Time to Act; Let Us Unite to Eliminate Malaria Among Pregnant Women in War Zone From Eastern Democratic Republic of the Congo: A Review

Background: Malaria remains a major public health challenge in sub-Saharan Africa, with the Democratic Republic of the Congo (DR Congo) contributing substantially to the global burden. DR Congo accounts for 12% of global malaria cases. This study aims to assess the intersectionality of epidemiological, immunological, and conflict-related factors increasing malaria severity and proposes targeted interventions. Methods: A narrative, non-systematic literature review was conducted using peer-reviewed articles, policy documents, and international health guidelines published between 2007 and 2025. The search focused on keywords including "malaria," "pregnancy," "conflict areas," and "intermittent preventive treatment." Sources were identified through databases including PubMed, Google Scholar, Scopus, and Web of Science, as well as reports from the World Health Organization, national malaria control programs, and humanitarian agencies. Findings were thematically synthesized. Results: Findings indicate Malaria in pregnancy (MiP) prevalence rates between 17% and 40%, with a significant 26% asymptomatic pooled estimate creating silent transmission reservoirs. Research shows early-stage parasitemia is linked to reduced umbilical artery resistance and fetal growth restriction. Armed conflict has decimated infrastructure, leading to critical shortages of insecticide-treated nets and intermittent preventive treatment. While innovations like the R21/Matrix-M vaccine and genomic surveillance offer hope, implementation is hindered by fragmented coordination, funding gaps, and emerging artemisinin resistance. Conclusion: Eliminating MiP in conflict zones requires a concerted effort to strengthen the six pillars of the health system: service delivery, workforce, information, medical products, financing, and governance. Immediate action is required to address stockouts, improve healthcare worker training, and ensure clear, context-specific policies. Sustained global funding, stronger national commitment, and the integration of mobile clinics with community-led engagement will bring success.