29/08/2016
MALARIA IN PREGNANCY
Malaria is a parasitic infection transmitted by the bite of a female Anopheles mosquito. It is one of the most devastating infectious diseases, killing more than 1 million people annually. Pregnant women, children, immunocompromised individuals and visitors from non-endemic areas are mostly at risk.
Malaria is caused by the 4 species of plasmodia that infect humans: Vivax, Ovale, Malariae and falciparum. Of these, Plasmodium falciparum is the most deadly.
Factors that influence mosquito breeding, such as temperature, humidity and rainfall affect malaria incidence.
PATHOPHYSIOLOGY
Malaria is transmitted when an infected mosquito takes a human blood meal and the Plasmodium Sporozoites are transferred from the saliva of the mosquito into the capillary bed of the host. Within hours, the parasite will migrate to the liver, where it undergoes further cycling and replication before being released back into the host’s bloodstream.
The incubation period from the time of the mosquito bite till clinical symptoms appears is typically 7 – 30days. Sumptoms include fever, headache, nausea, vomiting and myalgias (body pain).
Pregnant women are 3 times more likely to suffer from severe diseases as a result of malaria infection compared to their non-pregnant counterparts, and have a mortality rate from severe diseases that approach 50%. There is a higher risk of infection and morbidity in primigravidas (first pregnancy), adolescents and those infected with HIV. The second trimester appears to bring the highest rate of infection, supporting the need for antepartum care as part of malaria prevention and treatment efforts.
Some complications caused by malaria include: Placental malaria infection, fetal demise and low birth weight.
PREVENTION
Current prevention of malaria disease in pregnancy relies on 2 main strategies:
The use of insecticide treated beds nets (ITN)
Intermittent preventive treatment (IPT) with Antimalarial Sulfadoxine- Pyrimethamine.
IPT refers to the administration of 2 or more doses of chemoprophylaxis after 20 weeks of gestation in an attempt to reduce subclinical malarial load.
TREATMENT
For uncomplicated malaria, WHO recommends the use of Quinine in the first trimester and ACT (Artemisinin combination based therapy) in the second and third trimesters.
For severe malaria in pregnancy, the current recommendation by WHO is treatment with IV Quinine. IV Artesunate can also be used in the second and third trimesters.
CONCLUSION
Prevention, prompt diagnosis and early treatment is the gold standard in the management of malaria in pregnancy so as to reduce the public health challenges it poses, especially in malaria endemic environments.
