scholarly journals Pathogenesis of malaria in pregnancy

2008 ◽  
Vol 29 (4) ◽  
pp. 204
Author(s):  
Steven R Meshnick ◽  
Stephen J Rogerson
Keyword(s):  
Plasmodium Falciparum ◽  
Pregnant Women ◽  
Birth Outcomes ◽  
Preventive Therapy ◽  
Malaria In Pregnancy ◽  
Bed Nets ◽  
Common Disease ◽  
Protective Measures ◽  
Poor Countries ◽  
In Pregnancy

Even though we have good tools to prevent and treat malaria, it remains a tragically common disease in poor countries, especially in Africa. Pregnant women are particularly susceptible to malaria, causing anaemia and poor birth outcomes. There is marked sequestration of Plasmodium falciparum-infected erythrocytes (IEs) in the placenta, but the pathogenesis of malaria in pregnancy is still incompletely understood. Both intermittent preventive therapy and insecticide-impregnated bed nets are effective protective measures, but new measures are also needed.

scholarly journals Decreasing Burden of Malaria in Pregnancy in Malawian Women and Its Relationship to Use of Intermittent Preventive Therapy or Bed Nets

PLoS ONE ◽  
2010 ◽  
Vol 5 (8) ◽  
pp. e12012 ◽  
Author(s):  
Gaoqian Feng ◽  
Julie A. Simpson ◽  
Ebbie Chaluluka ◽  
Malcolm E. Molyneux ◽  
Stephen J. Rogerson
Keyword(s):  
Preventive Therapy ◽  
Malaria In Pregnancy ◽  
Bed Nets ◽  
In Pregnancy

scholarly journals A Socio-Ecological Approach To Understanding The Factors Influencing The Uptake Of Intermittent Preventive Treatment Of Malaria In Pregnancy (IPTp) In South Western Nigeria.

2020 ◽  
Author(s):  
Gertrude Nsorma Nyaaba ◽  
Atinuke O Olaleye ◽  
Mary O Obiyan ◽  
Oladapo Walker ◽  
Dilly OC Anumba
Keyword(s):  
Pregnant Women ◽  
Intermittent Preventive Treatment ◽  
Healthcare Providers ◽  
Preventive Treatment ◽  
Malaria In Pregnancy ◽  
Bed Nets ◽  
Public Healthcare ◽  
Birth Attendants ◽  
Faith Based ◽  
In Pregnancy

Abstract Background: Malaria in pregnancy (MiP) remains a key cause of poor maternal and neonatal health outcomes. Two key strategies globally promoted to address MiP require pregnant women in malaria-endemic regions to sleep under insecticide-treated bed nets (ITNs) and take at least three doses of intermittent preventive treatment (IPTp) during pregnancy. Particularly in the African region where weak health systems grapple with prevailing socio-cultural and traditional practices, several multilevel factors influence the effective uptake of these strategies. This study explores the factors for the poor uptake of IPTp and use of ITNs in lower socio-economic communities in Nigeria. Methods: We conducted semi-structured interviews (SSI) and focus group discussions (FGD) with a total of 201 key stakeholders in 6 communities in Ogun State, South-western Nigeria. Twelve SSIs were conducted with traditional birth attendants (TBAs), faith-based birth attendants and healthcare providers operating in public health facilities. Community leaders (7), pregnant women (30) and 20 caregivers were also individually interviewed. Sixteen FGDs were conducted with multi- and first- time pregnant women grouped by location and pregnancy experiences. A thematic approach were used for data analysis. Results: At the individual and social levels, there is high general awareness of MiP, its consequences and ITNs but a low awareness of IPTp, with type of antenatal care (ANC) provider being a key factor influencing access to IPTp. Choice of type of ANC provider, which facilitates access to IPTp and ITNs, is influenced by experiences of relatives with ANC providers, attitudes of ANC providers and community perceptions of the type of ANC providers. Concurrent use of multiple ANC providers and ANC providers’ relationships further influence acceptability and coverage for IPTp and ITN use. At the health sector level, there is low awareness about preventive malarial strategies including IPTp among TBAs and faith-based birth attendants, in contrast to high IPTp awareness among public healthcare providers. Conclusion: The findings highlight several factors that influence the utilisation of IPTp services and call for greater synergy and sensitisation between the three groups of healthcare providers towards improving access to and acceptability of IPTp for improving maternal and child outcomes.

scholarly journals Malaria in Pregnancy in Ethiope East Local Government Area of Delta State, Nigeria

2019 ◽  
pp. 1-8
Author(s):  
E. J. Onochie ◽  
A. O. Egwunyenga
Keyword(s):  
Local Government ◽  
Pregnant Women ◽  
Prevalence Rate ◽  
Scale Up ◽  
Intermittent Preventive Treatment ◽  
Local Government Area ◽  
Malaria In Pregnancy ◽  
Bed Nets ◽  
Antenatal Visit ◽  
In Pregnancy

The study was carried out to determine the prevalence of malaria in pregnant women in Ethiope East Local Government Area of Delta State, Nigeria during the period of March to August, 2014. A total of two hundred and seven pregnant women were examined, 60% were infected with malaria parasite. With respect to age, pregnant women within the age of 18-25 years had the higher prevalence rate of 67.8%. Prevalence rate of 63.5% were observed within pregnant women in their first trimester. Pregnant women who are farmers tend to have the highest prevalence rate of 71.4% while those who lived in rural areas showed prevalence rate of 69.1%. Primigravidae showed the higher prevalence rate of 68.9%. Of the two locations sampled Abraka had the highest overall prevalence in terms of malaria infection with 64% while Eku showed a prevalence rate of 56%. Based on the findings, there is clear evidence of high level of malaria in pregnant women in the study area, hence the need to reduce the morbidity of malaria in pregnancy in Delta State. Efforts should be made to scale-up intermittent preventive treatment of pregnant women (IPTp) for malaria with Sulfadoxine Pyrimethamine (SP), and ensure increased access to IPTp with SP in all areas in Delta State. Free bed nets should also be provided to pregnant women on their first antenatal visit.

scholarly journals A socio-ecological approach to understanding the factors influencing the uptake of intermittent preventive treatment of malaria in pregnancy (IPTp) in South-Western Nigeria

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0248412
Author(s):  
Gertrude N. Nyaaba ◽  
Atinuke O. Olaleye ◽  
Mary O. Obiyan ◽  
Oladapo Walker ◽  
Dilly O. C. Anumba
Keyword(s):  
Pregnant Women ◽  
Intermittent Preventive Treatment ◽  
Healthcare Providers ◽  
Preventive Treatment ◽  
Malaria In Pregnancy ◽  
Bed Nets ◽  
Public Healthcare ◽  
Birth Attendants ◽  
Faith Based ◽  
In Pregnancy

Malaria in pregnancy (MiP) remains a key cause of poor maternal and neonatal health outcomes, particularly in the African region. Two strategies globally promoted to address MiP require pregnant women in malaria-endemic regions to sleep under insecticide-treated bed nets (ITNs) and take at least three doses of intermittent preventive treatment (IPTp) during pregnancy. Yet, several multilevel factors influence the effective uptake of these strategies. This study explored the factors for the poor uptake of IPTp and use of ITNs in lower socio-economic communities in Nigeria. We conducted semi-structured interviews (SSI) and focus group discussions (FGD) with a total of 201 key stakeholders in six communities in Ogun State, South-Western Nigeria. Twelve SSIs were conducted with traditional birth attendants (TBAs), faith-based birth attendants and healthcare providers operating in public health facilities. Community leaders (7), pregnant women (30) and 20 caregivers were individually interviewed. Sixteen FGDs were conducted with multi- and first-time pregnant women grouped by location and pregnancy experiences. A thematic approach was used for data analysis. At the individual and social levels, there is a high general awareness of MiP, its consequences and ITNs but low awareness of IPTp, with type of antenatal care (ANC) provider being a key factor influencing access to IPTp. The choice of ANC provider, which facilitates access to IPTp and ITNs, is influenced by the experiences of women, relatives and friends, as well as the attitudes of ANC providers and community perceptions of the type of ANC providers. Concurrent use of multiple ANC providers and ANC providers’ relationships further influence acceptability and coverage for IPTp and ITN use. At the health sector level, there is low awareness about preventive malarial strategies including IPTp among TBAs and faith-based birth attendants, in contrast to high IPTp awareness among public healthcare providers. The findings highlight several factors that influence the utilisation of IPTp services and call for greater synergy and collaboration between the three groups of healthcare providers towards enhancing access to and acceptability of IPTp for improving maternal and child outcomes.

scholarly journals Risk factors for Plasmodium falciparum infection in pregnant women in Burkina Faso: a community-based cross-sectional survey

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Jean Baptiste Yaro ◽  
Alphonse Ouedraogo ◽  
Amidou Diarra ◽  
Salif Sombié ◽  
Z. Amidou Ouedraogo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Plasmodium Falciparum ◽  
Burkina Faso ◽  
Pregnant Women ◽  
Malaria Control ◽  
Dry Season ◽  
Malaria In Pregnancy ◽  
Wet Season ◽  
Cross Sectional ◽  
In Pregnancy

Abstract Background Malaria in pregnancy remains a public health problem in sub-Saharan Africa. Identifying risk factors for malaria in pregnancy could assist in developing interventions to reduce the risk of malaria in Burkina Faso and other countries in the region. Methods Two cross-sectional surveys were carried out to measure Plasmodium falciparum infection using microscopy in pregnant women in Saponé Health District, central Burkina Faso. Data were collected on individual, household and environmental variables and their association with P. falciparum infection assessed using multivariable analysis. Results A total of 356 pregnant women were enrolled in the surveys, 174 during the dry season and 182 during the wet season. The mean number of doses of sulfadoxine–pyrimethamine for Intermittent Preventive Treatment in pregnancy (IPTp-SP) was 0.4 doses during the first trimester, 1.1 doses at the second and 2.3 doses at the third. Overall prevalence of P. falciparum infection by microscopy was 15.7%; 17.8% in the dry season and 13.7% in the wet season. 88.2% of pregnant women reported sleeping under an insecticide-treated net (ITN) on the previous night. The odds of P. falciparum infection was 65% lower in women who reported using an ITN compared to those that did not use an ITN (Odds ratio, OR = 0.35, 95% CI 0.14–0.86, p = 0.02). IPTp-SP was also associated with reduced P. falciparum infection, with each additional dose of IPTp-SP reducing the odds of infection by 44% (OR = 0.56, 95% CI 0.39–0.79, p = 0.001). Literate women had a 2.54 times higher odds of P. falciparum infection compared to illiterate women (95% CI 1.31–4.91, p = 0.006). Conclusions The prevalence of P. falciparum infection among pregnant women remains high in Burkina Faso, although use of IPTp-SP and ITNs were found to reduce the odds of infection. Despite this, compliance with IPTp-SP remains far from that recommended by the National Malaria Control Programme and World Health Organization. Behaviour change communication should be strengthened to encourage compliance with protective malaria control tools during pregnancy.

scholarly journals Knowledge of risks of malaria in pregnancy on use of ITNs among pregnant women in northern Ghana

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
F Dun-Dery ◽  
C Beiersmann ◽  
N Kuunibe ◽  
O Müller
Keyword(s):  
Antenatal Care ◽  
Pregnant Women ◽  
Malaria Prevention ◽  
Malaria In Pregnancy ◽  
Sub Saharan Africa ◽  
Bed Nets ◽  
Maternal Knowledge ◽  
Itn Use ◽  
Malaria Knowledge ◽  
In Pregnancy

Abstract Background Every year malaria in pregnancy causes 10,000 maternal mortalities worldwide, 20% of stillbirths, 11% of all new-born deaths and 900,000 low-birth-weight babies in sub-Saharan Africa. Maternal knowledge of malaria risks in pregnancy plays a significant role in malaria prevention. However, it is unknown if this preventable loss of lives and morbidities are caused by lack of knowledge, lack of prevention tools or both. We measured the pregnancy-related risks of malaria knowledge and bed net availability and use among pregnant women in Ghana. Methods We interviewed 770 pregnant women who attended antenatal care in 37 primary care clinics in Ghana from January through May 2019. We integrated this data in a sequential explanatory design with qualitative insights from 6 focus groups with 8 pregnant women each. Results 697/770 questionnaires were analyzed. 67% have general knowledge on malaria prevention but only 19% knew the specific risks on pregnancy outcomes. ITNs were owned by 89%, but only 75% reported to regularly use them. There was a statistically significant correlation between specific risks of malaria knowledge and ITN use (P<.001, OR = 2.0, CI:1.3-3.0). Other factors associated with ITN use were higher income, owning an ITN, higher parity, formal education, religion, and age. Reasons for non-adherence to ITN use include inappropriate hanging infrastructure, discomfort with using an ITN, and use of other prevention alternatives. Conclusions The study demonstrates that maternal knowledge on the risks of malaria in pregnancy significantly influenced their adherence to the use of insecticide-treated bed nets. Key messages The use of ITNs as a prevention method for malaria correlates to the knowledge of mothers about risks of malaria in pregnancy. Antenatal care malaria prevention efforts should focus more on teaching the specific risks of malaria in pregnancy.

scholarly journals Evaluation of the Antigenic Diversity of Placenta-Binding Plasmodium falciparum Variants and the Antibody Repertoire among Pregnant Women

2010 ◽  
Vol 78 (5) ◽  
pp. 1963-1978 ◽  
Author(s):  
Mirja Hommel ◽  
Salenna R. Elliott ◽  
Viju Soma ◽  
Greg Kelly ◽  
Freya J. I. Fowkes ◽  
...  
Keyword(s):  
Plasmodium Falciparum ◽  
Pregnant Women ◽  
Vaccine Development ◽  
Malaria In Pregnancy ◽  
Antigenic Diversity ◽  
Molecular Approaches ◽  
Major Antigen ◽  
Different Populations ◽  
High Level ◽  
In Pregnancy

ABSTRACTPregnant women are infected by specific variants ofPlasmodium falciparumthat adhere and accumulate in the placenta. Using serological and molecular approaches, we assessed the global antigenic diversity of surface antigens expressed by placenta-binding isolates to better understand immunity to malaria in pregnancy and evolution of polymorphisms and to inform vaccine development. We found that placenta-binding isolates originating from all major regions where malaria occurs were commonly recognized by antibodies in different populations of pregnant women. There was substantial antigenic overlap and sharing of epitopes between isolates, including isolates from distant geographic locations, suggesting that there are limitations to antigenic diversity; however, differences between populations and isolates were also seen. Many women had cross-reactive antibodies and/or a broad repertoire of antibodies to different isolates. Studying VAR2CSA as the major antigen expressed by placenta-binding isolates, we identified antibody epitopes encoded by variable sequence blocks in the DBL3 domain. Analysis of globalvar2csaDBL3 sequences demonstrated that there was extensive sharing of variable blocks between Africa, Asia, Papua New Guinea, and Latin America, which likely contributes to the high level of antigenic overlap between different isolates. However, there was also evidence of geographic clustering of sequences and differences in VAR2CSA sequences between populations. The results indicate that there is limited antigenic diversity in placenta-binding isolates and may explain why immunity to malaria in pregnancy can be achieved after exposure during one pregnancy. Inclusion of a limited number of variants in a candidate vaccine may be sufficient for broad population coverage, but geographic considerations may also have to be included in vaccine design.

scholarly journals Piperaquine pharmacokinetics during intermittent preventive treatment for malaria in pregnancy

2020 ◽  
Author(s):  
Palang Chotsiri ◽  
Julie Gutman ◽  
Rukhsana Ahmed ◽  
Jeanne Rini Poespoprodjo ◽  
Din Syafruddin ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Intermittent Preventive Treatment ◽  
Preventive Treatment ◽  
Preventive Therapy ◽  
Malaria In Pregnancy ◽  
Pharmacokinetic Parameters ◽  
Population Pharmacokinetic ◽  
Pharmacokinetic Studies ◽  
Pharmacokinetic Properties ◽  
In Pregnancy

Background: Dihydroartemisinin-piperaquine (DP) is a long-acting artemisinin combination treatment that provides effective chemoprevention and has been proposed as an alternative antimalarial drug for intermittent-preventive therapy in pregnancy (IPTp). Several pharmacokinetic studies have shown that dose adjustment may not be needed for the treatment of malaria in pregnancy with DP. However, there are limited data on the optimal dosing for IPTp. Objective: This study aimed to evaluate the population pharmacokinetics of piperaquine given as IPTp in pregnant women. Methods: Pregnant women were enrolled in clinical trials conducted in Kenya and Indonesia and treated with standard 3-day courses of DP, administered in 4-8 weeks intervals from the second trimester until delivery. Pharmacokinetic blood samples were collected for piperaquine drug measurements before each treatment round, time of breakthrough symptomatic malaria, and at delivery. Piperaquine population pharmacokinetic properties were investigated using nonlinear mixed-effects modelling with a prior approach. Results: In total data from 366 Kenyan and 101 Indonesian women were analysed. The pharmacokinetic properties of piperaquine were adequately described using a flexible transit absorption (n=5) followed by a three-compartment disposition model. Gestational age did not affect the pharmacokinetic parameters of piperaquine. After three rounds of monthly IPTp, 9.45% (95% CI: 1.8-26.5) of pregnant women had trough piperaquine concentrations below the suggested target concentration (10.3 ng/mL). Translational simulations suggest that providing the full treatment dose of DP at monthly intervals provides sufficient protection to prevent malaria infection. Conclusions: Monthly administration of a DP has the potential to offer optimal prevention of malaria during pregnancy.

scholarly journals Risk Factors for Plasmodium Falciparum Infection in Pregnant Women in Burkina Faso: A Community-Based Malaria Cross-Sectional Survey

2021 ◽  
Author(s):  
Jean Baptiste Yaro ◽  
Alphonse Ouedraogo ◽  
Amidou Diarra ◽  
Salif Sombié ◽  
Z Amidou Ouedraogo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Plasmodium Falciparum ◽  
Burkina Faso ◽  
Pregnant Women ◽  
Malaria Control ◽  
Dry Season ◽  
Malaria In Pregnancy ◽  
Wet Season ◽  
Cross Sectional ◽  
In Pregnancy

Abstract Background: Malaria in pregnancy remains a public health problem in sub-Saharan Africa. Identifying risk factors for malaria in pregnancy could assist in developing interventions to reduce the risk of malaria in Burkina Faso and other countries in the region.Methodology: Two cross-sectional surveys were carried out to measure Plasmodium falciparum infection using microscopy in pregnant women in Saponé Health District, central Burkina Faso. Data were collected on individual, household and environmental variables and their association with P. falciparum infection assessed using multivariate analysis. Results: A total of 356 pregnant women were enrolled in the surveys, 174 during the dry season and 182 during the wet season. The mean number of doses of sulphadoxine pyrimethamine for Intermittent Preventive Treatment in pregnancy (IPTp-SP) was 0.4 doses during the first trimester, 1.1 doses at the second and 2.3 doses at the third. Overall prevalence of P. falciparum infection by microscopy was 15.7%; 17.8% in the dry season and 13.7% in the wet season. 88.2% of pregnant women reported sleeping under an insecticide-treated net on the previous night. P. falciparum infection risk in pregnancy was reduced in those women who reported using an ITN (Odds ratio, OR=0.31, 95% CI 0.12-0.79, p=0.02) and an increasing number of IPTp-SP doses during pregnancy, with each additional dose reducing the odds by 40% (OR=0.59, 95% CI 0.43–0.81, p<0.001). ConclusionThe prevalence of P. falciparum infection among pregnant women remains high in Burkina Faso although use of IPTp-SP and ITNs were found to reduce the odds of infection. Despite this, compliance with IPTp remains far from that recommended by the National Malaria Control Programme and World Health Organization. Behaviour change communication should be improved to encourage compliance with protective malaria control tools during pregnancy.

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