Introduction (1)
Introduction (2)
EPIDEMIOLOGY OF MALARIA
35 countries in the
world reponsible for
98 %
of total malaria deaths
30 in Africa:
Nigeria,DRC,Uganda,Ethiopia,Tanzani
a,KenyaSudan.aniger,Burkinofaso,Gha
na,Mali,Cameroon,Angola,CotedIvoire
,Mozambique,Chand,Guinea
,Zambia,Malawi,Benin,Senegal,Sierra
Leone,Burundi,Togo,Liberia,Rwanda,C
ongo,Central African
Republic,Somalia,Guinea Bissau.
5 in Asia- Pacific:
India,Myanmar,Bangladesh,Indonesia,Pap
ua New Guinea
Africa-highest
mortality
Effects of Malaria on
Pregnant Women
Maternal complications
In Endemic Areas
Malaria-related
anaemia
Febrile illness
Placental
sequestration
In Non-Endemic Areas
Greater risk of severe
disease
Higher risk of death
Anaemia,
hypoglycemia,
pulmonary oedema,
renal failure
Fetal complications
In endemic areas
Low birth weight
Intra-uterine growth
retardation
In non-endemic areas
Abortions
Preterm delivery
Congenital malaria
Low birth weight
Effects on Communities
P.falciparum
falciparum malaria
malaria
P.
Placental infection
infection
Placental
Lowbirth
birth weight
weight
Low
Maternal
Maternal
anemia
anemia
Riskof
of infant
infant mortality
mortality
Risk
STABLE TRANSMISSION
Acquired Immunity-high
Asymptomatic infection
Placenta sequestration
Altered placental Integrity
Maternal
Morbidity
Higher infant
Mortality
WHO 2004
UNSTABLE TRANSMISSION
Acquired Immunity low or
none
Clinical Illness
Severe Disease
Risk to Mother
Risk to Fetus
WHO 2004
Intermittent Preventive
Treatment
1.
Chemoprophylaxis in
Pregnancy
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Chemoprophylaxis in
Pregnancy
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Intermittent Preventive
Treatment: WHO
Recommendation
All pregnant women should receive at least
two doses of IPT after quickening, during
routinely scheduled ANC visits (WHO
recommends a schedule of four visits, three
after quickening)
Presently, the most effective drug for IPT is
sulfadoxine-pyrimethamine (SP)
Women should receive at least two doses of
IPT with SP at ANC visits after quickening,
but no more frequently than monthly
Intermittent Preventive
Treatment: Dose and Timing
tablets of SP
Record SP dose on ANC and clinic card
Advise the woman when to return:
For her next scheduled visit
If she has signs of malaria
If she has other danger signs
Intermittent Preventive
Treatment: Contraindications to
Using
SP
Do NOT
give during first trimester: Be sure
All trimesters:
First line - Chloroquine; Quinine;
Second line - Artesunate / Artemether /
Arteether
Contra indicated:
Primaquine; Tetracycline; Doxycycline;
Halofantrine
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1st trimester
Quinine + Clindamycine
Failure :
- Quinine + Clindamycine
- ACT
- Artesunate + Clindamycine
2nd / 3rd trimester
ACT
Artesunate + Clindamycine
Failure :
Artesunate + Clindamycine
Quinine + Clindamycine
Treatment of Severe
Falciparum Malaria in
Initial : Artesunate
Pregnancy
2,4 mg/kg BW hour 0,12,24-every 24hour
Chloroquine:
600mg (base) start, 300mg after 6 hours, 24 hours & 48 hours
Quinine:
IV - 20mg/kg infusion over 4 hours, repeat 8 hourly.
Artesunate:
Oral-100mg BD on day 1, then 50mg BD for 4-6 days (Total
dose 10mg/kg).
IM / IV-120mg on Day 1 followed by 60mg daily for 4 days. In
severe cases an additional dose of 60mg after 6 hours on Day
1.
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Artemether:
Six amp (480mg) IM in 5 / 3 days. 1x2x1+1x1x4 OR 1x2x3.
Arteether:
One amp (150mg) IM / day for3 consecutive days.
Mefloquine:
15mg / kg body wt., up to 1 Gm in a single dose. OR
Tablets of 250mg, 3 tab start, then 2 tab after 6-8 hours.
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Conclusion