Expanding choices for the treatment of malaria in pregnancy

THE Tropical Diseases Research Center (TDRC) has recommended that dihydroartemisinin-piperaquine a new malaria treatment drug to be added to the malaria treatment policy for pregnancy women. This is after a study conducted by TDRC in collaboration with the Institute of medicine in Belgium entitled, Safety and efficacy of four artemisinin-based combination treatments in African pregnant women with malaria revealed that dihydroartemisinin-piperaquine was efficient and stayed long in the blood to kill the malaria parasite and prevent re-occurring of the infection in pregnant women than the other drugs.

A Phase 3, non-inferiority, multicentre, randomized, open-label clinical trial compared the efficacy and safety of four ACTs, namely amodiaquine-artesunate, dihydroartemisinin-piperaquine, artemether-lumefantrine, and mefloquine-artesunate, in women with malaria and in the second or third trimester of pregnancy

A total of 3,423 pregnant women were recruited in Burkina Faso, Ghana, Malawi and Zambia. This is the largest trial on ACT use during pregnancy ever done in sub-Saharan Africa.

The study has also shown that the new drug had a good cure rate, safe in terms of drug related resistant and that it was easier to administer to patients because of the dosage

TDRC has proposed to the Ministry of Health to adopt Euratesim instead of quinine for the routine management of malaria in pregnant women and that quinine could be reserved for severe malaria cases in hospitals.

Apart from being cost effective, the new drug had a good cure rate, safe in terms of drug related resistant and was easier to administer to patients because of its low the dosage.

TDRC Head of Clinical trials Unit Michael Nambozi who is also the Principal Investigator said the study which took five years to be concluded revealed that Euratesim is more effective in treating malaria in pregnant women in highly infected areas. He added that the drugs for treating malaria should be localized and administered according to the prevalence of the disease in particular localities

For instance, where there was high malaria infections like in the Luapula Province, Euratesim could be used and Coartem be administered in areas where the malaria rate is low like in Lusaka and Southern Provinces.

Malaria in pregnancy is associated with increased maternal, fetal and neonatal morbidity and mortality. There are few choices for the treatment of malaria in pregnancy. Artemisinin-based combination treatments (ACT) are recommended for pregnant women in their second and third trimesters of pregnancy though information on their safety and efficacy in African pregnant women is limited a matter that prompted this study