Q: Good day Doc. Thanks for your teachings. Please I went to ask u if it is advisable to give a pregnant woman ACTM tabs or injections or is there any order treatment for as it regards malaria during pregnancy
A: Hallos! Thanks for writing in. The use of medications in pregnancy is always considered very carefully to ensure that there is no harm to the growing baby. So, the conversation on malaria in pregnancy always starts from prevention.
Sulphadoxine-Pyrimethamine (SP) with a common brand in these climes being Fansidar, is used for the prevention of malaria in pregnancy. Its use for this is referred to as Intermittent Preventive Treatment of Malaria in pregnancy (IPTp-SP). Is it safe in pregnancy? Yes and no. In the first trimester, it is not recommended for use but from the second trimester, it is considered appropriate and indeed is recommended by World Health Organization (WHO) for administration to pregnant women. If you live in a malaria endemic area like Nigeria, your doctor will ensure that you get your Intermittent Preventive Treatment (IPT) courses for malaria (sulphadoxine-pyrimethmine) during your pregnancy, as your doctor has already done. The assumed rule before was for pregnant women to receive 2 doses of this drug (full dose of 3 tablets) but WHO has since clarified that the appropriate regimen is for women to receive the full dose of Sulphadoxine-Pyrimethamine from week 13 of pregnancy. She should get a full dose at every antenatal visit provided the last dose was taken at least one month before. There is evidence that women who received 3 or more doses of IPTp had children with higher average birth weights than those who got 2 doses.
Your doctor will ensure that the Folic Acid dose you’re getting in your prenatal drugs is not more than 0.4mg. Doses of Folic Acid higher than or equal to 5mg affects the efficacy of the anti-malarial, SP. So, be sure to check with your doctor before you start buying other non-prescribed prenatal vitamins. If you do have malaria the gold standard had always been Quinine, Clindamycin, Proguanil which are considered safe by the WHO treatment guideline in the first trimester. But, don’t be quick to go take any of them without prescription. Remember that every drug is a potential toxin and your doctor is really in the best place to weigh potential risks of taking any drug against the potential benefits.
The Malaria Policy Advisory Committee in its meeting in 2015, did find that Artemisinin-cased combination therapy drugs may not be as toxic as had been previously thought in early pregnancy and called for a review of the WHO guidelines on the treatment of malaria in pregnancy to consider the timely use of ACTs in these cases. So, this is not a license for you to go take any ACT medication. Have a chat with your doctor and s/he will advice.
Doing all of the above will be meaningless if you do not pay any attention to the environment. Those anopheles mosquitoes that are associated with malaria need a place to lay eggs so they can muster the right army to wreak havoc. So deprive them of a breeding camp. Who would know the conditions necessary for a terrorist camp to be set up and make their homes or environment, the right one for that? Nobody…in their right minds at least 😀 If you have to go out in the evenings, depending on whether you will be out in mosquito infested areas, wear protective clothing that cover arms and legs, preferably in light colours. Mosquitoes love dark colours and the dark….no wonder their deeds are evil!
So, I hope this helps.
Have a good night, y’all 😀