When a pregnant woman presents with severe malaria, the priority is to save her life. These guidelines consist of recommendations on the diagnosis and treatment of uncomplicated and severe malaria, including among atrisk populations young children, pregnant women, tuberculosis or hivaids patients, nonimmune travellers, in epidemic situations and in humanitarian emergencies. Malaria chapter 4 2020 yellow book travelers health. Malaria infection in pregnancy is a major cause of maternal death, maternal anemia, and adverse pregnancy outcome spontaneous abortion, preterm delivery, growth restrictionlow birth weight, stillbirth, congenital infection, neonatal mortality in geographic areas where malaria infection occurs commonly in pregnant women. Pregnant women are at increased risk for malaria infection. Acts can be used in the second and third trimesters. Doxycycline should be avoided in pregnancy affects teeth and skeletal development.
Recommended interventions for malaria prevention and control during pregnancy policies for malaria prevention and control during pregnancy in areas of stable transmission should emphasize a package of intermittent preventive treatment and use of insecticidetreated nets and ensure effective case management of. Malaria during pregnancy is very serious even in the best of hands and requires treatment by someone who is an expert in this area. Malaria symptoms, treatment, causes, types, contagious. The adult treatment doses or oral and intravenous quinine including the loading dose can safely be given to pregnant women. Malaria in pregnancy is an obstetric, social and medical problem requiring multidisciplinary and multidimensional solution. This is the second in a series of three papers about malaria in pregnancy.
If the malaria species is not known, treat as uncomplicated p. In line with who guidelines, pmi supports a threepronged approach to reducing malaria in pregnancy. The gaps on efficacy and safety information for use during pregnancy are also discussed. Malaria in pregnancy, diagnosis and treatment greentop. Malaria remains one of the most preventable causes of adverse birth outcomes. Malaria in pregnancy geneva foundation for medical education. Who recommends a specific package of interventions for the prevention and treatment of malaria during pregnancy. In africa, malaria infection in pregnancy is a major threat to the lives of mothers, fetuses, and infants. Determination of the infecting plasmodium species for treatment purposes is important for three main reasons. This third edition of the who guidelines for the treatment of malaria contains updated recommendations. The objectives of treatment for severe malaria are to prevent death, neurological deficit and. The seaquamat trial showed it to be superior to parenteral quinine in asian adults 32. Studies of the association between malaria in pregnancy mip and malaria during infancy have provided mixed results.
Malaria in pregnancy mip is a major, preventable cause of maternal morbidity. Malaria causes symptoms that typically include fever, tiredness, vomiting, and headaches. Sulfadoxine pyrimethamine is given during antenatal visits at curative doses 1,500 mg sulfadoxine and 75 mg pyrimethamine. Annually, around 125 million pregnancies around the world are at risk from malaria. Although important advances have been made in the last years, the mechanisms that explain the. Read more about standby emergency treatment for malaria. Pdf treatment and prevention of malaria in pregnancy and newborn. Guidelines for the treatment of malaria, 3rd ed, who, geneva 2015. Current recommended mip prevention and control includes intermittent preventive treatment iptp, distribution of insecticidetreated bed nets itns and appropriate case management.
The objectives of treatment for uncomplicated malaria are to cure radical the infection rapidly, prevent progression to severe disease, reduce transmission of the infection to others and prevent the emergence of antimalarial drug resistance. Complications of malaria in pregnancy can include premature birth, miscarriage, and stillbirth, as well as severe complications in the mother. In 2006, the who recommended a combination of quinine and clindamycin for treatment of uncomplicated malaria in pregnancy. Prevention of malaria in pregnancy the lancet infectious. Clindamycin should be given after quinine unlicensed indication. Chloroquine is a safe option for treatment of nonfalciparum malaria throughout pregnancy. Falciparum malaria is particularly dangerous in pregnancy, especially in the last trimester. Who recommends a package of interventions for preventing and controlling malaria during pregnancy, which includes promotion and use of insecticidetreated nets, appropriate case management with prompt, effective treatment, and, in areas with moderate to high transmission of plasmodium falciparum, administration of iptpsp 1. Other sources used in the development of this guideline included uk malaria treatment guidelines, published3 and online at the health protection agency. Malaria and pregnancy medicines for malaria venture. Issuemalaria infection during pregnancy is a significant public health problem with substantial risks for the pregnant woman, her foetus and the newborn child. Malaria case management, consisting of early diagnosis and prompt effective treatment, remains a vital component of malaria control and elimination strategies. Prevention and management of malaria during pregnancy. Malaria in pregnancy adversely affects the mother and fetus.
On confirmation following treatment is to be given. Treatment of uncomplicated malaria in pregnancy is a balance between potential fetal adverse effects from drug toxicity and improved clinical status with clearance of the parasite. When the transmission is high, maternal anaemia is common, and infant low birth weight due to foetal growth restriction andor premature delivery is frequent 2. Malaria is a mosquitoborne infectious disease that affects humans and other animals. This article explores the social and cultural context to the. Intermittent preventive treatment in pregnancy iptp with sulfadoxinepyrimethamine is used to prevent malaria, but resistance to this drug combination has decreased its efficacy and new alternatives are needed. Intermittent preventive treatment in pregnancy iptp with sulfadoxinepyrimethamine is used to prevent malaria, but resistance to this drug combination has decreased. Intermittent preventive treatment in pregnancy iptp.
Malaria infection during pregnancy is a significant public health problem with substantial risks for the woman, her fetus and the newborn child. Malaria during pregnancy is a major public health concern and an important contributor to maternal and infant morbidity and mortality in malariaendemic countries. Treatment of malaria during pregnancy and postpartum. The control of the impact of malaria during pregnancy, therefore, depends on both preventing the infection and in clearing parasitaemia when the disease occurs. Malaria is a serious, lifethreatening, and sometimes fatal, disease spread by mosquitoes and caused by a parasite. Pregnant women have an increased risk of developing severe malaria, and both. The advisory committee on malaria prevention have agreed to take over and update this guideline. Adverse effects of falciparum and vivax malaria and the safety of antimalarial treatment in early pregnancy. Malaria is a serious illness that can be fatal if not diagnosed and treated quickly. For pregnant women diagnosed with uncomplicated malaria caused by p. The diagnosis and treatment of malaria in pregnancy rcog. Treatment for the disease is typically provided in a hospital. Once the woman recovers, treatment can be continued with appropriate oral medication.
In severe cases it can cause yellow skin, seizures, coma, or death. If not properly treated, people may have recurrences of the. Quinine may be used in the first trimester if there is concern about resistant vivax. Intermittent preventive treatment of malaria for pregnant women iptp is a very important strategy for the control of malaria in pregnancy in malariaendemic tropical countries, where mosquito. Clinicians who require assistance with the diagnosis or treatment of malaria should call the cdc malaria hotline 7704887788 or tollfree at 85585647 from 9 am to 5 pm eastern time. If youre pregnant, its advisable to avoid travelling to areas where theres a risk of malaria. During pregnancy, a woman faces a much higher risk of contracting. Impact of plasmodium falciparum malaria and intermittent. For pregnant women diagnosed with uncomplicated malaria caused by chloroquineresistant p. Intermittent screening and treatment or intermittent preventive treatment with dihydroartemisininpiperaquine versus intermittent preventive treatment with sulfadoxinepyrimethamine for the control of malaria during pregnancy in western kenya. Current knowledge and challenges of antimalarial drugs for. Symptoms usually begin ten to fifteen days after being bitten by an infected mosquito. Treatment for malaria during pregnancy is now recommended for all pregnant women living in areas with stable malaria transmission 3. Guidelines for the treatment of malaria, second edition, who 2010.
South australian perinatal practice guidelines workgroup at. Plasmodium infections are notable causes of adverse birth outcomes, including fetal loss, intrauterine growth retardation, and preterm delivery. Pam is caused primarily by infection with plasmodium falciparum, the most dangerous of the four species of malariacausing parasites that infect humans. This guideline provides clinicians with evidencebased information on the diagnosis and treatment of malaria in pregnancy in situations likely to be encountered in uk medical practice. The plasmodium falciparum parasite causes the most severe malaria symptoms and most deaths. Malaria in pregnancy mip contributes significantly to maternal and neonatal mortality 1.
Intermittent preventive treatment in pregnancy iptp is a highly costeffective preventive malaria intervention that significantly improves the health of mothers and their newborns in. In low transmission areas, when nonimmune pregnant women become infected, malaria infection may become severe and lifethreatening, requiring. Policies for malaria prevention and control during pregnancy in areas of stable. Who guidance for prevention and treatment of malaria in. Editorials the new england journal of medicine n engl j med 374. Prevention and case management of malaria during pregnancy is based on risk benefit criteria and poses one of the greatest. After hours or on weekends and holidays, clinicians requiring assistance should call the cdc emergency operations center at 7704887100 and ask the operator. Pregnant women constitute the main adult risk group for malaria and 80% of deaths due to malaria in africa occur in pregnant women and children below 5 years. Pregnancyassociated malaria pam or placental malaria is a presentation of the common illness that is particularly lifethreatening to both mother and developing fetus. Uk malaria treatment guidelines 2016 sciencedirect. Artemisinin, diagnosis, malaria, plasmodium, pregnant, treatment.
Pregnant women are particularly vulnerable as a malaria infection during pregnancy can lead to miscarriage, premature delivery, low birth weight, congenital infection, andor perinatal death. Malaria can be a lifethreatening condition, especially if youre infected with the parasite p. Malaria in pregnancy is a priority area in the roll back malaria strategy. Treatment of vivax malaria diagnosis of vivax malaria may be made by the use of rdt bivalent or microscopic examination of the blood smear. As complications of severe malaria can occur within hours or days of the first symptoms. Malaria infection during pregnancy is a major cause of maternal and neonatal death in zambia and throughout tropical and subtropical regions of the world. In areas with chloroquine susceptible infections, treat uncomplicated p. Who recommendation on intermittent preventive treatment of. Early treatment of malaria in the woman reduces the systemic effects of parasitaemia and reduces the. The recommended treatment for severe malaria at any time in pregnancy is with parenteral artesunate 31. The european regulatory guidelines for labelling of medicines use in. Prevention of malaria in the community and during pregnancy. Issues related to prevention and treatment of malaria in pregnant women.
Malaria during pregnancy is a major public health concern and an important contributor to maternal and infant morbidity and mortality in malaria endemic countries. Alternatively, hydroxychloroquine, may be given instead. Malaria in pregnancy national malaria control programme. In endemic regions of subsaharan africa, malaria during pregnancy mip is a major preventable cause of maternal and infant morbidity and mortality. Malaria infection during pregnancy can lead to miscarriage, premature delivery, low birth weight, congenital infection, andor perinatal death.