1. Malaria Prevention & Treatment in Pregnancy
Journal Club
Faculty of Pharmacy
Obafemi Awolowo University

2. Outline The problem - malaria in pregnancy (2 mins)
Current standard of care (SoC, 2 mins)
Alternative strategies in recent studies (15 mins):
Tagbor et al 2015; PLoS ONE 10(8): e
Desai et al 2015; Lancet 2015; 386: 2507–19
The PREGACT Study Group 2016; N Engl J Med 374;10
Kakuru et al 2016; N Engl J Med 374;10
Exploring opportunities (discussion, 30 mins)
13 October 2016

3. The Problem - Malaria in Pregnancy
About 12.4 million pregnancies exposed to Plasmodium falciparum malaria annually in sub-Saharan Africa;
Malaria parasitemia during pregnancy, symptomatic or not, increases the risk of severe maternal anemia ;
Placental malaria is strongly associated with adverse pregnancy outcomes:
intrauterine growth restriction, prematurity, low birth weight, spontaneous abortion
900K low birthweight deliveries, 100K infant deaths/year
Malar J. 2008; 7(Suppl 1): S6
13 October 2016

4. The Problem - Malaria in Pregnancy
13 October 2016

5. Current Standard of Care
WHO recommends routine preventive measures among pregnant women in all P. falciparum malaria endemic countries;
Long-lasting insecticide-treated bed nets;
Intermittent preventive treatment with sulfadoxine– pyrimethamine (IPTp-SP) during ANC T2 & T3
Treatment: 3-day course with an artemisinin-based combination therapy (ACT);
Resistance to SP & limited info about safety of ACTs
or clindamycin + a 7-day course of either artesunate or quinine

6. Tagbor et al 2015; PLoS ONE 10(8): e0132247
An open, individually randomized, non-inferiority trial of IPTp-SP versus ISTp; n = 5,354; 4 West African countries;
IPTp-SP group: SP on 2 or 3 occasions
ISTp group: screened 2 or 3 times with a RDT & treated if +ve for malaria with artemether-lumefantrine (AL).
ISTp-AL was non-inferior to IPTp-SP in preventing low birth weight, anemia and placental malaria, the primary trial endpoints.
13 October 2016

7. Desai et al 2015; Lancet 2015; 386: 2507–19
13 October 2016

8. The PREGACT Study Group 2016; N Engl J Med 374;10
13 October 2016

9. Kakuru et al 2016; N Engl J Med 374;10
13 October 2016

10. Exploring Opportunities
Discussion
13 October 2016