A Review of Malaria Prevention in Pregnancy: Sulfadoxine-pyrimethamine Intermittent Preventive Treatment, Resistance and Update on Potential Preventive Strategy
Mila Nu Nu Htay *
Melaka Manipal Medical College (MMMC), Manipal Academy of Higher Education (MAHE), Bukit Baru, Melaka, Malaysia.
Wai Wai Myint
Universiti Malaysia Sarawak (UNIMAS), Kota Samarahan, Sarawak, Malaysia.
Htay Lwin
Melaka Manipal Medical College (MMMC), Manipal Academy of Higher Education (MAHE), Bukit Baru, Melaka, Malaysia.
Angus E. Aranan
Newcastle University Medicine Malaysia, Johor, Malaysia.
*Author to whom correspondence should be addressed.
Abstract
Malaria in pregnancy is a major international public health concern in tropical and subtropical regions because pregnancy is a unique period vulnerable to malaria infection. In the Sub Saharan Africa region, the subclinical infection usually occurs during pregnancy and leads to the maternal anaemia, intrauterine growth retardation of the foetus, low birth weight and infantile deaths. The WHO recommended the use of sulfadoxine and pyrimethamine (SP) as intermittent preventive treatment (IPTp) for pregnant women living in moderate to high malaria transmission regions. The increasing number of SP-resistant parasites is a threatening matter for public health prophylaxis intervention. Therefore, in the context of threatening SP resistance, there is a need to consider the alternative strategies to IPTp-SP. This review discussed the epidemiology, pathophysiology, clinical features of malaria in pregnancy, a current preventive regimen with SP, and the threat of SP resistance and outlined the potential preventive treatment strategy with dihydroartemisinin-piperaquine (DP).
Keywords: Malaria in pregnancy, sulfadoxine-pyrimethamine resistance, dihydroartemisinin-piperaquine, IPTp-SP, IPTp-DP, Plasmodium falciparum