E-drug: Re: Malaria prophylaxis during pregnancy (6)
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Dear E-druggers,
I have been away and so may have missed some of the discussion on this
subject. Of course the most important prophylaxis of all is to urge
pregnant women whether travellers or those living in endemic areas
(naturally the former are more at risk) to use an impregnated bed-net and
in an endemic area to get going a community-based bed-net scheme through
possibly a Bamako-type village pharmacy scheme. This is more important than
drug prophylaxis. On top of a bed-net I would be quite happy to prescribe
proguanil/chloroquine with folic acid to a pregnant non-immune in a malaria
area until the doubts about mefloquine prophylaxis in pregnancy have been
resolved.
I have looked after dozens of pregnant non-immunes (as well as hundreds of
semi-immunes in their first pregnancy when they lose part of their
immunity) on the above basis in a holoendemic area for malaria and have
never run into trouble yet. This includes my wife during two pregnancies.
It is wise to always have accessibility to a dependable laboratory for
malaria slides in any febrile illness during pregnancy and also to have
available a curative course of whatever treatment is recommended for the
area.
Gunnar Holmgren,
Consultant in International Health, ICH, Uppsala, Sweden. Formerly
district medical officer in Zambia for 16 years.
Gunnar.Holmgren@ich.uu.se
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