MALARIA IN PREGNANCY

Malaria can contribute to pregnancy complications such as abortion, poor foetal mental development, premature labour, intrauterine growth retardation and foetal death, severe maternal anaemia due to haemolysis, and death.

Complications are more common in mothers of low gravidity (primi- and secundigravidae), HIV positivity, adolescent age, sickle-cell disease, and those from areas of low endemicity, e.g. in Kisoro and Kabale.

MANAGEMENT OF MALARIA IN PREGNANCY

APPROACH MANAGEMENT

Prophylaxis

All pregnant
mothers
except those
with HIV on
cotrimoxazole
prophylaxis

  • Intermittent Preventive
    Treatment (IPTp) with
    Sulphadoxine/
    pyrimethamine (SP) once
    a month starting at 13 weeks
    until delivery
Treatment of
Uncomplicated
malaria in 1st
trimester
  • Quinine oral 600 mg 8 hourly
    for 7 days (if Quinine not
    available, ACT may be used)
Treatment of
Uncomplicated
malaria in
2nd and 3rd
trimesters
First line

  • Artemether/Lumefantrine
    80/480 mg 12 hourly for 3 days

First line alternative

  • Dihydroartemisinin/
    Piperaquine 3 tablets (1080
    mg) once daily for 3 days

And if no response

  • Quinine, oral 600 mg 8 hourly
    for 7 days
Severe malaria
All trimesters
and lactation
  • IM/IV Artesunate 2.4 mg/kg
    at 0, 12 and 24 hours, then once
    a day until mother can tolerate
    oral medication. Complete
    treatment with 3 days of oral
    ACT

First line alternative

  • IM artemether 3.2 mg/kg
    loading dose then 1.6 mg/
    Kg once daily until mother
    can tolerate oral medication.
    Complete treatment with 3
    days of oral ACT

If artesunate or arthemeter not
available, use

  • Quinine 10 mg/Kg IV every
    8 hours in Dextrose 5%
Caution
  • Quinine is associated with an increased risk of hypoglycaemia in late pregnancy

Prevention and control of malaria in pregnancy

  • Use insecticide-treated mosquito nets (ITN) before, during, and after pregnancy.
  • Give all pregnant women intermittent preventive treatment (IPTp) with sulfadoxine pyrimethamine
    (SP) – Except in allergy to sulphonamide
  • Prompt diagnosis and effective treatment of malaria in pregnancy

Education messages to mothers and the community

  • Malaria is transmitted by female anopheles mosquitoes
  • Pregnant women and children are at particular risk of malaria
  • If untreated, malaria can cause severe anaemia and death in pregnant women
  • Malaria can lead to anaemia, miscarriage, stillbirth, mentally-retarded children, or low birth weight children,
    who are more prone to infant/childhood mortality compared to normal weight children
  • It is better and cheaper to prevent than to treat malaria
  • The individual, family, and the community can control malaria by taking appropriate actions
  • Sleeping under an insecticide-treated mosquito net is the best way to prevent malaria
  • It is very important to complete the course of treatment in order to achieve a cure
  • Severe complicated malaria needs special management, therefore refer