Document Detail


Developing effective strategies for malaria prevention programs for pregnant African women.
MedLine Citation:
PMID:  8702046     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The control of malaria in pregnant African women, one of several child survival strategies applied through antenatal care, has been particularly challenging. Prevention and control recommendations for typical areas of high Plasmodium falciparum transmission have promoted the use of antimalarial chemoprophylaxis to prevent placental infection. Persistently low program coverage coupled with diminishing intervention effectiveness have forced a re-evaluation of the relative importance of malaria in pregnancy. The Mangochi Malaria Research Project (MMRP), a prospective evaluation of malaria prevention in pregnant women in rural Malawi conducted during 1987-1990, contributed to establishing new criteria for policy and program development for malaria prevention in pregnancy. The principle findings of the MMRP include: 1) populations at risk of the adverse consequences of malaria in pregnancy include women with low parity, women infected with human immunodeficiency virus, pregnancy during the high malaria transmission season, and the use of a malaria drug that is suboptimally efficacious; 2) the estimated maximum benefits of an antimalarial intervention that clears placental and umbilical cord parasitemia are a 5-12% reduction of low birth weight (LBW), an approximately 35% reduction in the risk of LBW for risks that are actually preventable once a woman has become pregnant (e.g., risks such as infectious disease or poor nutrition during gestation), and a 3-5% reduction in the rate of infant mortality; 3) the intervention must be capable of rendering the woman malaria parasite free, including clearance of parasites from the placental vascular space and umbilical cord blood; 4) other diseases adversely affect pregnancy outcome and, while the control of malaria in pregnancy may not warrant independent programming, if coupled with prevention programs to provide a range of antenatal services, the incremental costs of malaria control may prove to be highly cost-effective; and 5) the choice of a regimen must balance intervention efficacy with safety, availability, affordability, and simplicity of delivery, and several antimalarials may meet these criteria. The Malawi Ministry of Health has modified its malaria prevention in pregnancy recommendations and now faces the challenge of effective programming to improve child survival.
During 1987-90, a prospective evaluation of malaria prevention in pregnant women in rural Malawi, the Mangochi Malaria Research Project, was conducted. It aimed to address systematically the evolving obstacles to effective program strategies. The findings contribute to the establishment of new criteria for decision-making in policy and program development for malaria prevention and control in pregnancy. The project resulted in five key lessons learned. Populations at risk of the adverse effects of malaria during pregnancy are low-parity women, HIV-infected women, women pregnant during the high malaria transmission season, and pregnant women using a less effective malaria drug. The estimated maximum benefits of an antimalarial intervention include a 5-12% reduction in low birth weight (LBW), an approximate 35% reduction in the risk of LBW for risks that are preventable once a woman has conceived (i.e., infectious disease or poor nutrition during pregnancy), and a 3-5% reduction in infant mortality. The antimalarial intervention must be able to make the pregnant women malaria-parasite free and to effect clearance of parasites from the placental vascular space and umbilical cord blood. Since other diseases also adversely affect pregnancy outcome, the control of malaria should be integrated with prevention programs to provide a range of prenatal services. When choosing a regimen, the health provider must balance the regimen's efficacy with safety, availability, affordability, and ease of delivery. Several antimalarial regimens appear to meet these criteria. Based on the findings of the project, the Malawi Ministry of Health has changed its recommendations for malaria prevention in pregnancy.
Authors:
R W Steketee; J J Wirima; C C Campbell
Related Documents :
24308596 - Successful laparoscopic management of a primary omental pregnancy: case report and revi...
23444766 - Successful pregnancy after uterovaginal anastomosis in patients with congenital atresia...
17230286 - A survey of knowledge, attitude and practice of malaria management among pregnant women...
23157046 - Diagnosis and management of cesarean scar pregnancy.
6943576 - Alterations in chromatin structure during early sea urchin embryogenesis.
17525006 - Management of symptomatic urolithiasis during pregnancy.
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, Non-P.H.S.    
Journal Detail:
Title:  The American journal of tropical medicine and hygiene     Volume:  55     ISSN:  0002-9637     ISO Abbreviation:  Am. J. Trop. Med. Hyg.     Publication Date:  1996  
Date Detail:
Created Date:  1996-09-04     Completed Date:  1996-09-04     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0370507     Medline TA:  Am J Trop Med Hyg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  95-100     Citation Subset:  AIM; IM; J; X    
Affiliation:
Division of HIV/AIDS, National Center for Prevention Services, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Africa
Antimalarials / therapeutic use
Female
Health Policy
Health Promotion / methods*
Humans
Malaria, Falciparum / complications,  prevention & control*
Parasitemia / prevention & control
Pregnancy
Pregnancy Complications, Parasitic / prevention & control*
Risk Factors
Chemical
Reg. No./Substance:
0/Antimalarials

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  Evaluation of maternal practices, efficacy, and cost-effectiveness of alternative antimalarial regim...
Next Document:  The physiopathology of sepsis. Current concepts