E-DRUG: The use of SP for prophylaxis of malaria in pregnancy
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Dear friends
can anyone explain why SP is still used for prophylaxis of
foetus against malaria in pregnancy while we know that the drug has lost
potency in those areas due to resistance. Anyone who can share its mode of
action in line with this use?
Minzi OMS
Professor Minzi OMS
Associate Professor in pharmacology and therapeutics
School of Pharmacy
Muhimbili University of Health and Allied Sciences
Dar Es Salaam, Tanzania
Omary Minzi <minziobejayesu@gmail.com>
E-DRUG: The use of SP for prophylaxis of malaria in pregnancy (2)
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The WHO Policy brief for the implementation of IPTp-SP which was revised in January 2014 provides the justification for continuous use of SP for malaria prophylaxis in pregnancy. This intervention strategy remains effective in improving maternal and fetal outcomes even in areas where resistance to SP is considered high, unless sufficient scientific evidence proves otherwise.
The meta-analysis study which was published in JAMA two years ago, involving 6,281 pregnant women showed that three or more doses of SP was associated with higher birth weight and lower risk of low birth weight (LBW). The relative risk reduction of LBW of 20% and absolute risk reduction of 33% per 1,000 live births which the authors found in this study was quite significant, considering the burden of malaria. Three or more doses of SP also reduce the risk of moderate-severe maternal anemia and placental malaria.
Note that, the study compared three or more doses of SP versus the previous standard dose of two, meaning the effects could have been higher when compared with placebo. Considering that treatment efficacy is a different notion to prophylaxis, it is not strange that SP has a poor efficacy but with relatively good prophylactic effect. Therefore, I can reasonably say that although the mechanism of action of SP on malaria parasite is the same, the effects of partial parasite clearance on birth-weight and cure of clinical malaria is different.
MORI, Amani Thomas (PhD. Cand)
Center for International Health
University of Bergen
Norway
Amani Thomas <pax_amani@yahoo.com>
The use of SP for prophylaxis of malaria in pregnancy (3)
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[ See E-DRUG post from Amani Thomas Mori - earlier today.
That should answer your questions. BS Moderator]
I am curious too about the use of SP as IPT. It is a a question I usually raise at different fora.
I will be glad if someone can throw light to this use.
Dr. (Mrs.) B.A. Aina
Dept. of Clinical Pharmacy and Biopharmacy
Faculty of Pharmacy University of Lagos
CMUL Campus, Idi Araba,
Lagos, NIGERIA
bolajoko aina <bolajokoaina@yahoo.com>
E-DRUG: The use of SP for prophylaxis of malaria in pregnancy (3)
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Dear Prof
Your question is a good one. I would like to refer you to the latest WHO guidelines on the treatment of malaria 2015. In think they were released last month and are available on their website.
The decision to do IPTp (intermittent preventive treatment for malaria in pregnancy) with SP is entirely a country decision depending on the prevailing epidemiology and endemicity of malaria.
In countries where the prevalence is low, one may choose to ignore IPTp all together and strengthen vector control, surveillance and effective case management.
It is claimed that despite the decline in the efficacy of SPs, it is apparently still effective against placental malaria parasites. There is evidence therefore that IPTp in high transmission areas actually reduces the incidences of low birth weight due to malaria.
More details are available in the WHO website.
Andrew
Andrew Nyandigisi,
CEO HealthStrat (formerly in MoH, NMCP)
Kenya
Andrew Nyandigisi <anyandigisi@gmail.com>