Prevention of Malaria in Pregnancy GTG Flashcards
What the 3 mains type of malaria?
Plasmodium Falciparum, viva and ovale
What proportion of malaria is cause by P falciparum, where most commonly found?
79% West Africa (Nigerai/Ghana)
Most dangerous
What proportion of malaria is cause by P vivax, where most commonly found?
5.5% Asia (India Subcontinent)
Relapsing remitting
What proportion of malaria is cause by P ovale?
2% Relapsing remitting
Risk of malaria in pregnancy
Susceptibility to infection
Severe anaemia
Severe cerebral malaria
Maternal + fetal mortality
Reduction in birth weight
Miscarriage, PTB, stillbirth
Placental parasiaemia
Women with little/no immunity more at risk
Which gravida of pregnancy is at high risk?
Primps - higher rates of parasitaemia, risk of malaria decreases with number of pregnancies
What to do if pregnant woman planning a trip to endemic area?
Advice to postpone trip if possible
Seek advice from centra with expertise on malaria risks
How long after trip should malaria be considered a differential if fever or flu-like illness?
Over 1 year
What is the ABCD or malaria prevention
Awareness of risk
Bite prevention
Chemoprophlyaxsis
Diagnosis and prompt Tx
Risk of malaria in Oceania, Sub-sarah Africa and Indian subcontinent?
Oceania 1:20
Sub-sarah Africa 1:50
Indian subcontinent 1:500
What factors impact malaria risk?
o Level of transmission in area
o Time of year (rainy or dry)
o Prescence of drugs resistant strains
o Rural/urban sleepovers
o Lenth of travel
o Take up of malaria prevention intervetions
How to prevent mosquito bites?
- Skin repellents, knock-down mosquito sprays, insecticide- treated bed nets, clothing and room protection.
o Repellents 50% DEET 24 hours/day
o Knock down mosquito sprays – permethrin and pyrethroids sprays to kill resting mosquitoes
o Insecticide bed nets – long lasting pyrethroid
o Clothing that covers the body and forms barrier
Which chemoprophylaxis is considered safe in 2nd/3rd trimester?
Mefloquine 5mg/kg once a week
Chloroquine/proguanil - most areas now resistant
Continue 4 weeks after return
Should any chemoprophylaxis be taken in 1st trimester?
No, should stop the chemoprophylaxsis for excretion time before becoming pregnant
Half life and excretion time of mefloquine?
14-21 days
Excretion 3 months
Half life and excretion time of doxycycline?
12-24 hrs
Excretion 1 week
Half life and excretion time of Malarone/Atovaquone
2-3 days
2 weeks
Half life and excretion time of proguanil
14-21 hours, 1 weeks
Half life and excretion time of chloroquine
1-2 months
No affects on 1st trimester
Contraindications to mefloquine?
Current or previous depression
Neuropsychiatric conditions
Epilepsy
Hypersensitivity to quinine or mefloquine
What drug is 2nd line of chloroquine resistant and mefloquine not tolerated?
Atrovaquone-proguanil (malarone), must be given with 5mg folic acid
What can be given if no chloroquine resistance?
Proguanila + chloroquine
Which chemoprophylaxis are contraindicated?
Doxycycline and primaquine
What are the effects of doxycycline on pregnancy?
Disturb bone growth of the foetus, irreversible teeth colouration, congenital cataract
What are the effects of primaquine on pregnancy?
Haemolysis, especially if G6PD deficiency
What emergency standby treatment can be given? When to take?
Quinine 600mg TDS 7/7
Clindaymcin 450mg TDS 5-7/7
Take if flu-like illness, temp >38 - and unable to seek medical attention, advise must seek medical attention asap
