Pregnancy outcomes after first-trimester treatment with artemisinin derivatives versus non-artemisinin antimalarials: a systematic review and individual patient data meta-analysis

Saito, Makoto; McGready, Rose; Tinto, Halidou; Rouamba, Toussaint; Mosha, Dominic; Rulisa, Stephen; Kariuki, Simon; Desai, Meghna; Manyando, Christine; Njunju, Eric M.; Sevene, Esperança; Valá, Anifa; Augusto, Orvalho; Clerk, Christine; Were, Edwin; Mrema, Sigilbert; Kisinza, William; Byamugisha, Josaphat; Kagawa, Mike; Singlovic, Jan; Yore, Mackensie; Eijk, Anna Maria van; Mehta, Ushma; Stergachis, Andy; Hill, Jenny; Stepniewska, Kasia; Gomes, Melba; Guérin, Philippe J; Nosten, François; Kuile, Feiko O. Ter; Dellicour, Stephanie

doi:10.1016/s0140-6736(22)01881-5

Cited by 21 publications

(17 citation statements)

References 53 publications

(86 reference statements)

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“…As a result, providers prescribed artemetherlumefantrine instead of quinine, demonstrating poor adherence to treatment policy, as also documented in a systematic review and metaanalysis [31]. It is worth noting that since the study was conducted, the safety of artemether-lumefantrine in the rst trimester has been reviewed, and WHO has since updated its treatment guidelines to recommend the use of artemether-lumefantrine over quinine [6,7,40].…”

Section: Discussionmentioning

confidence: 99%

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Perceptions and drivers of healthcare provider and drug dispenser practices for the case management of malaria in pregnancy in the context of multiple first-line therapies in western Kenya: a qualitative study

Osoro

Dellicour

Ochodo

et al. 2023

Preprint

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Background Emergence of Plasmodium falciparum resistance to artemether-lumefantrine in Africa prompted the pilot introduction of multiple first-line therapies (MFT) against malaria in Kenya, potentially exposing women-of-childbearing-age (WOCBAs) to antimalarials with unknown safety profiles in the first trimester. We undertook a qualitative study to explore knowledge and perceptions among healthcare providers providing malaria treatment to WOCBAs and pregnant women.Methods In-depth interviews were conducted with purposively selected public and private health facility (HF) and drug outlet (DO) providers within and outside the pilot-MFT area. County health managers were interviewed about their knowledge of the national treatment guidelines. Transcripts were coded by content analysis using the WHO health system building blocks (leadership/governance, financing, health workforce, health information systems, access to medicines, and service delivery).Results Thirty providers (HF:21, DO:9) and three health managers were interviewed. Eighteen providers were from HFs in the pilot-MFT area; the remaining three and all nine DOs were outside the pilot-MFT area. The analysis revealed that providers had not been trained in malaria case management in the previous twelve months. DO providers were unfamiliar with national treatment guidelines in pregnancy and reported having no pregnancy tests. Health managers were unable to supervise DOs due to resource limitations. Providers from HFs and DOs noted poor sensitivity of malaria rapid diagnostic tests (RDTs) and hesitancy among patients who associated malaria-RDTs with HIV testing. Almost all providers reported antimalarial stock-outs, with quinine most affected. Patient preference was a major factor in prescribing antimalarials. Providers in HFs and DOs reported preferentially using artemether-lumefantrine in the first trimester due to the side effects and unavailability of quinine.Conclusion Knowledge of malaria case management in drug outlets and health facilities remains poor. Improved regulation of DO providers is warranted. Optimising treatment of malaria in pregnancy requires training, availability of malaria commodities, and pregnancy tests.

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Section: Discussionmentioning

confidence: 99%

“…Not all antimalarials are safe for pregnancy, especially in the rst trimester. It is essential that healthcare providers know and adhere to malaria case management guidelines for women-ofchildbearing-age (WOCBA) and pregnant women to ensure effective and safe treatment [7].…”

Section: Introductionmentioning

confidence: 99%

Perceptions and drivers of healthcare provider and drug dispenser practices for the case management of malaria in pregnancy in the context of multiple first-line therapies in western Kenya: a qualitative study

Osoro

Dellicour

Ochodo

et al. 2023

Preprint

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“…Treatment with artemether-lumefantrine was shown to be associated with fewer adverse pregnancy outcomes than quinine and was more effective and better tolerated, supporting the updated CDC and WHO recommen-dations. 33 For pregnant persons with uncomplicated malaria due to chloroquine-sensitive species, treatment with chloroquine or hydroxychloroquine is recommended (Table 1).…”

Section: Uncomplicated Malariamentioning

confidence: 99%

Malaria and Pregnancy

Rasmussen,

Arguin,

Jamieson

2023

Obstetrics &Amp; Gynecology

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Recent identification of local mosquito-borne transmission of malaria in Florida, Texas, and Maryland and increasing travel to malaria-endemic countries raise the likelihood that U.S. obstetricians might encounter a pregnant patient with malaria. Pregnancy increases the risk of becoming infected with malaria and of developing severe disease. Malaria during pregnancy also increases the risk of adverse pregnancy outcomes, including low birth weight, pregnancy loss, and preterm birth; thus, prevention and prompt diagnosis and treatment are essential. Diagnosis can be challenging during pregnancy among persons with partial immunity because placental sequestration of parasite-infected red blood cells can result in lower parasite levels in peripheral blood. Treatment for uncomplicated malaria depends on the expected resistance pattern, which is determined by the specific Plasmodium species identified and where infection was acquired. For severe disease, parenteral artesunate treatment needs to be initiated immediately. Given the dire consequences of malaria in pregnancy, prevention is crucial. For persons born and raised in endemic areas, interventions include use of insecticide-treated bed nets, intermittent preventive treatment, and prompt diagnosis and treatment of illness. U.S. pregnant persons should avoid travel to endemic countries; for unavoidable travel, pregnant travelers should receive chemoprophylaxis and avoid mosquito bites. Although the risk is low to U.S. pregnant persons who are not traveling internationally, avoiding mosquito bites is important, especially for pregnant persons residing in or visiting areas with recent local mosquito-borne transmission.

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“…Nevertheless, most of the RWD studies reported are focused on imported malaria in European countries [15][16][17]. Furthermore, only a few observational cohort studies regarding MDP patients have been reported using patient clinical data [18,19].…”

Section: Introductionmentioning

confidence: 99%

First severe malaria in pregnancy followed in Philippine real-world setting: proof-of-concept of probabilistic record linkage between disease surveillance and hospital administrative data

Kinoshita,

Espino,

Bunagan

et al. 2023

Preprint

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Background Although the Philippines targets malaria elimination by 2030, it is a disease of public health importance in provinces that report malaria. Pregnant women residing in endemic areas are a vulnerable population because their pregnancy is not followed through, and the outcome of their pregnancy is unknown. This study determined the utility of real-world data integrated with disease surveillance dataset as real-world evidence of pregnancy and delivery outcomes in areas endemic for malaria in the Philippines. Methods For the period of 2015 to 2019, electronic datasets of malaria surveillance data and Ospital ng Palawan hospital admission log of pregnant women residing in the four selected barangays of Rizal, Palawan were merged using probabilistic linkage. The source data for record linkage were first and last names, birth date, and address as the mutual variable. The data used for characteristics of the pregnant women from the hospital data set were admission date, discharge date, admitting and final diagnosis and body weight on admission. From the malaria surveillance data these were date of consultation, and malaria parasite species. The Levenshtein distance formula was used for a fuzzy string-matching algorithm. Chi-square test, and Mann-Whitney U test were used to compare the means of the two datasets. Results The prevalence of pregnant women admitted to the tertiary referral hospital, Ospital ng Palawan, was estimated to be 8.34/100 overall, and 11.64/100 from the four study barangays; that of malaria during pregnancy patients was 3.45/100 and 2.64/100, respectively. There was only one true-positive matched case from 238 women from the hospital and 54 women from the surveillance datasets. The overall Levenshstein score was 97.7; for non-matched cases, the mean overall score was 36.6 (35.6–37.7). The matched case was a minor who was hospitalized for severe malaria. The outcome of her pregnancy was detected from neither dataset but from village-based records. Conclusion This proof-of-concept study demonstrated that probabilistic record linkage could match real-world data in the Philippines with further validation required. The study underscored the need for more integrated and comprehensive database to monitor disease intervention impact on pregnancy and its outcome in the Philippines.

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Pregnancy outcomes after first-trimester treatment with artemisinin derivatives versus non-artemisinin antimalarials: a systematic review and individual patient data meta-analysis

Cited by 21 publications

References 53 publications

Perceptions and drivers of healthcare provider and drug dispenser practices for the case management of malaria in pregnancy in the context of multiple first-line therapies in western Kenya: a qualitative study

Perceptions and drivers of healthcare provider and drug dispenser practices for the case management of malaria in pregnancy in the context of multiple first-line therapies in western Kenya: a qualitative study

Malaria and Pregnancy

First severe malaria in pregnancy followed in Philippine real-world setting: proof-of-concept of probabilistic record linkage between disease surveillance and hospital administrative data

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