1. Malaria is a maternal, newborn and child health issue because these groups of people are most at risk for infection. a. TRUE b.

Transcription

1 Malaria in Pregnancy Questionnaire 1. Malaria is a maternal, newborn and child health issue because these groups of people are most at risk for infection. 2. Malaria poses a serious health risk to the pregnant woman but the unborn child is protected by the placenta from the harmful effects of malaria. 3. The World Health Organization recommends the following interventions for malaria in pregnancy in areas of moderate to high transmission (circle all that apply): a. Use of insecticide treated nets (ITNs) b. Intermittent preventive treatment (IPT) with sulfadoxine pyrimethamine (SP) c. Indoor residual spraying (IRS) d. Early diagnosis and prompt treatment for those infected with malaria 4. Pregnant women should seek services for prevention of malaria: a. In the community b. Through traditional healers c. During regularly scheduled antenatal care visits 5. The World Health Organization recommends that pregnant women in areas of moderate to high malaria transmission take IPT with SP: a. At the beginning of pregnancy b. At least two times during pregnancy, after quickening c. At each scheduled antenatal care visit, starting the first dose as early as possible during the 2 nd trimester of gestation 6. SP should not be taken by pregnant women who: a. Take folic acid b. Are HIV positive and taking cotrimoxazole c. Sleep under an ITN

2 7. The last dose of IPTp with SP can be administered up to the time of delivery, without safety concerns. 8. Pregnant women exhibit signs and symptoms of malaria more readily than the general population. 9. Diagnosis of malaria in pregnancy using laboratory testing or rapid diagnostic tests is not recommended before treating pregnant women showing signs and symptoms of illness. 10. Parasitological diagnosis has several major advantages, including (circle all that apply): a. Improves care in parasite positive patients due to greater certainty of malaria diagnosis b. Identifies parasite negative patients who need another diagnosis c. Prevents unnecessary exposure to malaria drugs d. Improves malaria case detection and reporting e. Confirms treatment failure

3 Malaria in Pregnancy: Answers and Justifications 1. Malaria is a maternal, newborn and child health issue because these groups of people are most at risk for infection. Justification: Some population groups are at considerably higher risk of contracting malaria and suffering from, or dying of it, than others. Pregnant women are particularly vulnerable to malaria as pregnancy reduces a woman s immunity to malaria, making her more susceptible to malaria infection and increasing the risk of illness, severe anaemia and death. For the unborn child, maternal malaria increases the risk of spontaneous abortion, stillbirth, premature delivery and low birth weight a leading cause of child mortality. Infants and young children are vulnerable to malaria from approximately 3 months of age, when immunity acquired from the mother starts to wane. Sources: and 2. Malaria poses a serious health risk to the pregnant woman but the unborn child is protected by the placenta from the harmful effects of malaria. Justification: During pregnancy, malaria parasites hide in the placenta and interfere with the transfer of oxygen and nutrients (food) from the mother to the unborn baby. Combined with anemia, this increases the risk of spontaneous abortion and stillbirth. In the second half of pregnancy, it can hinder fetal weight gain, causing low birth weight and preterm births. Pregnant women who are co infected with HIV and malaria are at a very high risk for anemia and malaria infection of the placenta. Source: 3. The World Health Organization recommends the following interventions for malaria in pregnancy in areas of moderate to high transmission (circle all that apply): a. Use of insecticide treated nets (ITNs) b. Intermittent preventive treatment (IPT) with sulfadoxine pyrimethamine (SP) c. Indoor residual spraying (IRS) d. Early diagnosis and prompt treatment for those infected with malaria Justification: WHO recommends a three pronged approach to the prevention and management of malaria in pregnancy: Insecticide treated nets (ITNs); Intermittent preventive treatment; Effective case management of malarial illness. Source:

4 4. Pregnant women should seek services for prevention of malaria: a. In the community b. Through traditional healers c. During regularly scheduled antenatal care visits Justification: About two thirds of pregnant women in sub Saharan Africa attend antenatal clinics at least once during pregnancy, presenting a major opportunity to prevent and treat malaria. The aim is to deliver ITNs, IPTp and case management, the WHO recommended three pronged approach especially IPTp to pregnant women as part of their routine antenatal care, using and strengthening the existing antenatal care infrastructure. Source: 5. The World Health Organization recommends that pregnant women in areas of moderate to high malaria transmission take IPT with SP: a. At the beginning of pregnancy b. At least two times during pregnancy, after quickening c. At each scheduled antenatal care visit, starting the first dose as early as possible during the 2 nd trimester of gestation Justification: WHO has observed a slowing of efforts to scale up IPTp for malaria with SP in a number of countries in Africa. Based on a recent WHO evidence review, WHO updated its policy recommendation for IPTp with SP. WHO recommends a schedule of four antenatal care visits. In areas of moderate to high malaria transmission, IPTp with SP is recommended for all pregnant women at each scheduled antenatal care visit, starting the first dose as early as possible during the 2nd trimester of gestation. Source: f and SP_implementation_11april2013.pdf.pdf 6. SP should not be taken by pregnant women who: a. Take folic acid b. Are HIV positive and taking cotrimoxazole c. Sleep under an ITN Justification: Because cotrimoxazole and SP have similar properties (both contain sulfamides), there is concern about possible severe adverse reactions to sulfa drugs in HIV patients on daily cotrimoxazole. WHO therefore recommends that persons on daily cotrimoxazole should not be given SP. Source: WHO recommends the administration of folic acid at a dose of 0.4mg daily;

5 this dose may be safely used in conjunction with SP. Folic acid at a daily dose equal or above 5mg should not be given together with SP as this counteracts its efficacy as an antimalarial. Source: SP_implementation_11april2013.pdf.pdf 7. The last dose of IPTp with SP can be administered up to the time of delivery, without safety concerns. Justification: Based on a recent WHO evidence review, WHO updated its policy recommendation for IPTp with SP. WHO recommends that the last dose of IPTp with SP can be administered up to the time of delivery, without safety concerns. Source: f 8. Pregnant women exhibit signs and symptoms of malaria more readily than the general population. Justification: Even though there are more malaria infections in areas of stable transmission, many pregnant women with malaria parasites do not have symptoms (no fever or clinical signs of illness). This is because women in stable areas have some immunity, which decreases the chance of severe malaria illness. However, the lack of clinical symptoms does not mean that the woman s health is not affected. The major complication of malaria among pregnant women in stable areas is anemia, which can eventually cause death in severe cases. Women who are pregnant for the first or second time are most at risk for such complications. Source: 9. Diagnosis of malaria in pregnancy using laboratory testing or rapid diagnostic tests is not recommended before treating pregnant women showing signs and symptoms of illness. Justification: In all settings, clinical suspicion of malaria should be confirmed with a parasitological diagnosis. However, in settings where parasitological diagnosis is not possible, the decision to provide antimalarial treatment must be based on the prior probability of the illness being malaria. Other possible causes of fever and need for

6 alternative treatment must always be carefully considered. Source: WHO Guidelines for the Treatment of Malaria second edition Parasitological diagnosis has several major advantages, including (circle all that apply): a. Improves care in parasite positive patients due to greater certainty of malaria diagnosis b. Identifies parasite negative patients who need another diagnosis c. Prevents unnecessary exposure to malaria drugs d. Improves malaria case detection and reporting e. Confirms treatment failure Justification: The changing epidemiology of malaria and the introduction of ACTs have increased the urgency of improving the specificity of malaria diagnosis. Source: WHO Guidelines for the Treatment of Malaria second edition