MALARIA IN PREGNANCY

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					MALARIA IN PREGNANCY.
          MAL/ AIR(HISTORICAL).
  PREVENTABLE AND TREATABLE INFECTION
 PREDOMINANTLY BY THE BITE OF THE FEMALE
  ANOPHELES MOSQUITO (Anopheles gambiae
              predominantly)
            INTRODUCTION.

AETIOLOGY- Plasmodium falciparum++
( Life cycle in mosquito/man).
DISEASE BURDEN.
 Globally, 1 infant death Q 30 sec.
 1 in 10 maternal death-cardiac failure consequent to
   severe anaemia.
 60-70% GOPD attendance.
 Absenteeism at school/work.
 US D 4.2 Billon needed for control and treatment.
       CLINICAL FEATURES.

• UNCOMPLICATED (mild)- parasitaemia,
  fever (low grade), body aches,chills.e.t.c.

• COMPLICATED (severe)- parasitaemia,
   high grade fever, anaemia (severe,very
  severe),cardiac failure, dehydration,
  haemoglobinuria (coca-coloured
  urine),renal failure, jaundice ,
  prostration,coma(cerebral malaria).
 EFFECT OF PREGNANCY ON
         MALARIA.
• WORSE IN PRIMIGRAVIDA/ 2nd
  Trimester.

EFFECT OF MALARIA ON PREGNANCY
• PLACENTAL PARASITAEMIA-
  IUGR,IUFD.
• PRETERM CONTRACTIONS/LABOUR.
• MISCARRIAGES.
                  DIAGNOSIS.
• CLINICAL(PRESUMPTIVE).
• LABORATORY(CONFIRMATORY)
   -MICROSCOPIC
     * THIN BLOOD SMEAR (speciation)
     * THICK BLOOD SMEAR( density)
     * BUFFY COAT (FLOURESCENCE
       MICROSCOPY)

   -NON MICROSCOPIC
    *Ag Pla LDH
    *Ab Pla LDH
    *Rapid diagnostic test.
    *Polymerase Chain Reaction (PCR)
   ROLL BACK MALARIA(RBM)
          INITIATIVE.
• GLOBAL FRAMEWORK (1998) –TO IMPLEMENT
  COORDINATED ACTION AGAINST MALARIA SO THAT WE CAN
  HAVE A WORLD FREE FROM THE BURDEN OF
  MALARIA.(WHO,UNDP,UNICEF AND W.B.)

• 2015-MALARIA SPECIFIC MDG(6) IS ACHIEVED
 -NO LONGER A MAJOR CAUSE OF MORTALITY.
 - NOT A BARRIER TO SOCIO-ECONOMIC GROWTH.

o RBM STRATEGY- TO REDUCE MALARIA MORBIDITY AND
  MORTALITY BY SCALING UP FOR IMPACT OF PREVENTIVE&
  THERAPEUTIC INTERVENTIONS AND SUSTAINING CONTROL
  OVER TIME.
    SPECIFIC MEASURES FOR RBM
•      INTEGRATED VECTOR CONTROL
    ENVIRONMENTAL
    ITNs (Long Lasting).

o       IPT- FIXED DOSES OF SULFONAMIDE/PYRIMETHAMINE GIVEN AT SPECIFIC INTERVALS AT LEAST 4 WEEKS APART TO
        COMBAT A PRESUMED LOAD OF PARASITES.
    HIV –VE AT LEAST 2 DOSES(16-36 WKS)
    HIV+VE AT LEAST 3 DOSES.
    OTHER PROPHYLACTICS-PROGUANIL.

o      EFFECTIVE CASE MANAGEMENT.
    RAPID DIAGNOSIS AND PROMPT TREATMENT
    USING ARTEMISININ COMBINATION Therapy (ACT)
    SCHIZONTOCIDAL.
    ARTHEMETHER/LUMEFANTRINE (20/120)
    ARTEMISININ/FANSIDAR
    ARTEMISININ/AMODIAQUINE

 ****MONOTHERAPY DISCOURAGED BUT QUININE MAY STILL BE USED CAREFULLY.
•         Level of resistance to chloroquine in the region : A National survey by the Federal Ministry of Health, Abuja, Nigeria in 2003,
      revealed an average national Adequate Clinical/Parasitological Response(ACPR) for Chloroquine to be 39%. Consequently,
•     the level of resistance to chloroquine was 61%. However, the ACPR for the South-Western geopolitical zone in which our
      institution (OAUTHC) is based was 40.9%,with the level of resistance to Chloroquine being 59.1%.
•     Level of resistance to SULPHADOXINE-Pyrimethamine (S-P) : The average national Adequate Clinical/Parasitological
      Response(ACPR) in 2003 to S-P was 57. CONSEQUENTLY, it’s level of resistance was 43%. However, the ACPR of S-P in the
      South-western geo-political zone in which our institution(OAUTHC) is based was 75.6%. Consequently, the level of resistance
      to S-P was 24.4%.
VACCINES
CONCLUSION.

				
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posted:8/7/2012
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