Malaria prophylaxis in pregnancy:result from a field trial conducted in Kigoma urban district in western Tanzania
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Date
2001
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Publisher
Tanzania Public Health Association
Abstract
A randomized study field study was conducted to assess the effectiveness of the chemoprophylactic regiments during pregnancy in Kigoma urban district. The study objective was to assess the effectiveness of alternative strategies of malaria chemoprophylaxis on the reduction of malaria episodes and the prevalence of parasitaemia among pregnant women attending maternal and childbirth (MCH) clinics. Study intervention measures were intermittent and continuous malaria chemoprophylaxis using chloroquine and proguanil. The study was conducted at two randomly selected antenatal care clinics as part of routine antenatal care services.
Consecutive eligible pregnant women having their first and second pregnancies (designated as primigravidae) were randomized to chloroquine (continuous and intermittent prophylaxis)and proguanil (paludrine). Women having three or more pregnancies (multigravidae) were randomized to chloroquine(intermittent prophylaxis and chemotherapy when ill) and proguanil. Proguanil (paludrine). Women having three or pregnancies (multigravidae) were randomized to chloroquine (intermittent prophylaxis and chemotherapy when ill) and proguanil. Proguanil (continuous) was the golden standard for prophylaxis in both groups. Baseline laboratory investigations (hemoglobin, blood slide for malaria parasites and stool) and other routine clinic measurements were recorded, and women found with any infection were treated and some were referred to the regional hospital. There were follow-up studies consisting of a series of measurements and recording of all parameters as baselines; for each woman during subsequent visits to the clinic until delivery.
A total of 705 eligible women registering at the clinic participated in the study and 701 had baseline results recorded. At baseline 17.8% (N=701) had helminithic infection; 9.3% (N=701) had malaria parasitaemia, while 71.1% (N=578) had anemia. Results: After 4 visits to the antenatal clinic, parasitaemia was reduced to 1.3% (N=578), and anemia drastically reduced from 71.1% to only 14.5 (N=578) during the intervention with chemoprophylaxis. However, there was no significant difference in the occurrence of a few malaria episodes/ parasitaemia and anemia among women receiving continuous prophylaxis with pronguanil as compared to those getting either continuous or intermitted chloroquine prophylaxis.
The conclusions made from the study are clear usefulness of chemoprophylaxis as a practice in reducing anemia and malaria parasitaemia during pregnancy. Secondly, the chemoprophylactic regimens tested in this study had similar effects in reducing malaria parasitaemia episodes and pronguanil showed better either outcome results, though the difference was not statistically significant. These results pose a dilemma as well as challenges in malaria control programmes in Tanzania and, indeed suggest that results obtained in malaria holoendemic areas may not be easily generalizable to other parts of Tanzania.
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Keywords
Malaria, Pregnancy, Kigoma
Citation
Kabalimu,Titus K.2001.Malaria prophylaxis in pregnancy:result from a field trial conducted in kigoma urban district in western Tanzania.Proceedings of nintheenth annual scientific conference of the Tanzania public health association.pp151-155.