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 Population Pharmacokinetics of Mefloquine Intermittent Preventive Treatment for Malaria in Pregnancy in Gabon

2018 ◽  
Vol 63 (2) ◽  
pp. e01113-18 ◽  
Author(s):  
Michael Ramharter ◽  
Matthias Schwab ◽  
Ghyslain Mombo-Ngoma ◽  
Rella Zoleko Manego ◽  
Daisy Akerey-Diop ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Intermittent Preventive Treatment ◽  
Preventive Treatment ◽  
Malaria In Pregnancy ◽  
Pharmacokinetic Analysis ◽  
Population Pharmacokinetic ◽  
Blood Concentrations ◽  
Split Dose ◽  
Dosing Regimens ◽  
In Pregnancy

ABSTRACT Mefloquine was evaluated as an alternative for intermittent preventive treatment of malaria in pregnancy (IPTp) due to increasing resistance against the first-line drug sulfadoxine-pyrimethamine (SP). This study determined the pharmacokinetic characteristics of the mefloquine stereoisomers and the metabolite carboxymefloquine (CMQ) when given as IPTp in pregnant women. Also, the relationship between plasma concentrations of the three analytes and cord samples was evaluated, and potential covariates influencing the pharmacokinetic properties were assessed. A population pharmacokinetic analysis was performed with 264 pregnant women from a randomized controlled trial evaluating a single and a split-dose regimen of two 15-mg/kg mefloquine doses at least 1 month apart versus SP-IPTp. Both enantiomers of mefloquine and its carboxy-metabolite (CMQ), measured in plasma and cord samples, were applied for pharmacokinetic modelling using NONMEM 7.3. Both enantiomers and CMQ were described simultaneously by two-compartment models. In the split-dose group, mefloquine bioavailability was significantly increased by 5%. CMQ induced its own metabolism significantly. Maternal and cord blood concentrations were significantly correlated (r2 = 0.84) at delivery. With the dosing regimens investigated, prophylactic levels are not constantly achieved. A modeling tool for simulation of the pharmacokinetics of alternative mefloquine regimens is presented. This first pharmacokinetic characterization of mefloquine IPTp indicates adequate exposure in both mefloquine regimens; however, concentrations at delivery were below previously suggested threshold levels. Our model can serve as a valuable tool for researchers and clinicians to develop and optimize alternative dosing regimens for IPTp in pregnant women.

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 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 Participatory research for the development of information, education and communication tools to promote intermittent preventive treatment of malaria in pregnancy in the Democratic Republic of the Congo, Nigeria and Mozambique

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Sylvain Landry Birane Faye ◽  
Maud Majeres Lugand
Keyword(s):  
Pregnant Women ◽  
Democratic Republic ◽  
Intermittent Preventive Treatment ◽  
Healthcare Providers ◽  
Preventive Treatment ◽  
User Preferences ◽  
Malaria In Pregnancy ◽  
Communication Tools ◽  
Republic Of The Congo ◽  
In Pregnancy

Abstract Background To improve the coverage of intermittent preventive treatment of malaria in pregnancy (IPTp) in Africa, Medicines for Malaria Venture (MMV) developed, tested and validated a new packaging of sulfadoxine–pyrimethamine (SP), as well as specific communications tools designed to improve knowledge of IPTp and the motivation of women to adhere to it, particularly if it is distributed by community health workers (CHW). Methods This article describes and analyses the results of an empirical research carried out in the Democratic Republic of the Congo (DRC), Nigeria and Mozambique, to evaluate the perception and social acceptability of SP for healthcare providers, CHW and pregnant women, and to assess the ability of the new SP packaging and the communications tools to change their perception of SP and improve their attitudes towards IPTp. Results The results indicate that SP’s new individual packaging was perceived by pregnant women and healthcare providers as a “hygienic” and “safe”, with a specific identity. The graphics used in IPTp communications tools were modified according to the respondents’ feedback to make them more culturally and socially sensitive, and then validated. However, although the new blister packaging and IPTp communications tools generated greater confidence and motivation, SP side effects as well as preconceived ideas, particularly regarding its efficacy, remain a challenge that must be addressed to improve IPTp acceptance and compliance by healthcare providers and pregnant women. Conclusion This participatory approach to social research based on ongoing feedback to the graphic designer provided more empirical evidence to improve and adapt the textual and visual content of communication tools (SP blister packaging, leaflet, user guide) to local contexts and user preferences. Tested and validated in different socio-cultural and socio-political contexts, these tools provide a good basis for the promotion of IPTp in Africa.

scholarly journals Impact of Insecticide Treated Nets and Intermittent Preventive Treatment in Reducing Malaria Morbidity among Pregnant Women in Gombe, Nigeria

2020 ◽  
Vol 24 (7) ◽  
pp. 1279-1282
Author(s):  
R. Ali ◽  
M.A. Qadeer ◽  
B. Mohammed ◽  
A. Sarki
Keyword(s):  
Pregnant Women ◽  
Malaria Parasite ◽  
Intermittent Preventive Treatment ◽  
Public Health Problem ◽  
Preventive Treatment ◽  
Malaria In Pregnancy ◽  
Major Public Health Problem ◽  
Insecticide Treated Nets ◽  
The Difference ◽  
In Pregnancy

Malaria in pregnancy is a major public health problem affecting women fetuses and new borns. Many studies highlight the critical importance of continuing the use of Insecticide Treated Nets (ITN) and Intermittent Preventive Treatment In Pregnancy (IPTp) among pregnant women to reduce the adverse consequences of malaria in pregnancy. This study was conducted in order to determine malaria prevalence in relation to the use ofITN and IPTp among the pregnant women in the study area. Five (5) ml of blood was obtained from each participant by the use of a sterile syringe and placed in a sterile EDTA container for laboratory analysis. The malaria parasite was detected by microscopic examination of Giemsa-stained thick blood films. Information on the use of ITN and IPTP was collected using administered questionnaire. A high prevalence of 78.4% was observed among the studied population. Although 74.4% of those that use ITN were positive for malaria parasite as against the 83.6% of those that reported not using the ITN, the difference was statistically not significant (p<0.05). 70.0% of those reported using IPTp were positive however, higher percentage was observed for those reported not using IPTp (83.7.0%). The difference was statistically significant in this case. This study has shown the influence of malaria prevention method during pregnancy on malaria infection and the need for targeted preventive starategies when  designing and implementing policies aimed at improving uptake of these measures during pregnancy in Gombe. Keywords: malaria, pregnant women, ITN, Gombe, IPTp  

scholarly journals Optimal Antimalarial Dose Regimens for Sulfadoxine-Pyrimethamine with or without Azithromycin in Pregnancy Based on Population Pharmacokinetic Modeling

2017 ◽  
Vol 61 (5) ◽  
Author(s):  
Sam Salman ◽  
Francisca Baiwog ◽  
Madhu Page-Sharp ◽  
Susan Griffin ◽  
Harin A. Karunajeewa ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Drug Exposure ◽  
Intermittent Preventive Treatment ◽  
Preventive Treatment ◽  
Population Pharmacokinetic ◽  
Time Data ◽  
Mixed Effect ◽  
Population Pharmacokinetic Modeling ◽  
Final Population ◽  
In Pregnancy

ABSTRACT Optimal dosing of sulfadoxine-pyrimethamine (SP) as intermittent preventive treatment in pregnancy remains to be established, particularly when coadministered with azithromycin (AZI). To further characterize SP pharmacokinetics in pregnancy, plasma concentration-time data from 45 nonpregnant and 45 pregnant women treated with SP-AZI (n = 15 in each group) and SP-chloroquine (n = 30 in each group) were analyzed. Population nonlinear mixed-effect pharmacokinetic models were developed for pyrimethamine (PYR), sulfadoxine (SDOX), and N-acetylsulfadoxine (the SDOX metabolite NASDOX), and potential covariates were included. Pregnancy increased the relative clearance (CL/F) of PYR, SDOX, and NASDOX by 48, 29, and 70%, respectively, as well as the relative volumes of distribution (V/F) of PYR (46 and 99%) and NASDOX (46%). Coadministration of AZI resulted in a greater increase in PYR CL/F (80%) and also increased NASDOX V/F by 76%. Apparent differences between these results and those of published studies of SP disposition may reflect key differences in study design, including the use of an early postpartum follow-up study rather than a nonpregnant comparator group. Simulations based on the final population model demonstrated that, compared to conventional single-dose SP in nonpregnant women, two such doses given 24 h apart should ensure that pregnant women have similar drug exposure, while three daily SP doses may be required if SP is given with AZI. The results of past and ongoing trials using recommended adult SP doses with or without AZI in pregnant women may need to be interpreted in light of these findings and consideration given to using increased doses in future trials.

scholarly journals Acceptability of Intermittent Screening and Treatment (IST) versus Intermittent Preventive Treatment (IPT) for the control of malaria in pregnancy: perspective of the Nigerian pregnant woman

2021 ◽  
Vol 17 (2) ◽  
pp. 142-152
Author(s):  
Danlami W. Dayom ◽  
Ehijie F.O. Enato ◽  
Godwin P. Ekpe ◽  
Ibrahim A. Kamal
Keyword(s):  
Focus Group ◽  
Intermittent Preventive Treatment ◽  
Preventive Treatment ◽  
Malaria Prevention ◽  
Preventive Therapy ◽  
Malaria In Pregnancy ◽  
Postpartum Women ◽  
Focus Group Discussions ◽  
Group Discussions ◽  
In Pregnancy

This study qualitatively compared the acceptability of intermittent preventive therapy with an alternative intervention - intermittent screening and treatment for prevention of malaria in pregnancy (MiP) among postpartum women in Edo State, Nigeria. Four focused group discussions were held with postpartum women who participated in a multi-center clinical trial that compared intermittent preventive therapy and intermittent screening and treatment for malaria in pregnancy between 2014 and 2015. The focus group discussions were guided by semi-structured open ended questions covering topics related to their experiences and choice of either interventions. Discussions were analyzed inductively based on emerged themes. Intermittent screening and treatment was most preferred and acceptable by the study participants compared to the intermittent preventive treatment approached. The quest to know their health status through the investigations was a motivation for their choice of the intervention. The rejection of intermittent  preventive therapy was due to the general fear of medication use during pregnancy without apparent indication considering theside effects experienced with SP-based intermittent preventive therapy by women who considered themselves healthy. A properly designed and implemented intermittent screening and treatment programme could therefore be more effective in reducing the burden of malaria in pregnancy in the country. Keywords: Acceptability; Focus group discussions; Malaria prevention; Pregnant women

scholarly journals Determinants of the Uptake of Intermittent Preventive Treatment of Malaria in Pregnancy with Sulphadoxine Pyrimethamine in Sabatia Sub County, Western Kenya

2021 ◽  
Author(s):  
Joshua Andala Mutanyi ◽  
Daniel O. Onguru ◽  
Sidney O. Ogolla ◽  
Lawrence B. Adipo
Keyword(s):  
Pregnant Women ◽  
Health Workers ◽  
Intermittent Preventive Treatment ◽  
Preventive Treatment ◽  
Malaria In Pregnancy ◽  
World Health ◽  
Maternal Knowledge ◽  
Western Kenya ◽  
Sulphadoxine Pyrimethamine ◽  
In Pregnancy

Abstract Background: Malaria in pregnancy remains a major public health problem. Annually, 125.2 million pregnant women worldwide are at risk of malaria infection including 30.3 million and 1 million pregnant women in Sub-Saharan Africa and Kenya respectively. The World Health Organization recommends that pregnant women in malaria endemic areas receive at least three doses of sulphadoxine pyrimethamine for intermittent preventive treatment of malaria in pregnancy (IPTp-SP) for optimal benefit. However, IPTp-SP optimal uptake is undesirably low in Kenya. This study investigated the prevalence of and factors influencing IPTp-SP optimal uptake in Sabatia Sub County, Western Kenya. Understanding the epidemiology of malaria in pregnancy is core for making decisions and setting priorities towards IPTp-SP optimization.Methods: This was a cross-sectional study conducted in Sabatia Sub County. Using a validated semi structured questionnaire, data were obtained from 372 randomly sampled post-delivery women aged 15 – 49 years who had a live birth within one year preceding the study. Women on cotrimoxazole prophylaxis during their pregnancy were excluded. Association between IPTp-SP uptake and independent variables was analysed using Pearson Chi-square and Fisher’s Exact test. Bivariate and multiple binary logistic regression analysed predictors of optimal IPTp-SP uptake.Results: Overall, 99.46 % of the respondents received at least one IPTp-SP dose. The prevalence of optimal IPTp-SP uptake was 79.57% (95% CI 75.47%, 83.67%). After multivariate analysis; gestational age at first antenatal care (ANC) visit (p = 0.04), frequency of ANC visits (p < 0.001), maternal knowledge of IPTp-SP benefits (p < 0.001), maternal knowledge of optimal SP dose (p = 0.03) and administration of sulphadoxine pyrimethamine at ANC clinic (p = 0.03) significantly predicted the optimal uptake of IPTp-SP.Conclusions: Optimal uptake of IPTp-SP is high in the study area. Efforts towards early and more frequent ANC attendance should be enhanced and sustained. Structured and targeted health education should be adopted and health workers should always administer SP drugs or explain to some pregnant women their ineligibility for initial IPTp-SP receipt. Future studies considering large sample drawn from the whole country and health workers’ perspective of the health system delivery factors are recommended.

scholarly journals Pharmacokinetic Properties of Azithromycin in Pregnancy

2009 ◽  
Vol 54 (1) ◽  
pp. 360-366 ◽  
Author(s):  
Sam Salman ◽  
Stephen J. Rogerson ◽  
Kay Kose ◽  
Susan Griffin ◽  
Servina Gomorai ◽  
...  
Keyword(s):  
High Performance ◽  
Antimalarial Activity ◽  
Intermittent Preventive Treatment ◽  
Preventive Treatment ◽  
Central Compartment ◽  
Population Pharmacokinetic ◽  
Time Curve ◽  
Population Pharmacokinetic Modeling ◽  
Pharmacokinetic Properties ◽  
In Pregnancy

ABSTRACT Azithromycin (AZI) is an azalide antibiotic with antimalarial activity that is considered safe in pregnancy. To assess its pharmacokinetic properties when administered as intermittent preventive treatment in pregnancy (IPTp), two 2-g doses were given 24 h apart to 31 pregnant and 29 age-matched nonpregnant Papua New Guinean women. All subjects also received single-dose sulfadoxine-pyrimethamine (SP) (1,500 mg or 75 mg) or chloroquine (450-mg base daily for 3 days). Blood samples were taken at 0, 1, 2, 3, 6, 12, 24, 32, 40, 48, and 72 h and on days 4, 5, 7, 10, and 14 for AZI assay by ultra-high-performance liquid chromatography-tandem mass spectrometry. The treatments were well tolerated. Using population pharmacokinetic modeling, a three-compartment model with zero-order followed by first-order absorption and no lag time provided the best fit. The areas under the plasma concentration-time curve (AUC0-∞) (28.7 and 31.8 mg·h liter−1 for pregnant and nonpregnant subjects, respectively) were consistent with the results of previous studies, but the estimated terminal elimination half-lives (78 and 77 h, respectively) were generally longer. The only significant relationship for a range of potential covariates, including malarial parasitemia, was with pregnancy, which accounted for an 86% increase in the volume of distribution of the central compartment relative to bioavailability without a significant change in the AUC0-∞. These data suggest that AZI can be combined with compounds with longer half-lives, such as SP, in combination IPTp without the need for dose adjustment.

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