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NOT Open Access | Towards intermittent preventive therapy in pregnancy with dihydroartemisinin-piperaquine

August 17, 2021 - 14:22 -- NOT Open Access
Author(s): 
Ter Kuile FO
Reference: 
Clin Pharmacol Ther. 2021 Aug 13

Malaria is a major cause of adverse pregnancy outcomes in sub-Saharan Africa, but resistance to sulfadoxine-pyrimethamine, the only antimalarial recommended by the World Health Organisation for intermittent preventive therapy, is threatening the gains made in the last two decades. In this issue, Mlugu and colleagues present the results of a trial of dihydroartemisinin-piperaquine as an alternative to sulfadoxine-pyrimethamine. The results are impressive but raise the question why they differ so much from three previous trials.

A Genotyping Study in Benin Comparing the Carriage of Plasmodium falciparum Infections Before Pregnancy and in Early Pregnancy: Story of a Persistent Infection

July 21, 2021 - 18:02 -- Open Access
Author(s): 
Jafari-Guemouri S, Courtois L, Mama A, Rouas B, Neto Braga G, Accrombessi M, Massougbodji A, Ding XC, Tuikue Ndam N, Fievet N, Briand V
Reference: 
Clin Infect Dis. 2021 Jul 15;73(2):e355-e361

Malaria infections in the first trimester of pregnancy are frequent and deleterious for both mother and child health. To investigate if these early infections are newly acquired or already present in the host, we assessed whether parasites detected before pregnancy and those detected in early pregnancy are the same infection.

Improving malaria preventive practices and pregnancy outcomes through a health education intervention: A randomized controlled trial

January 27, 2021 - 11:43 -- Open Access
Author(s): 
Ahmed Dahiru Balami, Salmiah Md. Said, Nor Afiah Mohd Zulkefli, Bachok Norsa’adah and Bala Audu
Reference: 
Malaria Journal 2021 20:55, 21 January 2021

The prevalence of malaria in pregnancy and its complications, remain very high in Nigeria. This study aimed to determine the effects of a malaria health educational intervention based on the information-motivation-behavioural skills (IMB) model on malaria preventive practices and pregnancy outcomes.

NOT Open Access | Efficacy and safety of malarial prophylaxis with mefloquine during pregnancy in Kisangani, Democratic Republic of Congo: a randomized clinical trial

January 6, 2021 - 12:37 -- NOT Open Access
Author(s): 
Labama Otuli N, Marini Djang'eing'a R, Manga Okenge JP, et al.
Reference: 
Br J Clin Pharmacol. 2021 Jan 4

Kisangani is an area with intense malaria transmission and sulfadoxine‐pyrimethamine resistance. Alternative anti‐malaria prophylaxis medication and protocols are needed, particularly with pregnant individuals. In this study, we compare the tolerance and effectiveness of mefloquine regimen as a split dose with meal versus sulfadoxine‐pyrimethamine for the intermittent preventive treatment in pregnant individuals in Kisangani.

Changes in the frequencies of Plasmodium falciparum dhps and dhfr drug-resistant mutations in children from Western Kenya from 2005 to 2018: the rise of Pfdhps S436H

October 22, 2020 - 15:45 -- Open Access
Author(s): 
M. Andreína Pacheco, Kristan A. Schneider, Qiuying Cheng, Elly O. Munde, Caroline Ndege, Clinton Onyango, Evans Raballah, Samuel B. Anyona, Collins Ouma, Douglas J. Perkins and Ananias A. Escalante
Reference: 
Malaria Journal 2020 19:378, 22 October 2020

Sulfadoxine-pyrimethamine (SP) is the only anti-malarial drug formulation approved for intermittent preventive treatment in pregnancy (IPTp). However, mutations in the Plasmodium falciparum dhfr (Pfdhfr) and dhps (Pfdhps) genes confer resistance to pyrimethamine and sulfadoxine, respectively. Here, the frequencies of SP resistance-associated mutations from 2005 to 2018 were compared in samples from Kenyan children with malaria residing in a holoendemic transmission region.

Not Open Access | Teratogen update: Malaria in pregnancy and the use of antimalarial drugs in the first trimester

October 21, 2020 - 09:39 -- NOT Open Access
Author(s): 
Clark RL
Reference: 
Birth Defects Res. 2020 Oct 20

Malaria is a particular problem in pregnancy because of enhanced sensitivity, the possibility of placental malaria, and adverse effects on pregnancy outcome. Artemisinin-containing combination therapies (ACTs) are the most effective antimalarials known. WHO recommends 7-day quinine therapy for uncomplicated Plasmodium falciparum malaria in the first trimester despite the superior tolerability and efficacy of 3-day ACT regimens because artemisinins caused embryolethality and/or cardiovascular malformations at relatively low doses in rats, rabbits, and monkeys.

NOT Open Access | Associations between malaria preventive regimens and Plasmodium falciparum drug resistance mediating polymorphisms in Ugandan pregnant women

October 7, 2020 - 15:35 -- NOT Open Access
Author(s): 
Nayebare P, Asua V, Conrad MD, Kajubi R, Kakuru A, Nankabirwa JI, Muhanguzi D, Dorsey G, Kamya MR, Nsobya S, Rosenthal PJ
Reference: 
Antimicrob Agents Chemother. 2020 Oct 5:AAC.01047-20

Intermittent preventive treatment in pregnancy (IPTp) with monthly sulfadoxine-pyrimethamine (SP) is recommended for malaria-endemic parts of Africa, but efficacy is compromised by resistance and, in recent trials, dihydroartemisinin-piperaquine (DP) has shown better antimalarial protective efficacy. We utilized blood samples from a recent trial to evaluate selection by IPTp with DP or SP of Plasmodium falciparum genetic polymorphisms that alter susceptibility to these drugs.

Deleterious effects of malaria in pregnancy on the developing fetus: a review on prevention and treatment with antimalarial drugs

October 1, 2020 - 07:45 -- Open Access
Author(s): 
Saito M, Briand V, Min AM, McGready R
Reference: 
Lancet Child Adolesc Health. 2020 Oct;4(10):761-774

All malaria infections are harmful to both the pregnant mother and the developing fetus. One in ten maternal deaths in malaria endemic countries are estimated to result from Plasmodium falciparum infection. Malaria is associated with a 3-4 times increased risk of miscarriage and a substantially increased risk of stillbirth. Current treatment and prevention strategies reduce, but do not eliminate, malaria's damaging effects on pregnancy outcomes.

Managing intermittent preventive treatment of malaria in pregnancy challenges: an ethnographic study of two Ghanaian administrative regions

September 29, 2020 - 13:04 -- Open Access
Author(s): 
Matilda Aberese-Ako, Pascal Magnussen, Margaret Gyapong, Gifty D. Ampofo and Harry Tagbor
Reference: 
Malaria Journal 2020 19:347, 25 September 2020

Malaria in pregnancy (MiP) is an important public health problem across sub-Saharan Africa. The package of measures for its control in Ghana in the last 20 years include regular use of long-lasting insecticide-treated bed nets (LLINs), directly-observed administration (DOT) of intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP) and prompt and effective case management of MiP. Unfortunately, Ghana like other sub-Saharan African countries did not achieve the reset Abuja targets of 100% of pregnant women having access to IPTp and 100% using LLINs by 2015.

Active case detection of malaria in pregnancy using loop-mediated amplification (LAMP): a pilot outcomes study in South West Ethiopia

September 1, 2020 - 09:45 -- Open Access
Author(s): 
Guluma Tadesse, Claire Kamaliddin, Cody Doolan, Ranmalee Amarasekara, Ruth Legese, Abu Naser Mohon, James Cheaveau, Delenasaw Yewhalaw and Dylan R. Pillai
Reference: 
Malaria Journal 2020 19:305, 27 August 2020

125 million women are pregnant each year in malaria endemic areas and are, therefore, at risk of Malaria in Pregnancy (MiP). MiP is the direct consequence of Plasmodium infection during pregnancy. The sequestration of Plasmodium falciparum parasites in the placenta adversely affects fetal development and impacts newborn birth weight. Importantly, women presenting with MiP commonly develop anaemia. In Ethiopia, the Ministry of Health recommends screening symptomatic women only at antenatal care visits with no formal intermittent preventive therapy. Since MiP can display low-level parasitaemia, current tests which include microscopy and RDT are challenged to detect these cases. Loop mediated isothermal Amplification (LAMP) technology is a highly sensitive technique for DNA detection and is field compatible. This study aims to evaluate the impact of active malaria case detection during pregnancy using LAMP technology in terms of birth outcomes.

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