Is antimalarial treatment in pregnant women as effective as that in non- pregnant women? Elizabeth Juma, Rashid Aman, Florence Oloo, Bernhards Ogutu Centre for Research in Therapeutic Sciences (CREATES) Strathmore University

Summary of Presentation Malaria in Pregnancy Objectives of the Study Policy Relevance Findings Conclusion Further Research Acknowledgements

Malaria in Pregnancy Pregnant women and young children are at most risk of malaria Plasmodium falciparum – most deadly Impact on pregnant women ~ 50,000 severe anaemia ~ 5-10% of maternal death ~ 35% of preventable low birth weight ~ 5% of infant mortality due to low birth weight

Malaria in Pregnancy In endemic areas 1 st and 2 nd pregnancies most at risk Pregnant women here can have parasites without being sick – BUT Anaemic Miscarriage Very small weight babies – die easily Severe disease and death In non-endemic areas All pregnancies at risk Pregnant women always fall sick, very sick Risk of miscarriage and still birth very high

Objective of the Study To determine the effectiveness of artemether- lumefantrine (AL) in clearing malaria parasites when used in the treatment of infected pregnant women To determine blood levels of artemether-lumefantrine in pregnant women compared with non-pregnant women

Policy Relevance Current recommended treatment for malaria in Kenya is Artemether-lumefantrine (also called AL or Coartem) Quinine Due to dangerous effects of many drugs on pregnancy, there are not many options for treatment of pregnant women There is need to ensure available treatments are given at optimal doses to effect a cure and delay emergence of resistance

The Research Process Invited sick women visiting ANC and out-patient department at Ahero Sub-District Hospital Tested for malaria and other illness Only those positive for malaria asked to participate and if agreeing were admitted for 3 days All enrolled women were treated with AL Malaria tests were done three times a day until negative After discharge, women returned for review visits every week for 4 weeks

The Research Process Women with Malaria 435 Non-pregnant Screened 70 Enrolled 25 Completed Study 23 Cured 22 Pregnant Screened 365 Enrolled 50 Completed Study 44 Cured 43

Summary of Findings Out of 435 women screened, 50 pregnant women and 25 non- pregnant were enrolled 23(92%) non-pregnant women and 44(88%) pregnant women completed the study (one month of visits) 22(95%) of non-pregnant women and 43(97%) of pregnant women did not have parasites after one month DNA testing for parasite showed that 100% of both pregnant and non-pregnant women were cured Those who had parasites at one month had new infections

Conclusion The current recommended AL treatment for malaria is effective for treatment of pregnant women with uncomplicated malaria

Further Research We collected samples to determine blood levels of AL in pregnant and non-pregnant women and how fast the parasite is eliminated from the blood in both groups. This is important because: If levels are low, then women who are not usually exposed to malaria may not be cured if they fall sick If levels are low there may be need to increase the dose for pregnant women with malaria to ensure the amount of medicine in their blood is the same as other adults. If levels are the same – no further action will be required

Acknowledgements Study participants Ahero Sub-District Hospital Team at CREATES and KEMRI Consortium for National Health Research Thank you