Friday, September 24, 2010

Want To Know Why Pregnant Women Are Vulnerable To Malaria Infection?


“The Emergency Disease is a Case for Concern in African Countries”
 
VOL:1 ISSN:25 For the benefit of our readers, we are serialising the various presentations that were delivered by different presenters at the recently concluded one-day orientation of media personnel on Malaria Control and Prevention, organised by the National Malaria Control Programme (NMCP), at the NMCP/CIAM Conference Hall in Kanifing.

In this edition, I bring you a presentation on Malaria in Pregnancy, by the Programme Officer for Malaria in Pregnancy, Mrs. Olimatou Colley.


Why are pregnant women vulnerable to malaria infection?
Certain physiological changes during pregnancy reduced immunity; the placenta offers an advantageous location for adhering (sequestration) of parasites; many infected women present with zero peripheral parasitaemia (asymptomatic) and significant placenta load; and the sequestration of parasites in the placenta impede oxygen-nutrient transfer and cause intrauterine growth retardation.

Consequences of malaria in pregnancy

For pregnant women, she said malaria in pregnancy causes febrile illness, cerebral malaria, hypoglycaemia, anaemia, and maternal death.

For the feotus, it causes abortion, stillbirth and congenital infection, while the newborn experiences low birth weight from 8-14 per cent, prematurely from 8-36 per cent, IUGR 13-70 per cent and infant death.

Intervention Strategies for malaria in pregnancy

In order to reduce the adverse consequences of malaria during pregnancy, the World Health Organisation (WHO) recommends a three-pronged approach i.e. insecticide-treated bed nets, appropriate case management and intermittent preventive treatment in pregnancy (IPTp).

Intermittent preventive Treatment (IPTp)

ITPp is developed by WHO to replace chemoprophylaxis through the use of an effective drug by Directly Observe Treatment (DOT) and is based on the use of anti-malaria drugs given in treatment doses at predetermined intervals after quickening (16 weeks).

Note: IPT is not an alternative to active treatment of clinical malaria.

Benefits of IPT

The benefit of IPT for the mother is that it reduces burden of malaria complications; as well as reduces incidence of Anaemia during pregnancy.

For the baby, it reduces low birth weight; reduces IUGR and prematurity, while the health system benefits from a reduction of the workload on staff; reduces drug consumption and improve quality care.

IPT: Dose and Timing

All pregnant women should receive at least two doses of IPT after quickening, during routinely scheduled ANC visits. Presently, the most effective drug for IPT is Sulphadoxine-pyrimethamine (SP).

A single dose is three tablets of Sulphadoxine 500 mg plus pyrimethamine 25 mg. The interval between the first and second dose should be at least four weeks, and healthcare provider should dispense dose and directly observe client taking dose (DOT strategy).

IPT: Contradiction to using SP

Do not give during first trimester (before 16 weeks); the second dose should not be administered after 34 weeks; do not give to women with reported allergy to SP or other sulfa containing drugs e.g. co-trimoxazole; and do not give SP more frequently than monthly.

Achievements

The achievements include, a decline in malaria morbidity, high political commitment, IPT information now included in the HMIS, IPT guidelines available in all health facilities, increase capacity building of health workers, high acceptance of IPT, no stock out of SP, and high awareness of malaria control and prevention during pregnancy.

Challenges

Low uptake of the second dose of SP, late booking and irregular ante natal clinic attendance, reluctance to take fansidar by pregnant women, inadequate knowledge on the consequences malaria during pregnancy and benefits of ANC, inadequate skilled manpower and limited male participation in malaria prevention and control activities.

Way Forward

Increase advocacy for adequate skilled health workers, increase IEC/BCC at community level as well as advocate for active male participation on malaria prevention and control.

In our next edition on Health Concern, we are looking forward to bringing you the final presentation in this malaria series.

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