Intermittent preventive treatment for malaria in pregnancy: Is directly observed therapy still necessary? A prospective cohort study in a tertiary hospital, Southern Nigeria

Objective: Malaria is a major cause of indirect maternal death. In the last two decades several efforts have been made to combat the menace of this disease especially among pregnant women and children in developing countries. Directly observed therapy (DOT) was recommended to enhance the uptake of intermittent preventive treatment (IPT) of malaria with sulfadoxine – pyrimethamine among pregnant women. Due to challenges involved in the practice of DOT especially with regards to shortage of man power and clean water in rural areas, there is need to evaluate impact of DOT on the effectiveness of treatment. Material and Methods: A cohort study was carried out among 320 healthy pregnant women receiving ante natal care with equal assignment of subjects. The study group (160) received two doses of IPT by DOT while 160 matched controls were given prescription for self- drug administration at home. Malaria tests were done using microscopy method and the hemoglobin values determined using centrifuge one month after the second dose of IPT. Umbilical cord blood samples were obtained for a repeat microscopy at delivery. Results: The results showed that there were no statistical significant differences in the venous blood parasitemia, placental parasitemia and anaemia between the DOT group and the control group (P = 0.215; P = 0.100; P = 0.966) respectively. Lower social class was the main predictor of anaemia in pregnancy (P = 0.032). Conclusion: The delivery of IPT through DOT may not influence uptake in some settings. Effort may need to be channeled into ante natal education and women empowerment.

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Placental Malaria Parasitization at Delivery: Experience at a Nigerian Tertiary Hospital

European Scientific Journal ESJ ◽

10.19044/esj.2018.v14n9p243 ◽

2018 ◽

Vol 14 (9) ◽

pp. 243

Author(s):

Oweisi P.W. ◽

John C.T. ◽

Omietimi J.E. ◽

Aigere E.O.S. ◽

Allagoa D.O. ◽

...

Keyword(s):

Maternal Age ◽

Placental Malaria ◽

Intermittent Preventive Treatment ◽

Preventive Treatment ◽

Educational Status ◽

Tertiary Hospital ◽

Directly Observed Therapy ◽

Malaria Parasitaemia ◽

Cross Sectional ◽

In Pregnancy

Background: In malaria endemic areas, pregnant women are constantly at risk of repeated malaria infestation which if left untreated, poses a significant threat to the health and survival of the mother and her baby. Objective: This study determined the prevalence and risk factors for placental malaria parasitaemia among parturients at the Federal Medical Centre, Yenagoa, Nigeria. Methodology: A prospective cross-sectional analytical study of 205 parturients recruited consecutively at presentation for delivery. An interviewer-administered questionnaire was used to collect data. After delivery, placental blood was collected for microscopy to detect malaria parasites. Data was analysed using SPSS version 22. Results: The prevalence of placental malaria parasitaemia was 13.7%. Maternal age <25 years (P<0.001), low educational status (P = 0.03), low parity (P = 0.03), unbooked status (P < 0.001) and non-use of intermittent preventive treatment (P <0.001) were significantly associated with placental malaria parasitaemia. Receiving three or more doses of sulphadoxine-pyrimethamine for intermittent preventive treatment of malaria in pregnancy was by far, more protective for placental malaria than receiving 2 doses (odds ratio = 0.25). Plasmodium falciparum was the only parasite species detected. Conclusion: Malaria still ravages our obstetric population and the significant contributors include low maternal age, low educational status, low parity, unbooked status and non-use of intermittent preventive treatment in pregnancy. Women should be encouraged to utilize antenatal care. There should be a prompt adoption of the recent WHO recommendations regarding malaria prophylaxis in pregnancy in all obstetric units and the medication should be given as Directly Observed Therapy.

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

10.21203/rs.3.rs-40304/v1 ◽

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.

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Factors Associated with Anemia in Pregnancy in Cascades Region in Burkina Faso

European Journal of Nutrition & Food Safety ◽

10.9734/ejnfs/2015/21018 ◽

2015 ◽

pp. 663-664

Author(s):

Ilboudo Bernard ◽

Savadogo G. Léon Blaise ◽

Kinda Maurice ◽

Guiguemde T. Robert ◽

Dramaix-wilmet Michèle ◽

...

Keyword(s):

Burkina Faso ◽

Pregnant Women ◽

Intermittent Preventive Treatment ◽

Preventive Treatment ◽

Cross Sectional Study ◽

Cross Sectional ◽

Factors Associated ◽

Anemia In Pregnancy ◽

Prevalence Of Anemia ◽

In Pregnancy

Objectives: To analyze the factors associated with anemia in pregnancy in the Cascades region in Burkina Faso. Methods: A cross-sectional study was carried out in antenatal clinics of the Cascades region in Burkina Faso during one month from May to June 2012. We collected data on socio-demographics and health characteristics of pregnant women attending these clinics. Hemoglobin was measured to assess anemia. Factors associated with anemia were identified through a multivariate analysis. Results: A total of 1763 pregnant women, irrespectively of pregnancy stage, were enrolled. The mean (SD) hemoglobin level was 10.6 (1.4) g/dl. The prevalence of anemia in pregnancy was 58.9%, 3.2% of them being severe. Factors associated with anemia were the absence of intermittent preventive treatment of malaria with sulfadoxin-pyrimetamin (OR = 1.3, 95% CI: 1.0-1.7), number of pregnancies >6 (OR = 1.4, 95% CI: 1.1-1.9). Moderate consumption of local alcohol extracted from Palmyra was associated with a lower prevalence of anemia (OR = 0.7, 95% CI: 0.5-0.9). Surprisingly, anemia was not associated with supplementation with folic acid + iron (p = 0.60). Conclusions: Interventions which aim to reduce the prevalence of anemia in pregnancy in Burkina Faso should improve the coverage of the intermittent preventive treatment of malaria and support the limitation of births.

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

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.01113-18 ◽

2018 ◽

Vol 63 (2) ◽

pp. e01113-18 ◽

Cited By ~ 1

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.

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Helicobacter pylori infection and hyperemesis gravidarum: a prospective pilot study in India

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20193055 ◽

2019 ◽

Vol 8 (7) ◽

pp. 2856

Author(s):

Akhila M. V. ◽

Padmasri R.

Keyword(s):

Socioeconomic Status ◽

Helicobacter Pylori ◽

Pregnant Women ◽

Rural Areas ◽

Hyperemesis Gravidarum ◽

Venous Blood ◽

Tertiary Hospital ◽

Helicobacter Pylori Infection ◽

H Pylori ◽

A Prospective Study

Background: About 80% of all pregnant women experience some form of nausea and vomiting during their pregnancy. Hyperemesis gravidarum, the commonest indication for admission to hospital in the first half of pregnancy affects approximately 0.3%-2.0% of pregnancies. Helicobacter pylori infection has been implicated in the cause of nausea and occasional vomiting in early pregnancy. The objectives of this study are to determine the proportion of H. pylori seropositivity among women with hyperemesis gravidarum (HG) and determine its relation with socio-economic status.Methods: This was a prospective study conducted in a tertiary hospital in Bangalore among 60 pregnant women with HG for a period of 12 months. Venous blood samples were obtained and serum IgG for H. pylori was measured using enzyme-linked immunosorbant assay (ELISA). Details regarding socioeconomic status, recurrence of symptoms and severity were noted.Results: The proportion of H. pylori seropositivity among pregnant women with hyperemesis in our study was 70%.There was a significant increase in severity and recurrence of vomiting among seropositive cases. Women belonging to rural areas had 1.17 times the risk of infection compared to women with urban area. We also found women belonging to the lower socioeconomic status had 0.52 times more risk to develop Helicobacter pylori infection.Conclusions: This study suggests that H. pylori is an independent risk factor for vomiting in pregnancy. Effective treatment and eradication of H pylori infection may help reduce severity and recurrence of vomiting among positive cases thus reducing its adverse consequences.

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Intermittent screening and treatment with dihydroartemisinin-piperaquine for the prevention of malaria in pregnancy: implementation feasibility in a routine healthcare system setting in western Kenya

Malaria Journal ◽

10.1186/s12936-020-03505-0 ◽

2020 ◽

Vol 19 (1) ◽

Author(s):

Jenny Hill ◽

Peter Ouma ◽

Seth Oluoch ◽

Jane Bruce ◽

Simon Kariuki ◽

...

Keyword(s):

Intermittent Preventive Treatment ◽

Preventive Treatment ◽

Standard Of Care ◽

Health Facilities ◽

Malaria In Pregnancy ◽

Sub Saharan Africa ◽

Directly Observed Therapy ◽

Western Kenya ◽

Sub Saharan ◽

In Pregnancy

Abstract Background Intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) is recommended for preventing malaria in pregnancy in areas of moderate-to-high transmission in sub-Saharan Africa. However, due to increasing parasite resistance to SP, research on alternative strategies is a priority. The study assessed the implementation feasibility of intermittent screening and treatment (ISTp) in the second and third trimester at antenatal care (ANC) with malaria rapid diagnostic tests (RDTs) and treatment of positive cases with dihydroartemisinin-piperaquine (DP) compared to IPTp-SP in western Kenya. Methods A 10-month implementation study was conducted in 12 government health facilities in four sub-counties. Six health facilities were assigned to either ISTp-DP or IPTp-SP. Evaluation comprised of facility audits, ANC observations, and exit interviews. Intermediate and cumulative effectiveness analyses were performed on all processes involved in delivery of ISTp-DP including RDT proficiency and IPTp-SP ± directly observed therapy (DOT, standard of care). Logistic regression was used to identify predictors of receiving each intervention. Results A total of 388 and 389 women were recruited in the ISTp-DP and IPTp-SP arms, respectively. For ISTp-DP, 90% (289/320) of eligible women received an RDT. Of 11% (32/289) who tested positive, 71% received the correct dose of DP and 31% the first dose by DOT, and only 6% were counselled on subsequent doses. Women making a sick visit and being tested in a facility with a resident microscopist were more likely to receive ISTp-DP (AOR 1.78, 95% CI 1.31, 2.41; and AOR 3.75, 95% CI 1.31, 2.40, respectively). For IPTp-SP, only 57% received a dose of SP by DOT. Payment for a laboratory test was independently associated with receipt of SP by DOT (AOR 6.43, 95% CI 2.07, 19.98). Conclusions The findings indicate that the systems effectiveness of ANC clinics to deliver ISTp-DP under routine conditions was poor in comparison to IPTp-SP. Several challenges to integration of ISTp with ANC were identified that may need to be considered by countries that have introduced screening at first ANC visit and, potentially, for future adoption of ISTp with more sensitive RDTs. Understanding the effectiveness of ISTp-DP will require additional research on pregnant women’s adherence to ACT.

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Placental Malaria is Rare Among Zanzibari Pregnant Women who did not Receive Intermittent Preventive Treatment in Pregnancy

American Journal of Tropical Medicine and Hygiene ◽

10.4269/ajtmh.13-0586 ◽

2014 ◽

Vol 91 (2) ◽

pp. 367-373 ◽

Cited By ~ 1

Author(s):

Marya Plotkin ◽

Khadija Said ◽

Mwinyi I. Msellem ◽

Rachel P. Chase ◽

Natalie Hendler ◽

...

Keyword(s):

Pregnant Women ◽

Placental Malaria ◽

Intermittent Preventive Treatment ◽

Preventive Treatment ◽

In Pregnancy

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Decomposition of socioeconomic inequalities in the uptake of intermittent preventive treatment of malaria in pregnancy in Nigeria: evidence from Demographic Health Survey

Malaria Journal ◽

10.1186/s12936-021-03834-8 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Chijioke Ifeanyi Okoli ◽

Mohammad Hajizadeh ◽

Mohammad Mafizur Rahman ◽

Rasheda Khanam

Keyword(s):

Pregnant Women ◽

Health Survey ◽

Urban Areas ◽

Socioeconomic Inequality ◽

Intermittent Preventive Treatment ◽

Preventive Treatment ◽

Socioeconomic Inequalities ◽

Demographic Health Survey ◽

Antenatal Visits ◽

In Pregnancy

Abstract Background Although malaria in pregnancy is preventable with the use of intermittent preventive treatment with sulfadoxine–pyrimethamine (IPTp-SP), it still causes maternal morbidity and mortality, in sub-Saharan Africa and Nigeria in particular. Socioeconomic inequality leads to limited uptake of IPTp-SP by pregnant women and is, therefore, a public health challenge in Nigeria. This study aimed to measure and identify factors explaining socioeconomic inequality in the uptake of IPTp-SP in Nigeria. Methods The study re-analysed dataset of 12,294 women aged 15–49 years from 2018 Nigeria Demographic Health Survey (DHS). The normalized concentration index (Cn) and concentration curve were used to quantify and graphically present socioeconomic inequalities in the uptake of IPTp-SP among pregnant women in Nigeria. The Cn was decomposed to identify key factors contributing to the observed socioeconomic inequality in the uptake of adequate (≥ 3) IPTp-SP. Results The study showed a higher concentration of the adequate uptake of IPTp-SP among socioeconomically advantaged women (Cn = 0.062; 95% confidence interval [CI] 0.048 to 0.076) in Nigeria. There is a pro-rich inequality in the uptake of IPTp-SP in urban areas (Cn = 0.283; 95%CI 0.279 to 0.288). In contrast, a pro-poor inequality in the uptake of IPTp-SP was observed in rural areas (Cn = − 0.238; 95%CI − 0.242 to − 0.235). The result of the decomposition analysis indicated that geographic zone of residence and antenatal visits were the two main drivers for the concentration of the uptake of IPTp-SP among wealthier pregnant women in Nigeria. Conclusion The pro-rich inequalities in the uptake of IPTp-SP among pregnant women in Nigeria, particularly in urban areas, warrant further attention. Strategies to improve the uptake of IPTp-SP among women residing in socioeconomically disadvantaged geographic zones (North-East and North-West) and improving antenatal visits among the poor women may reduce pro-rich inequality in the uptake of IPTp-SP among pregnant women in Nigeria.

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Malaria Knowledge and Experiences with Community Health Workers among Recently Pregnant Women in Malawi

10.21203/rs.2.19379/v1 ◽

2019 ◽

Author(s):

Ashley Malpass ◽

Jobiba Chinkhumba ◽

Elizabeth Davlantes ◽

John Munthali ◽

Katherine Wright ◽

...

Keyword(s):

Pregnant Women ◽

Community Health ◽

Community Health Workers ◽

Health Workers ◽

Intermittent Preventive Treatment ◽

Preventive Treatment ◽

World Health ◽

P Value ◽

To Receive ◽

In Pregnancy

Abstract Background The World Health Organization (WHO) recommends three or more doses of intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) to mitigate the negative effects of malaria in pregnancy (MIP). Many pregnant women in Malawi are not receiving the recommended number of doses. Community delivery of IPTp (cIPTp) is being piloted as a new approach to increase coverage. This survey assessed recently pregnant women’s knowledge of MIP and their experiences with community health workers (CHWs) prior to implementing cIPTp.Methods Data were collected via a household survey in Ntcheu and Nkhata Bay Districts, Malawi, from women aged 16-49 years who had a pregnancy resulting in a live birth in the previous 12 months. Survey questions were primarily open response and utilized review of the woman’s health passport whenever possible. Analyses accounted for selection weighting and clustering at the health facility level and explored heterogeneity between districts.Results A total of 370 women were interviewed. Women in both districts found their CHWs to be helpful (77.9%), but only 35.7% spoke with a CHW about antenatal care and 25.8% received assistance for malaria during their most recent pregnancy. A greater proportion of women in Nkhata Bay than Ntcheu reported receiving assistance with malaria from a CHW (42.7% vs 21.9%, p=0.01); women in Nkhata Bay were more likely to cite IPTp-SP as a way to prevent MIP (41.0% vs 24.8%, p=0.02) and were more likely to cite mosquito bites as the only way to spread malaria (70.6% vs 62.0% p=.03). Women in Nkhata Bay were more likely to receive 3+ doses of IPTp-SP (IPTp3) (59.2% vs 41.8%, p=0.0002). Adequate knowledge was associated with increased odds of receiving IPTp3, although not statistically significantly so (adjusted odds ratio = 1.50, 95% confidence interval 0.97- 2.32, p-value 0.066).Conclusions Women reported positive experiences with CHWs, but there was not a focus on MIP. Women in Nkhata Bay were more likely to be assisted by a CHW, had better knowledge, and were more likely to receive IPTp3+. Increasing CHW focus on the dangers of MIP and implementing cIPTp has the potential to increase IPTp coverage. Keywords: Malaria Pregnancy Community Health Workers Malawi Intermittent preventive treatment Sulfadoxine-pyrimethamine

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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 ◽

10.1371/journal.pone.0248412 ◽

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.

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