How To Treat Malaria During Pregnancy, And The Right Drug To Use For Kids
Malaria is a common problem in mosquitoes’ predominant places and is one of the leading causes of morbidity and mortality in children under five years old. It’s a severe sickness among the people living in mosquitoes inhabited areas.
What Causes Malaria?
Malaria is caused by a parasite of the genus Plasmodium species such as Plasmodium falciparum, Plasmodium vivax, Plasmodium ovale, and Plasmodium malariae.
Plasmodium falciparum is the predominant species with about 92% and the causative agent of malaria mostly in tropical areas.
Mosquito is the reservoir for Plasmodium. It is where the parasite lives and is transmitted to the human host when you are bitten by an infected mosquito. There, the parasite continues its lifecycle thereby harming the human host and resulting in sickness.
- Endemic: These include altitude, rainfall, temperature, and humidity are the determinant factors of malaria transmission. The mosquito vector has a short lifecycle and its survival rates are high due to the favorable climatic conditions. When there is a favorable condition it promotes the survival of the mosquito vector in the environment and intensifies transmission.
- Seasonal Transmission: When the temperatures are usually high, water pools created during the rainy season provide breeding sites for the malaria vector resulting in epidemic outbreaks with high morbidity rates in such places.
- Areas With Low Malaria Risk: These are areas where the temperatures are usually too low to allow completion of the sporogenic cycle of the malaria parasite in the vector. As such, increased temperatures change the hydrological cycle associated with climatic changes which are likely to increase malaria vector breeding sites with the introduction of malaria transmission.
The Risk Of Malaria In Pregnancy
Women in their first and second pregnancies are at risk of malaria.
- Malaria is very bad for pregnant women. Malaria is the cause of death in at least 1 out of 10 women who die during pregnancy.
- Malaria is a serious sickness during the first pregnancy. It can cause a lack of blood in the blood (anemia), miscarriage (loss of pregnancy), premature birth (baby born before the time), or stillbirth (baby dead in the womb or at birth).
- Babies born to mothers who had malaria during pregnancy may be small when born and become sick easily or die before one year.
- Increases the risk of maternal illness and death.
Thus, a pregnant woman living in areas where malaria is predominant should acquaint herself with malaria preventive measures.
Diagnosis Of Malaria In Pregnancy
There is no difference in features or symptoms of malaria in pregnant women and non-pregnant women. Unless pregnant women have an increased risk of quinine-induced hypoglycemia and also complications from severe anemia.
The use of parasitological diagnosis is recommended to detect the presence of malaria parasites. Microscopy and Malaria Rapid Diagnostic Test (mRDTs) are the common methods used to detect the malaria parasite.
Microscopy is the gold standard method for parasitological diagnosis of malaria. mRDTs are used where microscopy services are not available.
This is performed by a trained medical laboratory practitioner. It is done by examining Giemsa-stained thick and thin blood films for the presence of malaria parasite.
The medical laboratory attendant collects your blood sample to examine under the microscope for the presence of malaria parasite. Thick films are used for parasite detection and thin films are used for species identification. All of these things will be done by the medical laboratory attendant. What he requires from you are your patience and trust. Your doctor will explain the outcome of the result to you.
Malaria Rapid Diagnostic Tests (mRDTs)
These are immunochromatographic tests based on the detection of specific parasite antigens. mRDTs are simple to use by a trained medical laboratory attendant and sensitive in detecting low parasitemia, unlike microscopy.
Your healthcare provider will request for mRDTs usually for follow-up of previously confirmed cases, sometimes with microscopy examination, as most of the tests remain positive for between 2 to 3 weeks following effective antimalarial treatment. No need to confirm an initial mRDT positive result with microscopy rather your medical laboratory attendant confirms an mRDT negative test with microscopy examination.
Treatment Of Malaria In Pregnancy
Your healthcare provider is the one to prescribe and administer the best antimalarial drugs for you. Don’t do self-medication.
The recommended treatment for pregnant women is different from non-pregnant women or any other person because not all antimalarial drugs are safe for you.
In the first trimester, your healthcare provider will administer 7-day quinine or Fansidar. Artemether-lumefantrine, Arteether, or any other treatment in the first trimester is not safe for you. This is more reason why you should discourage self-medication. Malaria if left untreated at this stage can be fatal to you.
In the second and third trimesters, Artemether-lumefantrine, Arteether, and Artesunate together with their injections can be prescribed and administered by your healthcare provider under certain conditions. However, as you treat malaria, you can use the opportunity to monitor and prevent hypoglycemia, fetal monitoring, hemoglobin, and anemia.
Complications Of Malaria In Pregnancy
Convulsions in pregnancy: Eclampsia will be requested by your healthcare provider for a diagnosis. He takes note of your recent history of fever, chills, temperature, blood pressure, enlarged spleen, jaundice, and proteinuria. Artesunate or Arteether is the most used medicine for complicated malaria in pregnancy.
The Risk Of Malaria In Adults/Children
- Malaria makes the body weak and causes the child to lose plenty of water by sweating.
- Children who have malaria and are still on breastmilk suffer because their bodies cannot fight against other diseases.
- Malaria in children can cause their brain and body, not to grow well and cause a lack of blood.
Treatment Of Malaria In Adults/Children
The first line of treatment in children for malaria is Artemether-lumefantrine. It is administered as a 6-dose regimen given over three days; a 12-dose, 18-dose, and 24-dose given 8, 24, 36, 48, and 60 hourly till the tablets get finished- dosage. It’s always available as co-formulated tablets containing 20mg, 40mg, 60mg, 80mg of Artemether and 120mg, 240mg, 360mg, and 480mg of Lumefantrine respectively.
Your healthcare provider will administer the medicine based on your body weight and age.
Treatment of Severe Malaria
The recommended treatment for severe malaria is parenteral artesunate. The preferred route of administration is intravenous (IV). However, intramuscular (IM) can be used as an alternative where the intravenous route is not feasible. In the absence of artesunate, parenteral quinine or IM artemether should be administered by your health caregiver.
Artesunate is dispensed as a powder of arsenic acid. This must be dissolved in sodium bicarbonate (5%) by your health caregiver to form sodium artesunate. The solution is then diluted in approximately 5ml of normal saline and given by intravenous (IV) injection or by intramuscular (IM) maximum of 5ml per site. The solution should be freshly prepared before administration and should be used within 1 hour. The solution should NEVER be stored.
The dosage and how to administer artesunate:
• For children ≤ 20kg your health caregiver will administer 3.0 mg/kg
• For other patients >20kg your health caregiver will administer 2.4 mg/kg.
Administration of Artesunate:
• Intravenous routes are preferred.
• Your health caregiver weighs you to determine the dosage needed and therefore the number of vials required.
• Your health caregiver dissolves each vial of arsenic powder with all the 5% sodium bicarbonate solution provided with each vial.
He will shake gently until the resultant solution is clear. (If it doesn’t dissolve and become clear, he discards the vial and reconstitutes a new one)
• He dilutes the resultant solution in each vial with 5ml normal saline if normal saline is not available 5% dextrose can be used.
• The final solution has a strength of 10mg/ml.
• He calculates the volume of solution containing the required amount to be given
seed skill in the calculation of artesunate.
• Administers by slow IV over 3-5 minutes.
• Weighs your weight to determine the dosage needed and therefore the number of vials required.
• Dissolves each vial of arsenic powder with all the 5% sodium bicarbonate solution provided with each vial. Shakes gently until the resultant solution is clear. (If it doesn’t dissolve and become clear, he discards the vial and reconstitutes a new one)
• Dilutes the resultant solution with 2ml normal saline if normal saline is not available 5% dextrose can be used.
• The final solution has a strength of 20mg/ml.
• Calculates the volume of solution containing the required amount to be given.
• Your health caregiver will administer by IM route.
• The doses of more than 2ml over different sites for babies and 5ml for adults must be spread.
• This refers to 60mg artesunate. For all other strengths refer to the product insert for diluent volume.
Artesunate powder Saline solution Bicarbonate solution
Artemether is dispensed as a clear oily solution of differing concentrations. Artemether must only be given by intramuscular (IM) injection.
Administering of artemether should be as follows:
• Artemether is administered by the intramuscular route at a loading dose of 3.2mg/ kg IM stat then 1.6mg/kg IM once every 24 hrs until the patient can tolerate oral medications (Maximum of 7 days).
• Thereafter a complete course of Artemether-lumefantrine is given.
• Quinine should only be given as an intravenous infusion and NEVER given as an intravenous (bolus) injection.
• Loading dose should be omitted and should be when you have received quinine in the last 24 hours or have received mefloquine in the last 7 days.
• Quinine is not contraindicated in severe anemia.
• In renal insufficiency, the dose of quinine should be reduced by a 1/3 to 10mg/kg every 12hours.
• In hepatic insufficiency, the dose of quinine should be reduced by 25%. Hypoglycemia is a potential side effect of quinine administration particularly in pregnant women and should therefore be administered in glucose-containing infusion (preferably 10% glucose)
Quinine administration in children
Administration of quinine is as follows:
Your health caregiver puts up an IV quinine drip of 20mg/kg body weight loading dose in 15mls/kg of 5% dextrose or normal saline to run over 4 hours to run at a rate not exceeding 5mg salt/kg body weight per hour.
Giving the child quinine doses every 8 hours to standardize practice and comply with WHO guidelines.
• Calculates the number of drops per minute to deliver the quinine in 4 hours.
• Gives 10mg/kg in 10ml/ kg of isotonic solution (5% dextrose or normal saline) to run at the same rate as the previous one, 8 hours from the commencement of the initial dose of quinine.
• Repeats 10mg/kg quinine infusion every 8 hours until the patient can take medication orally. Thereafter give a complete course of artemether-lumefantrine (AL).
• Alternatively, if AL is not available, treats with oral quinine are given at 10mg/kg every 8 hours to complete a total of 7 days.
Quinine administration in adults
Your healthcare giver will administer quinine as follows:
• Loads dose of quinine 20mg/kg (maximum 1,200mg) diluted in a maximum 500ml of isotonic solution (5% dextrose or normal saline) is given intravenously to run over 4 hours to run in a way not to exceed 5mg salt/kg body weight per hour.
• The number of drops will be calculated per minute to deliver the quinine in 4 hours.
• 10mg/kg (maximum 600mg) diluted in 10ml/kg (maximum 500ml) of isotonic solution (5% dextrose or normal saline) will be given 8 hours from the commencement of the initial dose of quinine to run over 4 hours at the same rate as previous one.
• 10mg/kg quinine infusion every 8 hours will be repeated until the person can take medication orally.
• Thereafter a complete course of artemether-lumefantrine (AL) is given.
• If AL is not available, oral quinine is continued at 10mg/kg (maximum 600mg) every 8 hours to complete a total of 7 days of treatment, in combination with clindamycin 150mg twice daily for 7 days or doxycycline 100mg twice daily for 7 days.
In the absence of injectable artemisinins or quinine, patients, particularly children with severe malaria who can tolerate it orally, should be given AL or other available ACT to initiate treatment. If the patient is unable to take oral medications, a nasogastric tube should be used to administer AL.
Prevention Of Malaria
• You are to take malaria medicine whenever they are given by your health caregivers. Although not all malaria drugs are safe during pregnancy.
• Sleep inside a long-lasting insecticidal net to prevent mosquito bites.
• Treat malaria very well whenever you are diagnosed with malaria.
• Close your doors and windows.
• Use mosquito coils and sprays.
• Wear long clothes that can cover the arms and legs in the evening time.
• Cover your windows and swing door with nets.
• Clean dirty places, cut grasses, remove containers of dirty water, and also clear the gutter near your house.
• Feed well.
• Long-lasting insecticidal nets should be used every time you want to sleep.
• Visit the healthcare facility often.
• Make your environment mosquitoes-free.
• Clearing bushes around houses
• Cover your water containers or tanks
• Stop activities that encourage the breeding of mosquitoes.