Treatment of malaria in pregnancy

1

• Treatment of malaria in pregnancy
• 2009

2
The problem of malaria in pregnancy

• Early years of the camps
• Maternal mortality estimated at more
• than 1 of all pregnant women per year
• Maternal mortality rate of 1,000/100,000
• Case management approach
• Nosten Trans. Roy Soc Trop Med Hyg, 199185
  424-429.

3
The problem of malaria in pregnancy?

• For the mother
• Maternal mortality gt 1 of all PW / year
• Cerebral malaria 80 case specific mortality PW
• Severe malaria 3 x (95 CI 1.4-6.2) higher
• For the infant
• LBW Increased neonatal mortality
• Premature birth from maternal fever
• Abortion, stillbirth
• For both mother and infant
• Anaemia

4
Incidence in camps in pregnancy

ITBN 90-92
0
P.falciparum P.vivax
MAS3
3.5
87 96 07 YEAR
5
ANC Malaria Screening

• IN THE CAMPS
• 1) 1st 2 ANC consultations
• 2) Fever or history of fever or symptoms
  suggestive of malaria immediately
• 3) Slept outside the camp in high risk area e.g.
  field, forest, Karen side (NOT Mae Sot) x 2 weeks
• 4) One episode malaria MUST be screened weekly
  until delivery
• OUTSIDE THE CAMPS
• 1) Weekly malaria smears

6
Treatment summary for pregnancy

• 1. Uncomplicated malaria
• 1st trimester 2nd/3rd trimester
• 1st infection PF QC7 AC7
• 2nd infection PF AC7 AC7
• (STAND-BY DHA-PPQ, ARtmalarone, not Coartem)
• 2. Uncomplicated hyperparasitaemia
• AC7 with ART 4 mg/kg 1st dose, then 2 mg/kg
• 3. Severe malaria
• AC7 Start with 2.4 mg/kg IV at 0, 12, 24 hr
  and every 24 hr until patient tolerates oral
  medication.

7

• TREATMENT SUMMARY
• Use combination ACT in pregnancy
• 1st line Rxment 1st trimester quinine plus
  clindamycin
• Choice is limited to clindamycin
• (be aware of colitis explain the patient)
• Use artemisinin when life of the mother is
  threatened
• Prompt fever management all pregnant women