated with *P*. *falciparium* malaria is in particular due to adherence of infected red blood cells in the brain causing metabolic disturbances and organ dysfunction [5].

What of the devastating effect on children? Those children who succumb to the infection but survive are often left damaged. Recurrent infections can leave the child listless and with a poor appetite. It reduces social interaction, leading to poor development. Two percent of children who survive the cerebral form of the disease are left with learning difficulties and conditions such as spasticity and epilepsy [4].
