scholarly journals Prevalence of asymptomatic Plasmodium falciparuminfection, anaemia and use of ITNs among pregnant women yet to receive IPTp in parts of southern Ghana

2020 ◽  
pp. 36-42
Author(s):  
Leslie L Afutu ◽  
Johnson N Boampong ◽  
Neils B Quashie
Keyword(s):  
Pregnant Women ◽  
Parasite Density ◽  
Intermittent Preventive Treatment ◽  
Malaria In Pregnancy ◽  
Asymptomatic Malaria ◽  
Nested Polymerase Chain Reaction ◽  
Increased Risk ◽  
The Mean ◽  
To Receive ◽  
In Pregnancy

Background: Asymptomatic malaria in pregnancy evades most fever-based surveillance systems yet causes significant morbidities such as anaemia in the pregnant woman and low birth weight in the neonate. Objective:This study determined the prevalence of asymptomatic malaria and its association with anaemia among pregnant women who are yet to receive their first dose of Sulphadoxine-Pyrimethamine (SP) as intermittent preventive treatment of malaria in pregnancy (IPTp). Information on the use of insecticide treated nets(ITNs)as vector control by the pregnant women was also sought. Methods: This is a cross-sectional hospital-based study conducted in the Western Region of Ghana. Pregnant women at gestational ages, 16-26 wkwere included. A structured questionnaire was used to collect vital information from the participants. Plasmodiumparasitaemia was determined by rapid diagnostic test (MRDT), microscopy and species-specific nested polymerase chain reaction (PCR). Anaemia was classified using the level of haemoglobin. Results: A total of 413 antenatal clinic attendants were recruited. Prevalence of asymptomatic Plasmodium falciparuminfection was 13.1% by MRDT, 10.1% by microscopy and 13.8% by PCR. The mean haemoglobin was 10.73g/dL. Prevalence of anaemia was 40.49% and the mean parasite density was 149.6 parasite/μL. Pregnant women with asymptomatic malaria were 4 times more at risk of being anaemic (adjusted odds ratio with 95% confidence interval: 4.42, 1.82 -10.70)than those who did not have malaria. There was statistically significant negative correlation between parasite density and anaemia (r=0.0028, p=0.02). Conclusion: Asymptomatic P. falciparuminfection was found among some of the pregnant women and the presence of the parasites make them 4 times at increased risk of developing anaemia. Anaemia when occurring amongst such women was significantly worsened by increasing parasitaemia.

Asymptomatic malaria and anemia among pregnant women during high and low malaria transmission seasons in Burkina Faso: household-based cross-sectional surveys in Burkina Faso, 2013–2017

2020 ◽  
Author(s):  
Toussaint Rouamba ◽  
Sékou Samadoulougou ◽  
Mady Ouédraogo ◽  
Hervé Hien ◽  
Halidou Tinto ◽  
...  
Keyword(s):  
Burkina Faso ◽  
Pregnant Women ◽  
Malaria Transmission ◽  
Malaria In Pregnancy ◽  
Asymptomatic Malaria ◽  
Cross Sectional ◽  
Transmission Season ◽  
Asymptomatic Carriage ◽  
Low Malaria Transmission ◽  
In Pregnancy

Abstract Background: Malaria in endemic countries is often asymptomatic during pregnancy, but it has substantial consequences for both the mother and her unborn baby. In Burkina Faso, the prevalence and risk factors of asymptomatic malaria in pregnancy and its main consequence, anemia, during high and low malaria transmission seasons is underexplored at the household level.Methods: Data of 1751 pregnant women from October 2013 to March 2014 and 1931 pregnant women from April 2017 to June 2017 were drawn from two cross-sectional household surveys conducted in 24 health districts of Burkina Faso. Pregnant women were tested for malaria in their household after consenting. Asymptomatic carriage was defined as a positive result from malaria rapid diagnostic tests in the absence of malaria symptoms. Anemia was defined as hemoglobin level less than 11 g/dL.Results: Prevalence of asymptomatic malaria in pregnancy was estimated at 23.9% (95%CI: 20.2–28.0) during the high transmission season (October–November) in 2013. During the low transmission season, it was 12.7% (95%CI: 10.9–14.7) between December and March in 2013–2014 and halved (6.4%; 95%CI: 5.3–7.6) between April and June 2017. Anemia prevalence was estimated at 43.7% (95%CI: 39.3–48.3) during the high transmission season in 2013. During the low transmission season, it was 32.7% (95%CI: 30.1–35.5) between December and March 2013–2014 and 46.6% (95%CI: 44.3–48.9) between April and June, 2017.Conclusion: Prevalence of asymptomatic malaria in pregnancy was significantly higher during the high malaria transmission season while anemia prevalence was lower. Our study provides an opportunity to assess the prevalence of asymptomatic carriage and one of its main consequences, anemia, among pregnant women at the community level throughout the year. In order to mitigate the harmful effects of asymptomatic carriage for both the mother and fetus, health programs aimed at increasing the number of women coming into contact with health workers are necessary.

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

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

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 Malaria knowledge and experiences with community health workers among recently pregnant women in Malawi

2020 ◽  
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 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.

scholarly journals Effectiveness of intermittent preventive treatment in pregnancy with sulphadoxine-pyrimethamine (IPTp-SP) in Ghana

2021 ◽  
Vol 6 (8) ◽  
pp. e005877
Author(s):  
David Kwame Dosoo ◽  
Kezia Malm ◽  
Felix Boakye Oppong ◽  
Richard Gyasi ◽  
Abraham Oduro ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Lower Risk ◽  
Dose Group ◽  
Placental Malaria ◽  
Intermittent Preventive Treatment ◽  
Preventive Treatment ◽  
Monthly Administration ◽  
To Receive ◽  
Sulphadoxine Pyrimethamine ◽  
In Pregnancy

IntroductionGhana adopted the revised WHO recommendation on intermittent preventive treatment in pregnancy using sulfadoxine-pyrimethamine (IPTp-SP) in 2012. This study has assessed the effectiveness and safety of this policy in Ghana.MethodsA total of 1926 pregnant women enrolled at antenatal care (ANC) clinics were assessed for birth outcomes at delivery, and placental histology results for malaria infection were obtained from 1642 participants. Association of reduced placental or peripheral malaria, anaemia and low birth weight (LBW) in women who received ≥4 IPTp-SP doses compared with 3 or ≤2 doses was determined by logistic regression analysis.ResultsAmong the 1926 participants, 5.3% (103), 19.2% (369), 33.2% (640) and 42.3% (817) of women had received ≤1, 2, 3 or ≥4 doses, respectively. There was no difference in risk of active placental malaria (PM) infection in women who received 3 doses compared with ≥4 doses (adjusted OR (aOR) 1.00, 95% CI 0.47 to 2.14). The risk of overall PM infection was 1.63 (95% CI 1.07 to 2.48) in 2 dose group and 1.06 (95% CI 0.72 to 1.57) in 3 dose group compared with ≥4 dose group. The risk of LBW was 1.55 (95% CI 0.97 to 2.47) and 1.06 (95% CI 0.68 to 1.65) for 2 and 3 dose groups, respectively, compared with the ≥4 dose group. Jaundice in babies was present in 0.16%, and 0% for women who received ≥4 doses of SP.ConclusionThere was no difference in the risk of PM, LBW or maternal anaemia among women receiving 3 doses compared with ≥4 doses. Receiving ≥3 IPTp-SP doses during pregnancy was associated with a lower risk of overall PM infection compared with 2 doses. As there are no safety concerns, monthly administration of IPTp-SP offers a more practical opportunity for pregnant women to receive ≥3 doses during pregnancy.

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.

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