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Current Treatment of Malaria in Pregnancy

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THE CURRENT MANAGEMENT OF MALARIA IN PREGNANCY
Malaria remains a major Health challenge, especially in Sub-Saharan Africa where it is a great contributor to maternal and perinatal morbidity and mortality. The burden is great and has necessitated the need for evolution in management strategies to combat the disease and its effects in pregnancy.
The current management is directed at mitigating the impact of the determinants & confounders of reduced effectiveness such as maternal (compliance with ANC, HIV infection, Age and gravidity) or in the health system (Quality / Access to care, DOT, SP quality, and high concomitant dosage of FA), in addition to consideration of other factors such as malaria transmission intensity (The higher, the more effective), No of timing of SP doses Vs. Gestational age, SP resistance, ITNs use, and the pharmacokinetic changes in pregnancy.
Currently, WHO has recommended changes in the areas of IPTp with SP, the Case Management of malaria in pregnancy and in the use of antimalarial vaccines. Previously, the management of malaria in pregnancy involved the use of ITNs, 2 doses of IPTp with SP and the use of chloroquine in the effective case management.
Currently, IPTp with SP still remains effective & is still administered. Presently, the recommendation for all pregnant women AT EACH SCHEDULED ANC in Areas of stable transmission (moderate - high) is that SP should be 1st administered as early as possible in the 2nd trimester, 3 doses may be given at least 1 month apart it may be administered late after 36 weeks without safety concern even up to delivery. Presently, it is also recommended that it should be used as DOT. It can be ingested on an empty stomach, without concomitant folic acid or folic acid at a reduced dose. Currently, SP is also contraindicated in women on septrin prophylaxis Currently, there is no established threshold

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