MALARIA IN

PREGNANCY

Objectives

Describe epidemiology of malaria

Describe maternal and fetal complication
Principle of management and preventive
strategies

Global Effect

Affects 300-500 million people yearly

Causes 1 to 2.7 million deaths
90% of deaths occur in Sub -Saharan
Africa

(approximately 3000 deaths each day)

Size of problem in Africa

(WHO 1999)

Population: 564
Annual births: 24.7
Exposed to malaria: 93%
ANC coverage: 63%
Low birth weight: 16%
Malaria attributable fraction to LBW:1250%

Effect of malaria on
pregnancy
Related to Level of transmission and
immunity of individual exposed

In areas of high transmission ,endemic

or stable malaria area.
In areas of low transmission or non
endemic or unstable areas

Maternal complication
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

Anaemia
Multi factorial:affects 50-60% pregnant women in
Sub-Saharan region
Haemolysis
Increased immune clearance of infected and
non infected RBCs
Malarial hyperactive splenomegaly
Nutritional & hookworm infestation
Increased risk in pregnancy to Post -partum
Hemorrhage & Heart failure

Severe malaria

Cerebral malaria: Unrousable coma with

asexual peripheral parsitaemia or
placental infection.
Hypoglycemia
Pulmonary edema (ARDS)
Acute 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

Management and Preventive

Strategies

Early diagnosis and effective treatment

Use of chemo-prophylaxis or
intermittent treatment presumptive
treatment.
Use of insecticide treated bed nets
Regular Antenatal care and health
education about malaria

Early Diagnosis and

Treatment
Use of National treatment guideline for
treatment.
In uncomplicated malaria: Chloroquine,
SP,Mefloquine,Quinine (combination
therapy)
In Severe malaria: Parenteral Quinine,
Artemesinin derivatives and supportive
therapy

Studies on IPT
Results:
A decrease in febrile illness
A decrease in peripheral &placental
parasitemia
A increase in maternal hemoglobin
level
A lower proportion of Low birth weights

Chemoprophylaxis and
Intermittent Presumptive
Treatment

In endemic areas ,use of intermittent

presumptive treatment (IPT):
Target population at Risk
Dosage: SP given in two doses;
1st dose: 16-24 weeks
2rd dose 28 to 36 weeks.
Alternative: Chloroquine Full dose than 2
tablets weekly dose till delivery or proguanil

Use of Insecticide treated

nets

Conclusions

Improve implementation of existing

strategies and health delivery system with
emphasis on integration in existing
services
Improve on Health education to
community on dangers of malaria and
early ,regular ANC attendance.

ANC-4
1.Micro-nutrient supplements
2.Prevention & treatment of infections
Intermittent presumptive treatment: 3 doses of
SP
identification& treatment of STI
3.Anti retroviral treatment
AZT
Neverapine

Care during Labour and

Delivery
1. Good Obstetric practice
2. Ante retroviral drugs
3. Modified Obstetric practice

Delay ARM
ECV
Routine episiotomies
Instrumental deliveries
Traumatic suction of child
Universal precautions.

4. Mode of delivery

Short course anti-retroviral

treatment
Options:
AZT after 36 weeks antepartum,intrapartum
amd post partum with neonatal treatment for
7 days. (%Reduction 50%) at 8weeks
Nevirapine In labour and neonatal treatment
for 48 to 72 hours. (% reduction 47%) at 8
weeks