Intervention 4: Malaria Prevention and IPTp
Malaria Prevention
Malaria in pregnancy has adverse effects both on the mother and on the unborn child. An integrated approach is needed for malaria prevention and prompt case management of pregnant women with fever and malarial illness. Antenatal clinics can easily provide preventive measures, prophylaxis, treatment and counselling and these should be integrated with maternal and child health interventions. Additionally, widespread distribution and use of LLINs is a cost-effective and highly successful intervention that reduces malaria and save lives.
7-11 programming will seek to achieve universal coverage of LLINs, including information regarding installation, care and use. Programming also promotes appropriate intermittent preventive treatment through ANC visits (at least two doses in sub-Saharan Africa), and increases awareness as to the importance of prompt care-seeking for fever during pregnancy in malarial areas. It also promotes appropriate treatments with artemisinin-based combination therapy (ACT) in the second and third trimesters, following national guidelines. Additional programming might include facilitating the ‘malaria competency approach’ (or community systems strengthening [CSS]) to promote community ownership of the response to malaria.
Definitions:
- Malaria is caused by a paraside called Plasmodium, which is transmitted via the bites of infected mosquitoes. In the human body, the parasites multiply in the liver, and then infect red blood cells.
Target Behaviours/Results:
- Pregnant woman attends antenatal care and receives Intermittent Preventative Treatment in pregnancy(IPTp) per national protocols
- Pregnant women is tested immediately for malaria is she has a high fever in an endemic area
- Pregnant woman seeks treatment for malaria, and is treated with Artemisinie based combination therapies(ACTs)
- Pregnant women sleep under Long Lasting Insecticide Treated Net(LLIN) every night
Questions:
What causes malaria?
Malaria is caused by a parasite called Plasmodium, which is transmitted through the bites of infected mosquitos. In the human body, the parasites multiply in the liver, and then infect the blood.
What are the symptoms of malaria?
Symptoms of malaria include fever, headache, and vomiting. These symptoms usually appear between 10 and 15 days after the mosquito bite. If not treated, malaria can quickly become life-threatening by disrupting the blood supply to vital organs. Pregnant women are at higher risk of dying from the complications of severe malaria.
What are the possible consequences of malaria in pregnant women? Why are we especially concerned about malaria in pregnant women?
Malaria can lead to maternal anemia, fetal loss, premature delivery, intrauterine growth retardation and low birth weight babies.
How can we prevent the transmission of malaria?
There are several ways to prevent the transmission of malaria: use of insecticide-treated mosquito nets(ITNs or Long Lasting ITNs), indoor spraying, prevention in pregnancy with LLINs(long lasting ITNs) and intermittent preventive treatment in pregnancy(IPTp).
What are the recommendations for treatment of malaria during pregnancy?
The goal of malaria treatment in pregnancy is to completely eliminate the infection because any amount of parasites in the blood can affect the mother, and can also affect the unborn baby. Not all malaria drugs are safe for pregnant women. The names of the drugs considered safe in the first trimester of pregnancy are quinine, chloroquine, proguanil and Pyrimethamine. Clindamycin is also safe, but must be used in combination with another drug, preferably.
What is Intermittent Preventive Treatment in pregnancy?(IPTp)
Intermittent preventive treatment in pregnancy means treating pregnant women for malaria even if they don’t have malaria now. It is prevention! The abbreviation is IPTp. IPTp is recommended in some countries but not in others. It is important to know the Ministry of Health policy for IPTp in your country. In countries where IPTp is recommended, two doses of IPTp should be given after 16 weeks of pregnancy. The two doses should be given one month apart. All pregnant women in these countries should receive these doses, even if they don’t have symptoms of malaria.
Are the recommendations different for a HIV+ pregnant woman?
Yes, if the HIV+ pregnant woman is already receiving co-trimoxazole prophylaxis, then she should not receive IPTp.
What if a pregnant woman only goes for ANC late in her pregnancy and there is not time to giver her two doses?
For these women, even one dose of IPTp is beneficial. The last dose of IPT-SP can be administered up to the time of delivery, without safety concerns.
How should IPTp doses be given?
IPTp should ideally be given as "directly observed therapy"(DOT). This means that somebody must watch the woman taking her dose, to make sure that she takes it!
When should IPTp NOT be given?
IPTp should not be given during the first trimester of pregnancy.