Content area
Full Text
Figure 1. Artemisinin-based combination therapy used for the treatment of laboratory-confirmed uncomplicated Plasmodium falciparum malaria (February 2011). AL: Artemether-lumefantrine; AQ: Amodiaquine; AS: Artesunate; DHA: Dihydroartemisinin piperaquine; MQ: Mefloquine; PPQ: Piperaquine; PQ: Primaquine; SP: Sulfadoxine/pyrimethamine. Reproduced with permission from [101].
(Figure omitted. See article PDF.)
Figure 2. Artemether.
(Figure omitted. See article PDF.)
Figure 3. Lumefantrine.
(Figure omitted. See article PDF.)
Malaria in pregnancy (MiP) is a major health problem with deleterious adverse effects (AEs) to the mother and fetus. The type and magnitude of effect depend on the infecting malaria species, intensity of transmission and the mother's immune status. AEs among women with little or no immunity, resident in low and unstable Plasmodium falciparum malaria transmission areas, include stillbirth, miscarriage or maternal death, while maternal anemia, placental malaria and low birth weight occur among women living in stable transmission areas with considerable acquired immunity [1]. MiP also impacts negatively on child survival and malaria-related morbidity [2]. The estimated global pregnancies at risk of malaria in 2007 was 125.2 million in areas with P. falciparum and/or Plasmodium vivax , 54.7 million with stable P. falciparum and 70.5 million in exceptionally low malaria transmission areas or areas with P. vivax only [3]. Effective case management is one strategy recommended by the WHO to control MiP besides insecticide-treated nets, indoor residual spraying (IRS) of insecticides and intermittent preventive treatment [1]. Commonly, multiple control strategies are applied in one control package.
Effective treatment has been compromised by P. falciparum resistance to chloroquine and sulfadoxine/pyrimethamine (SP), two drugs that were readily available, affordable and considered safe in pregnancy, except SP in the first trimester. The use of artemisinin-based combination therapy (ACT), like artemether-lumefantrine (AL) is hindered by limited knowledge on safety, particularly during the first trimester. WHO recommends ACTs only in the second and third trimester [4]. They may only be used in the first trimester if there are no suitable alternatives and aimed at saving life. As Figure 1 indicates, AL is widely deployed as first or second-line antimalarial treatment [101]. In low income countries (LICs), many pregnant women are inadvertently exposed to AL and other ACTs in the first trimester through rampant self-medication and through prescriptions in early pregnancy when women are unaware of being pregnant. Whereas...