4 ch 4 pp infec&malaria preg aa copy

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Infection

International

MALARIA IN PREGNANCY



Infection

International

Objectives

• Describe epidemiology of malaria

• Describe maternal and fetal complication

• Principle of management and preventive

strategies



Infection

International

Global Effect

• Affects 300-500 million people yearly

• a!ses " to #$% million deat&s

• '0( of deat&s occ!r in )!b -)a&aran

Africa

*appro+imately 3000 deat&s eac& day,



Infection

International )ie of problem in Africa

*./O "''',• Pop!lation 512

• Ann!al birt&s #2$%• E+posed to malaria '3(

• A coverage 13(

• 4o birt& eig&t "1(• 6alaria attrib!table fraction to 47."#-50(



Infection

International

INDONESIA

• Annual Paracite Inciden pertahunmasih tersebar di Seluruh Propinsi

• Bali s/d Papua



Infection

International



Infection

International

Scope of Focused ANC

Majority ofpregnant women needthese services only

Some pregnant womenrequire these servicesalso

Fewer pregnant women requirethese services



Infection

International

Anopheles Mosquito

Anopheles mosquitoes differ from other mosquitoes in the waytheir body is positioned. The body of the Anopheles points up in the

air in one line, but in other mosquitoes, the rear end is bent and

points down.



Infection

International

Malaria Ecolog and Burden!linical Manifestations

InfectedMosquito

Infected

Human

Chroniceffects

AnemiaNeurologic/cognitiveDevelopmental

Impairedgrowth anddevelopment

Malnutrition

Acutefebrileillness

Severeillness

Hpoglcem

iaAnemia

Cerebralmalaria

Death!espiratordistress

"regnanc

#etus

Maternal

Acute

illnessAnemia

Impairedproductivit

$ow birthweight

Infantmortalit



Infection

International Factors Aecting

Transmission• Breeding sites

• Parasites

• Climate

• Population



Infection

International

Insecticide-Treated Nets%ntreated Nets

• Provide a high level ofprotection against

malaria• Kill or repel mosquitoesthat touch the net

• educe num!er ofmosquitoes in"outside net

• Kill other insects such

as lice and !ed!ugs• #re safe for pregnant

women$ young children andinfants

Insecticide&'reated Nets

• Provide some protectionagainst malaria

• %o not &ill or repelmosquitoes that touchnet

• %o not reduce num!er ofmosquitoes

• %o not &ill other

insects li&e lice and!ed!ugs

• #re safe for pregnantwomen$ young childrenand infants



Infection

International

Insecticide-Treated Nets

ITN tucked under a bed ITN tucked under a mat



Infection

International

Effect of malaria on pregnancy

Related to Level of transmission and

immunity of individual exposed

• In areas of high transmission

endemi! or sta"le malaria area#

• In areas of lo$ transmission or

non endemi! or unsta"le areas



Infection

International

6aternal complication

In Endemi! areas

• malaria related

anaemia• %e"rile illness

• Pla!ental

se&uestration

In non'Endemi! areas

• Greater ris( of

severe disease

• )igher ris( of death

• Anaemia

hypogly!emia

pulmonary oedema

renal failure



Infection

International

Anaemia

6!lti factorialaffects 50-10( pregnant omen in

)!b-)a&aran region

• /aemolysis• 8ncreased imm!ne clearance of infected and non

infected 97s

• 6alarial &yperactive splenomegaly• !tritional : &oo;orm infestation

• 8ncreased ris; in pregnancy to Post -part!m

/emorr&age : /eart fail!re



Infection

International

)evere malaria

• erebral malaria <nro!sable coma

it& ase+!al perip&eral parsitaemia or

placental infection$• /ypoglycemia

• P!lmonary edema *A9D),

• Ac!te renal fail!re



Infection

International

=etal complications

8n endemic areas

• 4o birt& eig&t

• 8ntra-!terine grot&retardation

8n non-endemic areas

• Abortions

• preterm delivery• ongenital malaria

• 4o birt& eig&t



Infection

International

Malaria Diagnosis

• 'sually !ased on signs and symptoms ofthe patient$ clinical history andphysical e(amination and"or la!oratory

confirmation of the malaria parasite$if availa!le)

• Prompt and accurate diagnosis leads to*

+ ,mproved differential diagnosis of fe!rile

illness+ ,mproved management of non-malarial illness

+ .ffective case management of malaria

"#



Infection

International Indications for

Diagnostic Testing• For pregnant women$ a parasitological diagnosisis recommended prior to starting treatment*+ /hose who live in or have come from areas of unsta!le

transmission are the most li&ely candidates forsevere malaria$ which can !e life-threatening

• #s a test of cure in clients who have !eentreated for malaria !ut still have symptoms*+ ,f treatment was adequate$ clients may have !een

reinfected or have another pro!lem causing similarsymptoms

+ Counterfeit or poor quality drugs may also !e a thecause of treatment failure



Infection

International

Clinical Diagnosis

• Based on the patient9s symptomsand on physicalfindings at e(amination

• /he first symptoms of malaria andphysical findings are often not

specific and are common to otherdiseases



Infection

International

Types of Malaria

• 'ncomplicated*

+ Most common

• Severe*+ :ife-threatening$ can affect!rain

+ Pregnant women more li&ely toget severe malaria than non-pregnant women

i i M l i i



Infection

International

ecogni!ing Malaria in"regnant #omen

%ncomplicated Malaria

• Fever

• Shivering"chills"rigors

• 6eadaches

• Muscle"joint pains

• ;ausea"vomiting• False la!or pains

Severe Malaria

Signs of uncomplicated malaria P:'S one ormore of the following*

• Confusion"drowsiness"coma• Fast !reathing$

!reathlessness$ dyspnea

• <omiting every meal"una!le toeat

• Pale inner eyelids$ inside ofmouth$ tongue$ and palms

• =aundice



Infection

International

Com$ination Therapy

• Plasmodium falciparum has !ecomeresistant to single-drug therapy$resulting in ineffective treatment andincreased mor!idity and mortality

• 562 now recommends that countries use acom!ination of drugs to fight malaria

•%rug resistance is far less li&ely withcom!ination therapy than with single-drug treatments



Infection

International

Types of Com$ination Therapy

Artemisinin-based Combination Therapy(ACT):

• /he simultaneous use of drugs thatincludes a derivative of artemisininalong with another anti-malarial drug

• /his com!ination is currently the mosteffective treatment for malaria

• For second and third trimesters$ #C/sshould !e the first-line treatment ifavaila!le and in line with localprotocol



Infection

International

Selecting Treatment

• Follow local guidelines regardingwhich com!ination therapies to use 0if

any1 and how to use them• For uncomplicated malaria in the >sttrimester and for severe malaria inany trimester$ quinine is the drug of

choice• ,f #C/s are the only effectivetreatment availa!le$ they can !e usedin the first trimester



Infection

International

Treating %ncomplicated Malaria

#irst trimester(

• ?uinine >7 mg salt"&g !ody weight three times daily@ clindamycin >7 mg"&g !ody weight twice daily for A

days+ ,f clindamycin is not availa!le$ use quinine only

• #C/ can !e used if it is the only effectivetreatment availa!le

Second and third trimesters(

• 'se the #C/ &nown to !e effective in thecountry"region$ 2

• #rtesunate @ clindamycin 0>7 mg"&g !ody weight twicedaily1 for A days$ 2

• ?uinine @ clindamycin for A days



Infection

International

Treating %ncomplicated Malaria• 2!serve client ta&ing anti-malarial drugs

• #dvise client to*+ Complete course of drugs

+ eturn if no improvement in hours

+ Consume iron-rich foods

+ 'se ,/;s and other preventivemeasures

$#

4 ch 4 pp infec&malaria preg aa copy

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