Journal ArticleDOI
Prevention of malaria in pregnancy
Meghna Desai,Jenny Hill,Silke Fernandes,Patrick G T Walker,Christopher Pell,Julie Gutman,Kassoum Kayentao,Raquel González,Jayne Webster,Brian Greenwood,Michel Cot,Feiko O. ter Kuile +11 more
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TLDR
Modelling analysis suggests the importance of the prevention of malaria early in pregnancy and the need to protect pregnant women declines more slowly than the rate at which transmission declines, as coverage of IPTp and insecticide-treated nets continues to lag behind targets.Abstract:
Malaria remains one of the most preventable causes of adverse birth outcomes Intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine-pyrimethamine is used to prevent malaria, but resistance to this drug combination has decreased its efficacy and new alternatives are needed In Africa, a meta-analysis showed three-course or monthly IPTp with sulfadoxine-pyrimethamine to be safe and more effective than the original two-course sulfadoxine-pyrimethamine strategy, prompting WHO to update its policy in 2012 Although resistance to sulfadoxine-pyrimethamine reduces the parasitological efficacy of IPTp, this drug combination remains associated with reduced incidence of low birthweight in areas where prevalence of parasites with quintuple Plasmodium falciparum dihydrofolate reductase (Pfdhfr) and dihydropteroate synthetase (Pfdhps) mutations is greater than 90% Nevertheless, its effectiveness is compromised in women infected with sextuple mutant parasites Six trials of IPTp showed that neither amodiaquine, mefloquine, nor chloroquine-azithromycin are suitable replacements for sulfadoxine-pyrimethamine because of poor tolerability Furthermore, four trials showed that intermittent screening and treatment with the current generation of malaria rapid diagnostic tests was not a suitable alternative strategy to IPTp with sulfadoxine-pyrimethamine, even in areas with high prevalence of quintuple mutations Two trials showed that IPTp with dihydroartemisinin-piperaquine was well tolerated, effective, and acceptable for IPTp, with monthly regimens being the most effective Coverage of IPTp and insecticide-treated nets continues to lag behind targets The key barriers to uptake are well documented, and many are open to intervention Outside of Africa, a single trial suggests a potential role for integrated approaches that combine sulfadoxine-pyrimethamine with azithromycin for IPTp in areas of Papua New Guinea where malaria transmission is high Modelling analysis suggests the importance of the prevention of malaria early in pregnancy and the need to protect pregnant women declines more slowly than the rate at which transmission declines Improved funding has led to an increase in the number of prevention trials in the past decade, showing the value of more sustained protection with monthly IPTp regimens There is a need for confirmatory trials of the safety, efficacy, and feasibility of IPTp with dihydroartemisinin-piperaquine, for studies of intermittent screening and treatment with more sensitive rapid diagnostic tests, for studies of integrated strategies for malaria and other co-infections, and for studies of prevention strategies for malaria in pregnant women who are HIV-positive and living outside of Africa Additional research is required on how to improve uptake of WHO's updated policy on IPTp with sulfadoxine-pyrimethamine and insecticide-treated netsread more
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Journal ArticleDOI
Burden, pathology, and costs of malaria in pregnancy: new developments for an old problem
Stephen J. Rogerson,Meghna Desai,Alfredo Mayor,Alfredo Mayor,Elisa Sicuri,Elisa Sicuri,Steve M. Taylor,Anna Maria van Eijk +7 more
TL;DR: This Series paper summarises recent progress and highlights unresolved issues related to the burden of malaria in pregnancy and suggests pregnant women could be used to monitor malaria transmission.
Journal ArticleDOI
Antimalarial drug resistance in Africa: the calm before the storm?
TL;DR: This Review summarises evolving patterns of antimalarial drug resistance in Africa and indicates that resistance to artemisinins or key partner drugs included in combination therapies does not appear to be a substantial problem in Africa.
Journal ArticleDOI
Effect of Plasmodium falciparum sulfadoxine-pyrimethamine resistance on the effectiveness of intermittent preventive therapy for malaria in pregnancy in Africa: a systematic review and meta-analysis
Anna Maria van Eijk,David A. Larsen,Kassoum Kayentao,Gibby Koshy,Douglas E C Slaughter,Cally Roper,Lucy C Okell,Meghna Desai,Julie Gutman,Carole Khairallah,Stephen J. Rogerson,Carol Hopkins Sibley,Carol Hopkins Sibley,Steven R. Meshnick,Steve M. Taylor,Steve M. Taylor,Feiko O. ter Kuile +16 more
TL;DR: The effectiveness of sulfadoxine-pyrimethamine IPTp is reduced in areas with high resistance to sulfad Oxine- pyrimetamine among P falciparum parasites, but remains associated with reductions in low birthweight even in areas where dhps Lys540Glu prevalence exceeds 90% but where the sextuple-mutant parasite (harbouring the additional dhps Ala581Gly mutation) is uncommon.
Journal ArticleDOI
Elucidating Mechanisms of Drug-Resistant Plasmodium falciparum
Leila S. Ross,David A. Fidock +1 more
TL;DR: Four antimalarial resistance case studies are presented that differ in timeline, technical approaches, mechanisms of action, and categories of resistance: chloroquine, sulfadoxine-pyrimethamine, artemisinin, and piperaquine.
Journal ArticleDOI
Resistance to Artemisinin Combination Therapies (ACTs): Do Not Forget the Partner Drug!
TL;DR: There is an urgent need to strengthen and expand current resistance surveillance systems beyond the GMS to track the emergence or spread of artemisinin resistance, and strategies to improve surveillance and potential solutions to extend the useful therapeutic lifespan of the currently available malaria medicines are proposed.
References
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Journal ArticleDOI
Epidemiology and burden of malaria in pregnancy
Meghna Desai,Feiko O. ter Kuile,Feiko O. ter Kuile,François Nosten,François Nosten,Rose McGready,Rose McGready,Kwame Asamoa,Bernard J. Brabin,Bernard J. Brabin,Robert D. Newman,Robert D. Newman +11 more
TL;DR: In this article, the authors reviewed evidence of the clinical implications and burden of malaria in pregnancy and found that successful prevention of these infections reduces the risk of severe maternal anaemia by 38%, low birthweight by 43%, and perinatal mortality by 27% among paucigravidae.
Journal ArticleDOI
Malaria in pregnancy: pathogenesis and immunity.
Stephen J. Rogerson,Lars Hviid,Lars Hviid,Patrick E. Duffy,Patrick E. Duffy,Rose F. G. Leke,Diane Wallace Taylor,Diane Wallace Taylor +7 more
TL;DR: Understanding of placental immunopathology and how this contributes to anaemia and low birthweight remains restricted, although inflammatory cytokines produced by T cells, macrophages, and other cells are clearly important.
Journal ArticleDOI
The burden of co-infection with human immunodeficiency virus type 1 and malaria in pregnant women in sub-saharan Africa.
Feiko O. ter Kuile,Monica E. Parise,Francine H. Verhoeff,Venkatachalam Udhayakumar,Robert D. Newman,Anne M. Van Eijk,Stephen J. Rogerson,Richard W. Steketee +7 more
TL;DR: In this paper, the authors reviewed available information collected since the first report 15 years ago that HIV impaired the ability of pregnant women to control malaria parasitemia and found that pregnant women experienced consistently more peripheral and placental malaria (summary relative risk = 1.58 and 1.66, respectively), higher parasite densities, and more febrile illnesses, severe anemia, and adverse birth outcomes than HIV-uninfected women, particularly in multigravidae.
A strategic framework for malaria prevention and control during pregnancy in the African region
TL;DR: This document summarizes the aims and objectives of the WHO document, as well as investigating its applicability and scope and purpose, and some of the aspects of its development and usage.
Journal ArticleDOI
Intermittent preventive therapy for malaria during pregnancy using 2 vs 3 or more doses of sulfadoxine-pyrimethamine and risk of low birth weight in Africa: systematic review and meta-analysis.
Kassoum Kayentao,Paul Garner,Anne M. Van Eijk,Inbarani Naidoo,Cally Roper,Abdunoor Mulokozi,John R. MacArthur,Mari Luntamo,Per Ashorn,Ogobara K. Doumbo,Feiko O. ter Kuile +10 more
TL;DR: Support for the new WHO recommendations to provide at least 3 doses of intermittent preventive therapy during pregnancy at each scheduled antenatal care visit in the second and third trimester is provided.