Document Detail


Intermittent preventive treatment of malaria during pregnancy in central Mozambique.
MedLine Citation:
PMID:  18038078     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PROBLEM: New WHO strategies for control of malaria in pregnancy (MiP) recommend intermittent preventive treatment (IPTp), bednet use and improved case management.
APPROACH: A pilot MiP programme in Mozambique was designed to determine requirements for scale-up.
LOCAL SETTING: The Ministry of Health worked with a nongovernmental organization and an academic institution to establish and monitor a pilot programme in two impoverished malaria-endemic districts.
RELEVANT CHANGES: Implementing the pilot programme required provision of additional sulfadoxine-pyrimethamine (SP), materials for directly observed SP administration, bednets and a modified antenatal card. National-level formulary restrictions on SP needed to be waived. The original protocol required modification because imprecision in estimation of gestational age led to missed SP doses. Multiple incompatibilities with other health initiatives (including programmes for control of syphilis, anaemia and HIV) were discovered and overcome. Key outputs and impacts were measured; 92.5% of 7911 women received at least 1 dose of SP, with the mean number of SP doses received being 2.2. At the second antenatal visit, 13.5% of women used bednets. In subgroups (1167 for laboratory analyses; 2600 births), SP use was significantly associated with higher haemoglobin levels (10.9 g/dL if 3 doses, 10.3 if none), less malaria parasitaemia (prevalence 7.5% if 3 doses, 39.3% if none), and fewer low-birth-weight infants (7.3% if 3 doses, 12.5% if none).
LESSONS LEARNED: National-level scale-up will require attention to staffing, supplies, bednet availability, drug policy, gestational-age estimation and harmonization of vertical initiatives.
Authors:
Paula E Brentlinger; Martinho Dgedge; Maria Ana Chadreque Correia; Ana Judith Blanco Rojas; Francisco Saúte; Kenneth H Gimbel-Sherr; Benjamin A Stubbs; Mary Anne Mercer; Stephen Gloyd
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Bulletin of the World Health Organization     Volume:  85     ISSN:  0042-9686     ISO Abbreviation:  Bull. World Health Organ.     Publication Date:  2007 Nov 
Date Detail:
Created Date:  2007-11-26     Completed Date:  2007-12-28     Revised Date:  2012-05-23    
Medline Journal Info:
Nlm Unique ID:  7507052     Medline TA:  Bull World Health Organ     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  873-9     Citation Subset:  IM    
Affiliation:
Department of Health Services, School of Public Health and Community Medicine, University of Washington, Seattle, Washington 98195, USA. bretp2@u.washington.edu
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MeSH Terms
Descriptor/Qualifier:
Antimalarials / administration & dosage,  therapeutic use*
Drug Administration Schedule
Drug Combinations
Female
Health Policy
Humans
Malaria / prevention & control*
Mozambique / epidemiology
Practice Guidelines as Topic
Pregnancy
Pregnancy Complications, Infectious / prevention & control*
Prenatal Care / organization & administration*
Protective Devices / supply & distribution,  utilization
Pyrimethamine / administration & dosage,  therapeutic use*
Sulfadoxine / administration & dosage,  therapeutic use*
World Health Organization
Grant Support
ID/Acronym/Agency:
P30 AI027757/AI/NIAID NIH HHS; U36/CCU300430-20//PHS HHS
Chemical
Reg. No./Substance:
0/Antimalarials; 0/Drug Combinations; 2447-57-6/Sulfadoxine; 37338-39-9/sulfadoxine-pyrimethamine; 58-14-0/Pyrimethamine
Comments/Corrections

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


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