In
collaboration with many partners—other government agencies, international
organizations, and African ministries of health—CDC has worked to
- Quantify
the burden of adverse effects caused by malaria infection during pregnancy
- Evaluate
the efficacy of novel strategies to prevent malaria during pregnancy
- Formulate
strategies to deliver effective interventions to reduce malaria's ill
effects on the health of pregnant women and their children
- Work with partners to scale up interventions to prevent and control malaria during pregnancy.
Specific
Contributions
Reduction
of low birth weight: Determined the risk of malaria-associated low
birth weight and shown how this risk could be reduced through the delivery
of efficacious antimalarial drugs as part of routine antenatal care.
Estimates
of malaria burden: Updated estimates of the burden of anemia, low
birth weight (due both preterm delivery and intrauterine growth retardation),
and infant mortality associated with malaria infection during pregnancy [1].
With partners, have generated estimates of the burden of malaria during pregnancy in areas with limited data, including West Africa, areas of sub-Saharan Africa with low malaria transmission, and South/ South East Asia.
Rapid
assessment methodology: Developed a methodology that can be used by
ministries of health to estimate the burden of malaria during pregnancy
and assess how best to incorporate antimalarial interventions into the
existing antenatal care system [2]. To date, CDC has provided training for this methodology in Asia, Africa, and the Americas. (More about the rapid assessment methodology in our Malaria and Pregnancy spotlight.)
Intermittent
preventive treatment in pregnancy (IPTp): With partners, developed the strategy of IPTp, and demonstrated
that this intervention was effective in reducing maternal anemia and
delivery of low birth-weight babies in different settings in sub-Saharan Africa [3, 4].
Interaction
of Malaria and HIV: Demonstrated both the higher burden of malaria
in HIV-seropositive (compared to HIV-seronegative) pregnant women and
their impaired response to antimalarial treatment [5].
Insecticide-treated
nets (ITNs): Demonstrated that the use of ITNs by pregnant women can
reduce severe malarial anemia during pregnancy and reduce delivery of
low birth-weight infants [6].
Issues
Currently Under Study
Evaluation
of new antimalarial drugs for pregnancy: In collaboration with international
partners, CDC is working to evaluate the safety and efficacy of new antimalarial
drugs and drug combinations for the treatment and prevention of malaria
during pregnancy.
Evaluation
of the combined benefit of IPTp and ITNs: CDC is working on novel mechanisms
for increasing the percentage of pregnant women with access to IPTp and
ITNs, and on measuring the combined impact of these interventions on preventing
the adverse consequences of malaria during pregnancy.
Interaction
of antimalarial drugs and folic acid: CDC is evaluating a possible
interaction between IPTp with sulfadoxine-pyrimethamine and administration
of folic acid during pregnancy. There has been a theoretical concern that
these two beneficial antenatal interventions could interfere with one
another in practice; this research will help to answer that question.
Development
of a monitoring and evaluation system for malaria during pregnancy:
In conjunction with WHO and other international partners, CDC has been
developing a standardized system for monitoring the uptake of strategies
to prevent malaria during pregnancy, as well as for demonstrating impact on
preventing anemia and low birth weight.
Studying the efficacy of intermittent preventive treatment in infants (IPTi) for control of malaria and severe anemia in infancy: CDC is a member of the IPTi Consortium (www.ipti-malaria.org) and is conducting one of five large clinical trials that are currently under way in Africa to assess use of IPTi at time of routine vaccinations as a control strategy for prevention of malaria and anemia in infancy. (http://www.cdc.gov/malaria/cdcactivities/ipt_i.htm).
Review of the global burden of malaria in pregnancy and identifying gaps in knowledge: CDC is writing a review of the current knowledge and gaps in the burden of malaria in pregnancy. This is one of six state-of-the-art comprehensive reviews being undertaken by the MiP Consortium to develop a prioritized strategy defining the scope of future studies of malaria in pregnancy.
Citations
1. Steketee, R.W., B.L. Nahlen, et al., The burden of malaria in pregnancy in malaria-endemic areas. American Journal of Tropical Medicine & Hygiene, 2001. 64(1-2 Suppl): p. 28-35.
2. Parise, M.E., L.S. Lewis, et al., A rapid assessment approach for public health decision-making related to the prevention of malaria during pregnancy. Bull World Health Organ, 2003. 81(5): p. 316-23.
3. Kayentao, K., M. Kodio, et al., Comparison of Intermittent Preventive Treatment with Chemoprophylaxis for the Prevention of Malaria during Pregnancy in Mali. J Infect Dis, 2005. 191(1): p. 109-16.
4. Parise, M.E., J.G. Ayisi, et al., Efficacy of sulfadoxine-pyrimethamine for prevention of placental malaria in an area of Kenya with a high prevalence of malaria and human immunodeficiency virus infection. American Journal of Tropical Medicine & Hygiene, 1998. 59(5): p. 813-22.
5. ter Kuile, F.O., M.E. Parise, et al., The burden of co-infection with human immunodeficiency virus type 1 and malaria in pregnant women in sub-saharan Africa. Am J Trop Med Hyg, 2004. 71(2 Suppl): p. 41-54.
6. ter Kuile, F.O., D.J. Terlouw, et al., Reduction of malaria during pregnancy by permethrin-treated bed nets in an area of intense perennial malaria transmission in western Kenya. Am J Trop Med Hyg, 2003. 68(4 Suppl): p. 50-60.
Page last modified : August 15, 2006
Content source: Division of Parasitic Diseases
National Center for Zoonotic, Vector-Borne, and Enteric Diseases (ZVED)
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