What is intermittent preventive treatment (IPT) against malaria?
Intermittent preventive treatment (IPT) against malaria is a malaria control strategy aimed at reducing the burden of malaria in certain high-risk groups, namely pregnant women and children.
What are the treatment options for a malaria placenta?
A malaria-infected placenta is unable to carry out normally its main function: to provide nutrients to the fetus. Intermittent preventive treatment (IPTp) (for HIV negative women in high transmission areas).
What is intermittent preventive treatment for HIV infection?
Intermittent preventive treatment (IPTp) (for HIV negative women in high transmission areas). Women should also receive iron/folate supplementation to protect them against anemia, a common occurrence among all pregnant women.
What are the prevention and treatment strategies for malaria?
Malaria Prevention, Treatment, and Control Strategies 1 Special Populations. Malaria has a significant impact on the health of infants, young children,... 2 Vaccine Development. The development of a safe and effective vaccine against malaria will be... 3 Drug Development. Antimalarial drugs, in combination with mosquito control programs,...
What is intermittent preventive therapy in malaria?
Intermittent preventive treatment (IPT) against malaria is a malaria control strategy aimed at reducing the burden of malaria in certain high-risk groups, namely pregnant women and children.
What is meant by intermittent preventive treatment?
Intermittent preventive therapy or intermittent preventive treatment (IPT) is a public health intervention aimed at treating and preventing malaria episodes in infants (IPTi), children (IPTc), schoolchildren (IPTsc) and pregnant women (IPTp).
What is intermittent preventive treatment of malaria in pregnancy?
Intermittent Preventive Treatment of pregnancy (IPTp) involves the administration of therapeutic doses of an antimalarial drug to a population at risk whether or not they are known to be infected, at specific point intervals usually with the aim of reducing morbidity and mortality.
What is the preventive treatment for malaria?
Atovaquone/proguanil (Malarone), doxycycline, and mefloquine are the drugs of choice for malaria prevention in most malaria-endemic regions. Chloroquine (Aralen) may be used safely in all trimesters of pregnancy, and mefloquine may be used safely in the second and third trimesters of pregnancy.
Which of the following drug is used as an intermittent presumptive treatment *?
Intermittent presumptive treatment (IPT) with sulphadoxine-pyrimethamine (SP) in pregnancy and with amodiaquine or SP in infancy has been proposed for use in areas with high levels of malaria transmission. The duration of post treatment prophylaxis is likely to be an important determinant of the benefit of IPT.
What drug is used for intermittent presumptive treatment IPTp of malaria in pregnancy?
What is the program? Intermittent preventive treatment of malaria during pregnancy (IPTp) is a preventive regimen of the antimalarial drug sulfadoxine-pyrimethamine (SP) to be given monthly to all at-risk pregnant women in their second and third trimesters.
How many times should a pregnant woman take malaria drugs?
The National malaria control program,6,7 recommends 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.
When do you start SP in pregnancy?
IPTp-SP should be given to a pregnant woman at every ANC contact starting from 13 to 16 weeks, with each dose being given at least one month (four weeks) apart. Pregnant women who have an ANC contact twice between 13 and 20 weeks, at least one month apart, should receive IPTp-SP by DOT at both contacts.
What is the best treatment for malaria in pregnancy?
Uncomplicated malaria in pregnancy Currently, quinine and clindamycin is the recommended treatment for women in the first trimester of pregnancy31. In many places, clindamycin is unavailable, and quinine monotherapy is prescribed.
Is malaria prophylaxis effective?
Clinical trials indicate that the efficacy of primaquine is higher than 95% as terminal prophylaxis at doses of 30 mg daily for 14 days (in combination with a blood schizonticide such as chloroquine) and greater than 85% as prophylaxis [86].
How often should one take anti malaria drugs?
Begin 1-2 weeks before travel, weekly during travel, and for 4 weeks after leaving. Adults only: 200 mg per dose. Begin daily for 3 days prior to travel, weekly during travel, and for 1 week after leaving.
How many cases of malaria can IPTi prevent?
If IPTi is widely adopted and implemented in areas recommended by WHO (see below), it could prevent approximately 6 million cases of malaria and save tens of thousands of lives every year in Africa, the region of the world most affected by malaria. A doctor giving an SP injection as part of an IPTi study in Kenya.
What is intermittent preventive treatment?
Intermittent Preventive Treatment During Infancy (IPTi) The newest intervention recommended by the World Health Organization (in March 2010) is intermittent preventive treatment in infancy with SP (SP-IPTi). Studies show that SP-IPTi can significantly reduce clinical malaria and anemia in the first year of life, ...
When is SP IPTi administered?
SP-IPTi is the administration of a full therapeutic course of sulfadoxine-pyrimethamine (SP) delivered through the Expanded Program on Immunization (EPI) at intervals corresponding to routine vaccination schedules—usually at 10 weeks, 14 weeks, and about 9 months of age —to infants at risk of malaria, regardless of their malaria infection status.
Can infants take SP-IPTi?
Infants should not be given SP-IPTi if they are receiving a sulfa-based medication for treatment or prophylaxis, including co-trimoxazole (trimethoprim-sulfamethoxazole), a drug widely used as prophylaxis against opportunistic infections in HIV-infected or -exposed infants. More on: SP-IPTI. external icon.
Summary
What is the problem? Pregnant women living in malaria-endemic areas are particularly susceptible to malaria infection, creating health risks for both the mother and child.
What is the problem?
Pregnant women living in malaria-endemic areas are particularly susceptible to malaria infections and are also more likely to develop severe malaria infections, which may pose health risks to pregnant women and their fetuses.
What is the program?
Intermittent preventive treatment in pregnancy (IPTp) is a prophylactic regimen of antimalarial medicine for pregnant women.
Does the program have strong evidence of effectiveness?
To evaluate the effectiveness of IPTp interventions, we relied on Radeva-Petrova et al. 2014, a Cochrane Collaboration meta-analysis of seventeen randomized controlled trials (RCTs) and quasi-RCTs that compared treatment with various IPTp regimens during pregnancy to no preventive treatment.
Potential negative impacts of the program
Launching a large-scale IPTp program poses several risks. We would need to conduct additional research on these issues to form an opinion on the likelihood that any of these factors would lead to major negative consequences from IPTp.
Is the program cost-effective?
Based on a cost-effectiveness model we put together in October 2018 and updated with our most recent moral weights as of February 2021, we estimate that IPTp is below the range of cost-effectiveness of the opportunities that we expect to direct marginal donations to (about 10x cash or higher, as of 2021).
Does the program have room for more funding?
We would guess that this program has substantial room for more funding as program coverage rates remain low. WHO reports that among countries that have already adopted IPTp-SP, less than 20% of eligible women receive the minimum recommended number of doses. 21
What is the impact of malaria on maternal mortality?
A recent study estimated that malaria may contribute to 3–5% of maternal anaemia, 8–14% of LBW, and 3–8% of infant mortality [ 2 ]. Malaria consequences are particularly deleterious in women co-infected with HIV, as they have more frequently clinical and placental malaria, more detectable malaria parasitaemia and higher malaria parasite densities. HIV-positive women of all gravidities are at increased risk, although primi- and secundigravidae are the most affected overall [ 6 ].
Is malaria a maternal disease?
Malaria in pregnancy is one of the major causes of maternal morbidity and adverse birth outcomes. In high transmission areas, its prevention has recently changed, moving from a weekly or bimonthly chemoprophylaxis to intermittent preventive treatment (IPTp). IPTp consists in the administration of a single curative dose of an efficacious anti-malarial drug at least twice during pregnancy – regardless of whether the woman is infected or not. The drug is administered under supervision during antenatal care visits. Sulphadoxine-pyrimethamine (SP) is the drug currently recommended by the WHO. While SP-IPTp seems an adequate strategy, there are many issues still to be explored to optimize it. This paper reviewed data on IPTp efficacy and discussed how to improve it. In particular, the determination of both the optimal number of doses and time of administration of the drug is essential, and this has not yet been done. As both foetal growth and deleterious effects of malaria are maximum in late pregnancy women should particularly be protected during this period. Monitoring of IPTp efficacy should be applied to all women, and not only to primi- and secondigravidae, as it has not been definitively established that multigravidae are not at risk for malaria morbidity and mortality. In HIV-positive women, there is an urgent need for specific information on drug administration patterns (need for higher doses, possible interference with sulpha-based prophylaxis of opportunistic infections). Because of the growing level of resistance of parasites to SP, alternative drugs for IPTp are urgently needed. Mefloquine is presently one of the most attractive options because of its long half life, high efficacy in sub-Saharan Africa and safety during pregnancy. Also, efforts should be made to increase IPTp coverage by improving the practices of health care workers, the motivation of women and their perception of malaria complications in pregnancy. Because IPTp is not applicable in early pregnancy, which is a period when malaria may also be deleterious for women and their offspring, there is a necessity to integrate this strategy with other preventive measures which can be applied earlier in pregnancy such as insecticide-treated nets.
Is IPTP effective during pregnancy?
There is evidence that IPTp with SP is presently the most efficacious and adequate strategy for the prevention of malaria during pregnancy in high transmission areas. However, several years after having been implemented various problems have to be solved. In particular, it seems that only some of the women exposed to malaria are benefiting from this policy. Efforts should be made to improve performance of health worker and the motivation of women and their perception of malaria complications in pregnancy. The growing resistance of parasites to SP requires an urgent evaluation of alternative drugs to SP. Some attention should be given to the optimal dosage and frequency of administration, which have never been clearly determined. Finally, as IPTp is not applicable in early pregnancy – as most antimalarial drugs are contraindicated during the first trimester – one should continue combining the strategy with ITNs which can be applied earlier in pregnancy, and thus could add to late pregnancy's measures such as IPTp.
What Is The Problem?
What Is The Program?
- Intermittent preventive treatment in pregnancy (IPTp) is a prophylactic regimen of antimalarial medicine for pregnant women. The World Health Organization (WHO) recommends administering between three and six doses of IPTp using the antimalarial drug sulfadoxine-pyrimethamine (IPTp-SP) to all pregnant women living in areas with moderate to high mala...
Does The Program Have Strong Evidence of Effectiveness?
- To evaluate the effectiveness of IPTp interventions, we relied on Radeva-Petrova et al. 2014, a Cochrane Collaborationmeta-analysis of seventeen randomized controlled trials (RCTs) and quasi-RCTs that compared treatment with various IPTp regimens during pregnancy to no preventive treatment. Note: this evidence base is complicated because trials sometimes used a …
Potential Negative Impacts of The Program
- Launching a large-scale IPTp program poses several risks. We would need to conduct additional research on these issues to form an opinion on the likelihood that any of these factors would lead to major negative consequences from IPTp. More information is available here, where we have considered similar issues in the context of seasonal malaria chemoprevention programs. The ri…
Is The Program Cost-Effective?
- Based on a cost-effectiveness model we put together in October 2018 and updated with our most recent moral weights as of February 2021, we estimate that IPTp is below the range of cost-effectiveness of the opportunities that we expect to direct marginal donations to (about 10x cash or higher, as of 2021).18However, we have significant uncertainties about several of the assump…
Does The Program Have Room For More Funding?
- We would guess that this program has substantial room for more funding as program coverage rates remain low. WHO reports that among countries that have already adopted IPTp-SP, less than 20% of eligible women receive the minimum recommended number of doses.21
Focus of Further Investigation
- Questions we would ask as part of further investigation include: 1. Why do IPTp treatment outcomes differ so much by birth order? 2. How serious are the program risks that we have identified above (inducing drug resistance, drug interactions, or folic acid interactions)? 3. How do outcomes from the WHO-recommended SP drug compare to other antimalarial drugs used in th…