Malaria in Pregnancy Flashcards by Iseoluwa Ojo

Malaria
• _______ of the world’s population is at risk
• 94% of cases and deaths occur in ______ Region
• ________ is one of the top five countries for malaria deaths

Half

Africa

Nigeria

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the most important malaria health products: ________ , ________, ________ and ________.

ACTs

insecticides

LLINs

RDTs.

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Malaria is caused by ________ parasites.

The parasites are spread to people through the bites of infected anopheles mosquitoes, called “malaria vectors”,
which bite mainly between _______ and _________.

Plasmodium parasites.

dusk ; dawn.

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There are more than _____ different species of Anopheles mosquito and about _____ are malaria vectors of major
importance.

400 ; 30

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The 4 species of the protozoan Plasmodium parasite
responsible for malaria in humans are Plasmodium __________ , Plasmodium __________, Plasmodium __________ and
Plasmodium __________.

Plasmodium falciparum, Plasmodium vivax, Plasmodium malariae and
Plasmodium ovale.

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Plasmodium __________ is the most deadly

falciparum

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The intensity of transmission depends on factors related to
• the ————
• the _________
• the _________
• the _________

• the parasite
• the vector
• the human host
• the environment

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Specific population risk groups
• Infants, children under _____ years
• ________ women
• People with __________
• __________ travelers from non-endemic areas
• Non-immune migrants
• Mobile populations

5 years ; Pregnant

HIV/AIDS ; International

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Malaria in Pregnancy (MiP)
• Malarial infection during pregnancy is a major public health problem in _________ and _________ regions throughout the world.

tropical ; subtropical

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The burden of malaria infection during
pregnancy is caused chiefly by _______________, the most common malaria species in Africa.

Plasmodium falciparum

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Clinical features of MiP
• The incubation period of acute malaria is about ________

Symptoms
• Maybe asymptomatic
• Feeling of being unwell, fever, headaches, muscle/joint aches, poor appetite, nausea & vomiting.
• Ill looking, maybe anaemic, febrile, tachycardic, dehydrated.
• Parasite count _____%

10–15 days.

<2%

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Clinical features of MiP
• Complicated malaria:
• impaired level of ________ , ___________
distress, ___________ , convulsions,
shock, abnormal bleeding, jaundice and
haemoglobinuria.
• Other laboratory findings- severe anaemia (Hb _____ g/dL), thrombo________, ____glycaemia,
acidosis (pH < _____ ), renal impairment.
• parasite count____%

consciousness ; respiratory distress,

pulmonary oedema

< 8 g/dL ; thrombocytopaenia

hypoglycaemia ; < 7.3

> 2%

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Diagnosis of malaria

• Clinical or Laboratory
• Clinical- Symptoms
• Laboratory
• Microscopic (parasites- gold standard)- __________________
• Immunochromatographic (antigens derived from mp)- _____
• Molecular (parasite nucleic acids)- ______
• Serology (antibodies against mp- past exposure)- IFA/________
• Other investigations in patients with acute malaria should be determined by the severity of the infection and the
presence or otherwise of complications

Thick and thin blood film

RDTs ; PCR

ELISA

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Differential diagnosis of MiP
• _________
• _________
• Hepatitis
• _________
• Meningitis
• _________

• Chorioamnionitis
• UTI
• Hepatitis
• HIV/AIDS
• Meningitis
• eclampsia

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Complications of malaria in the
mother
• In areas of high and moderate (_________) malaria transmission, most adult women have developed enough immunity but during pregnancy, some of this acquired immunity becomes ________.
• __________ are most affected with the risk highest in the ____ and ______ trimesters.
• These infections maybe complicated by
acute __________→ _______ deficiencies,
anaemia, and if the patient suffers ante/post partum haemorrhage may go into _________→ death

stable ; lost.

Primigravidae

1st ; 2nd

haemolysis ; folate

shock

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Complications of malaria in the
mother 2
- ________ malaria
- renal failure, coagulation failure
- Threatened and inevitable _______
- ___________ labour
- Associated systemic disturbances-
dehydration, electrolyte disturbances,
pulmonary oedema, hypoglycaemia

cerebral ; abortions

Premature

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Complications of malaria on the
placenta & fetus
• The fetus is protected from malaria infection by certain mechanisms:
- passive immunity from ___________ passage of ___________________
- the ___________________ physically limits the passage of parasites into the foetal circulation
- the development of the malaria parasite is hindered in the presence of _______ haemoglobin
(_____)

transplacental

maternal malarial immunoglobin G antibodies

placental barrier

foetal haemoglobin
(HBF)

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Effects on foetus contd
• Foetal effects are either sequel to the maternal complications or are due to a direct effect on the foetus
- _________
- foetal ______
- _______________
- intra-uterine ______
- rarely, _________ malaria

prematurity
foetal distress
intra-uterine growth restriction
intra-uterine death
rarely, congenital malaria

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NMEP

National malaria elimination program

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Treatment of MiP
• Done in line with the _____ , _____ and _____ (3T) strategies (NMEP 2020)
• All suspected cases of malaria diagnosed using either Rapid
Diagnostic Test or microscopy
• All confirmed cases treated promptly with effective Artemisinin
combination therapy (ACT)
• All cases tracked through surveillance system

Test, Treat and Track

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Antimalarial therapy

First trimester (uncomplicated)- ______
Second & third trimester- ______

Complicated malaria, regardless of trimester
Parenteral _________ or _________ till the patient is able to tolerate orally, then maintained on oral drugs

ACTs
ACTs

artesunate ; arthemeter

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Prevention and control
Malaria prevention and control during
pregnancy has a three-pronged approach:
1. ________________________
2. _________________________
3. _________________________

Intermittent preventive treatment of malaria in pregnancy with Sulphadoxine and
Pyremethamine (IPTp-SP)

Long lasting insecticidal nets (LLINs)

Case management of malaria illness

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IPTp-SP
• WHO recommends a schedule of at least _______ antenatal care visits during pregnancy and IPTp-SP should be delivered at ______ scheduled ANC
visit.
• Initially, _____ doses of IPTp-SP were given but this was updated in October, 2012 following an evidence review by WHO

Study These Flashcards

eight ; each

IPTp-SP

Dosing should start in the ______ trimester and doses should be given atleast _______ apart with the objective of ensuring that atleast ____ doses are received

Study These Flashcards

second

1month

IPTp-SP • Starting as early as possible in the _______ trimester (_______ wks), • SP should not be given during the ________ trimester of pregnancy. • The last dose of IPTp-SP can be administered up to the time of delivery without safety concerns

second; 13-16 first

IPTp is a _______ antagonist and ________ antagonists can increase the risk of ____________ when taken during first trimester (period of __________)

folate; folate neural tube defects organogenesis

IPTp-SP • IPTp-SP should ideally be administered as _____________ of ______ tablets sulfadoxine/pyrimethamine (each tablet containing ____ mg/___ mg SP) giving the total required dosage of _____ mg/____ mg SP.

directly observed therapy (DOT) three tablets 500 ; 25 ; 1500 ; 75

SP can be given either on an empty stomach T/F

There is currently (sufficient or insufficient?) evidence to support a general recommendation for the use of IPTp-SP outside Africa.

insufficient

IPTp-SP with Iron and folic acid supplementation • WHO also recommends the administration of _____ to ____ mg of elemental iron and folic acid at a dose of ______ mg daily; this dose may be safely used in conjunction with SP.

30 ; 60 ; 0.4

Folic acid at a daily dose ≥___ mg should not be given together with SP as this ????????

5 mg counteracts its efficacy as an antimalarial.

IPTp and HIV • Pregnant women living with HIV and taking __________ prophylaxis should not receive SP

co-trimoxazole

Even When taken daily, co-trimoxazole does not provide protection against MiP T/F

F When taken daily, co-trimoxazole provides protection against MiP

co-trimoxazole has 2 components What are they?

Sulfamethoxazole Trimethoprim

IPTp vs ISTp • In recent years an alternative strategy, consisting of ______________________ (ISTp) using rapid diagnostic tests (RDTs) and treatment with artemisinin-based combination therapies (ACTs) during ANC visits, has been evaluated in several countries

intermittent screening and treatment in pregnancy (ISTp)

ISTp resulted in a (lower or higher?) proportion of maternal infections and clinical malaria during pregnancy compared to IPTp with SP given during ANC visits

higher

ISTp is also (more or less?) cost-effective than IPTp-SP

less

ISTp is not recommended as an alternative to IPTp-SP T/F

Challenges to IPTp uptake • _________ availability of sulfadoxine- pyrimethamine • Low antenatal care _________ • Poor ________ of antenatal care service delivery • Inadequate health __________

Sporadic ; attendance quality ; manpower

Future directions • Evaluation of alternative strategies eg, IST-pand alternative medicines (eg ____________________ , ____________________ ) for potential future use for intermittent preventive treatment in pregnancy.

azithromycin- chloroquine, dihydroartemisinin-piperaquine

LLIN • Properties of ITNs/LLINs • Treated mosquito nets work by acting as a _____________ to vector mosquitoes. Thus affords personal protection against malaria to those using the nets. • The ___________ insecticides used to treat nets have an excito-repellent effect that adds a chemical barrier to the physical one; this increases the protective efficacy of the mosquito net by further reducing human–vector contact.

physical barrier pyrethroid

New ITNs can combine pyrethroids with other chemicals like piperonyl butoxide, chlorfenpyr or pyriproxfen to enhance their effectiveness against resistant mosquitoes

Okay🌚

LLINs are treated at _________ level by a process that binds or incorporates insecticide into the ________. • Lasts for at least _______ under recommended conditions of use in the field, thus no need for regular insecticide re-treatment.

factory ; 3 years

LLIN - properties • The insecticidal efficacy of the nets should persist through at least _______ WHO standard washes • Health education programmes, social marketing and lobbying to reduce the prices of LLINs and re-treatments are helping to encourage the use of LLINs by pregnant women

Case management of malaria illness • This entails early diagnosis and prompt treatment with effective antimalarial medicines. • Especially important in non-immune pregnant women • _____________ (RBM), in partnership with Making Pregnancy Safer, has brought a new emphasis to the burden of malaria in pregnant women within malaria control efforts.

Roll Back Malaria (RBM)

Delivery of cost-effective malaria prevention to pregnant women • This will require: - increased ____________ of the problem among communities most affected by malaria; - integration of malaria ———— tools with other health programmes targeted to pregnant women and newborns; - strengthened _______ systems and involvement of _______ where they are part of health service delivery; - _________ investment

awareness ; control ANC ; TBAs financial

Global Malaria Action Plan (GMAP) • A comprehensive blueprint for global malaria ________ &________

control elimination

_______________ (GMAP) was developed by the __________ partnership and launched in _______

Global Malaria Action Plan Roll back malaria 2008

Baseline year for measuring progress is??

2015

Global technical strategy for malaria 2016-2030 • Adopted by the World Health Assembly in ————- • Provides a comprehensive framework to guide countries in their efforts to accelerate progress towards malaria elimination • Target is to reduce global malaria incidence and mortality rates by at least ———% by ______

May 2015 90% 2030

Updates World malaria day, malaria vaccine, IPT-SP • World malaria day celebrated yearly on ______________ to spread awareness about malaria disease and to promote efforts to prevent malaria

25th April

WMD 2024 theme: “ ________________________________.”

Accelerating the fight against malaria for a more equitable world

Malaria vaccine:_______ – A scientific breakthrough. It is the first vaccine recommended for use against a human parasitic disease of any kind. First launched in Africa in ________, April 2019. Now rolled out also in Ghana, Kenya, Nigeria??

RTS,S Malawi

RTS-S Aka??

Mosquirix

WMD 2025 theme is??

Malaria ends with us: Reinvest, Reimagine, Reignite

Malaria in Pregnancy Flashcards

(55 cards)