Malaria Drugs For Pregnant Women In Nigeria

There is strong debate among most medical professionals in Nigeria about the best malaria drug to give pregnant women. This is because over the years, the world health organization (WHO) and sister bodies like the national malaria control programme of the Federal Ministry of Health (FMOH) have changed treatment and prevention drugs for pregnant women.

Mosquito

In this post, all my focus is on the best and safe malaria drug to prevent and treat malaria in pregnancy. This post will focus on drugs in Nigeria.

Malaria In Pregnant Women Overview

Malaria infection in pregnant women is associated with high risk of both maternal and perinatal morbidity and mortality. The disease often results from infection with Plasmodium falciparum, which accounts for over 80% of the world malaria burden.

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Pregnant women have reduced immune response and therefore less effectively clear malaria infections.

Consequently, they are three times more likely to develop severe disease than non-pregnant women acquiring infections from the same area. Furthermore, because the malaria parasites sequester and replicate in the placenta, the malaria infection during pregnancy can lead to miscarriage, premature delivery, low birth weight, congenital malaria infection and perinatal death amongst others.

Malaria Prevention In Pregnant Women

The major preventive measures adopted by the WHO is insecticide treatment net. In addition, pregnant women can use drugs.

The chemoprophylaxis against malaria in pregnancy is the use of sulfadoxine/pyrimethamine (IPT-SP). Two doses of IPT-SP during normal pregnancy; the first dose to be administered at quickening, which ensures that the woman is in the second trimester, and the second dose given at least one month from the first. A third dose is recommended for human immunodeficiency virus (HIV)-positive women. Chloroquine may also be used as prophylaxis.

Example of IPT-SP are amalar, maldox, swidar (fansidar), etc.

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The use of drugs such as proguanil, pyrimethamine or chloroquine for chemoprophylaxis is no longer recommended because of the demonstrable resistance of malaria parasites to these drugs. Although, they are not harmful to the baby and mother.

Treatment Of Malaria In Pregnancy

Quinine for the first trimester and artemisinin-based combination therapy (ACT) for acute treatment of malaria in the second/third trimesters. The ACT recommended in pregnancy is the Arthemeter/lumefantrine or Artemisinin/amodiaquine combinations. Anti-malaria drugs such as primaquine, halofantrine, mefloquine, etc., are contraindicated in pregnancies and thus not recommended.

Example of artemether/lumefantrine are coartem, amatem, lonart, lokmal, etc

The Centers for Disease Control and Prevention (CDC) recently recommends the antimalarial drug mefloquine for pregnant women both as a malaria treatment option and as an option to prevent malaria infection for all trimesters. This is not yet in the national malaria control programme in Nigeria.

Proguanil has been used for decades in pregnant women; however, until such time as these data are fully evaluated, atovaquone-proguanil is not recommended for use during pregnancy. Doxycycline is contraindicated for malaria prophylaxis during pregnancy because of the risk for adverse effects seen with tetracycline, a related drug, on the fetus.

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These adverse effects include discoloration and dysplasia of the teeth and inhibition of bone growth. Primaquine and tafenoquine should not be used during pregnancy because the drug may be passed transplacentally to a G6PD-deficient fetus and cause hemolytic anemia in utero.

Malaria Treatment In Pregnant Women Summary

1st trimester: Quinine for treatment

2nd trimester: quinine or artemether/lumefantrine or Artemisinin/Amodiaquine for treatment and IPT-SP for prevention

3rd trimester: quinine or artemether/lumefantrine or Artemisinin/Amodiaquine for treatment and IPT-SP for prevention

All trimester: quinine for treatment

Mefloquine can be used for both prevention and treatment. Unfortunately, it has not been evaluated for use in Nigeria.