Intermittent preventive treatment for malaria in pregnancy in Africa: What's new, what's needed?

Abstract

Falciparum malaria is an important cause of maternal, perinatal and neonatal morbidity in high transmission settings in Sub-Saharan Africa. Intermittent preventive treatment with sulphadoxinepyrimethamine (SP-IPT) has proven efficacious in reducing the burden of pregnancy-associated malaria but increasing levels of parasite resistance mean that the benefits of national SP-IPT programmes may soon be seriously undermined in much of the region. Hence, there is an urgent need to develop alternative drug regimens for IPT in pregnancy. This paper reviews published safety and efficacy data on various antimalarials and proposes several candidate combination regimens for assessment in phase II/III clinical trials.

Burden of Placental Malaria among Pregnant Women Who Use or Do Not Use Intermittent Preventive Treatment at Mulago Hospital, Kampala

“…It therefore appears that a similar phenomenon occurs with SP-IPTp where the drug complements naturally acquired antimalarial immunity in order to register a beneficial clinical outcome. While various schools of thought have argued for and against the continued use of SP-IPTp [17, 41, 42], the present findings lend support for its continued use. Moreover, confidence in this position may be further assured when SP is used according to the revised guidelines advocating for more frequent dosing of SP [16].…”

Plasmodium falciparummalaria in pregnancy: Prevalence of peripheral parasitaemia, anaemia and malaria care-seeking behaviour among pregnant women attending two antenatal clinics in Edo State, Nigeria

“…Early detection, and prompt and accurate treatment are essential prerequisites for reducing the incidence of death, and should also be cardinal components of antimalarial intervention in endemic countries (WHO 2000;Uddenfeldt et al 2007;Vallely et al 2007). Although a majority of respondents in the present study said that they sought treatment at a healthcare facility (hospital/clinic), there were significant delays in seeking appropriate antimalarial care for over half of them.…”

“…In sub-Saharan Africa, over 50 million women living in malaria endemic areas become pregnant each year (WHO 2004;Menendez et al 2007;ter Kuile et al 2007). Although malaria in pregnancy can be asymptomatic, due to the fact that mothers living in areas with stable malaria transmission have developed a certain level of immunity against the parasite, it nevertheless is the cause of unfavourable pregnancy outcomes both in the mother and child (Kayentao et al 2005;Adegnika et al 2006;Uddenfeldt et al 2007;Vallely et al 2007). Typical outcomes of the invasion of the placenta by the malaria parasites are: abortion, premature labour, small-for-dates babies, low birth weight (LBW) and fetal/maternal death in some instances (Shulman et al 1996;Schellenberg et al 2003;Marchant et al 2004;Kayentao et al 2005;Adegnika et al 2006;Menendez et al 2007).…”

Effect of intermittent preventive treatment of malaria on the outcome of pregnancy among women attending antenatal clinic of a new Nigerian teaching hospital, Ado-Ekiti

“…Malaria is an important cause of maternal anaemia, intrauterine growth retardation, intrauterine death, still birth, premature delivery, low birth weight (LBW), perinatal and neonatal morbidity and mortality and post-partum morbidity 489. In Sub-Saharan Africa, poor nutrition, micronutrient imbalances (especially vitamin A, Zinc, Iron and Folate), Human immunodeficiency virus (HIV) co-infection, poverty and limited access to effective primary healthcare and emergency obstetric services exacerbate the impact of malaria in pregnancy 8.…”