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Pattern of the Antimalarials Prescription during Pregnancy in Bangui, Central African Republic

DOI: 10.4061/2011/414510

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Abstract:

Introduction. The aim of this study was to identify the antimalarials prescribed during the pregnancy and to document their timing. Method. From June to September 2009, a survey was conducted on 565 women who gave birth in the Castors maternity in Bangui. The antenatal clinics cards were checked in order to record the types of antimalarials prescribed during pregnancy according to gestational age. Results. A proportion of 28.8% ANC cards contained at least one antimalarial prescription. The commonest categories of antimalarials prescribed were: quinine (56.7%), artemisinin-based combinations (26.8%) and artemisinin monotherapy (14.4%). Among the prescriptions that occurred in the first trimester of pregnancy, artemisinin-based combinations and artemisinin monotherapies represented the proportions of (10.9%) and (13.3%). respectively. Conclusion. This study showed a relatively high rate (>80%) of the recommended antimalarials prescription regarding categories of indicated antimalarials from national guidelines. But, there is a concern about the prescription of the artemisinin derivatives in the first trimester of pregnancy, and the prescription of artemisinin monotherapy. Thus, the reinforcement of awareness activities of health care providers on the national malaria treatment during pregnancy is suggested. 1. Introduction Malaria in pregnancy is a serious public health problem in endemic regions. It is estimated that 85 millions pregnancies occurred in Plasmodium falciparum malaria-endemic areas [1]. This pathology is among the main causes of the low birth weight (LBW) [2, 3], resulting from 3% to 8% neonatal and infant deaths [3]. This led the World Health Organization (WHO) to recommend a package of affordable interventions including the use of the insecticide-treated nets (ITNs), the intermittent presumptive treatment (IPT) with sulfadoxine-pyrimethamine (SP), and the effective case management of clinical malaria with recommended antimalarials. The IPT with SP (IPT-SP) is given free of charge under direct observed therapy (DOT) during the antenatal clinics (ANCs) at regular predefined intervals of time [4], with the aim to achieve the clearance of the existing Plasmodium falciparum asymptomatic infection (therapeutic effect) and the suppression of new maternal infections (prophylactic effect) over a period of time [5]. At least two doses of IPT-SP are recommended during the second and third trimesters of pregnancy [4]. The occurring of clinical malaria should be treated with quinine or artemisinin-based combinations. Quinine is considered to be a

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