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400,000 cases of severe anemia every year Maternal death: 10,000 Infant death: 200,000 11% of neonatal deaths in malaria endemic African countries are due to low birth weight resulting from P. falciparum infections in pregnancy
-WHO. A Strategic Framework for malaria Prevention and Control During Pregnancy in the African Region. 2004. -Guyatt HL, Snow RW. Malaria in pregnancy as an indirect cause of infant mortality in sub-Saharan Africa. Trans R. Soc Trop Med Hyg 2001; 95: 569-76
Severe malaria Anemia Stillbirths Abortions Low Birth Weight Premature delivery, when infection occurs in 3rd trimester
WHO. A Strategic Framework for malaria Prevention and Control During Pregnancy in the African Region. 2004.
WHO Recommendations
WHO recommends a three-pronged approach to prevent and treat MIP:
1. Intermittent preventive treatment in pregnancy
2. Use of insecticide treated bed-net (ITN) 3. Diagnosis and treatment of malaria case mgt.
Updated WHO Policy Recommendation (October 2012)- Intermittent Preventive Treatment of malaria in pregnancy using Sulfadoxine-Pyrimethamine (IPTp-SP)
Plasmodium falciparum malaria Asymptomatic Infection Placental Sequestration Altered Placental Integrity
Malaria during
Clinical Illness
Severe Disease
Risk to Mother
Risk to Fetus
Malaria during
Malaria prevention in pregnancy is associated with substantial reductions in neonatal mortality and low birth weight under routine program conditions
Thomas P Eisele, David A Larsen, Philip A Anglewicz, Joseph Keating, Josh Yukich, Adam Bennett, Paul Hutchinson, Richard W Steketee. Malaria prevention in pregnancy, birthweight, and neonatal mortality; a meta-analysis of 32 national cross-sectional datasets in Africa. The Lancet. Published online Sept 18, 2012.
Attended first ANC at <4 months of pregnancy *% of weighed newborns <2.5 KGs
Prevalence of HIV among women % pregnant women receiving IPTp 1 % pregnant women receiving IPTp 2+ % pregnant women sleeping under a mosquito ITN the previous night
14.3%
4.6% N/A N/A N/A 8%
N/A
N/A N/A 69.1% 58.6% 25%
19.2%
4.4% 16.1% N/A 66% 33%
N/A
N/A N/A 73% 66% 43.2%
N/A
N/A N/A N/A 70% 46%
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Commodities
Address Stock-outs of SP & ITNs at ANC Avoid inappropriate use of SP Make ITNs free for pregnant women and available through ANC
19
Quality Assurance
Ensure performance standards in place Drinking water for DOTS available Routine supportive supervision
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