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Patterns of anti-malarial drug treatment among pregnant women in Uganda

Laura R Sangaré1*, Noel S Weiss2, Paula E Brentlinger1, Barbra A Richardson3, Sarah G Staedke45, Mpungu S Kiwuwa6 and Andy Stergachis2

Author Affiliations

1 Department of Global Health, University of Washington, Seattle, WA, USA

2 Department of Epidemiology, University of Washington, Seattle, WA, USA

3 Department of Biostatistics, University of Washington, Seattle, WA, USA

4 Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK

5 Infectious Disease Research Collaboration, Kampala, Uganda

6 Clinical Epidemiology, Makerere University, College of Health Sciences, School of Medicine Kampala, Uganda

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Malaria Journal 2011, 10:152  doi:10.1186/1475-2875-10-152

Published: 6 June 2011

Abstract

Background

Prompt use of an effective anti-malarial drug is essential for controlling malaria and its adverse effects in pregnancy. The World Health Organization recommends an artemisinin-based combination therapy as the first-line treatment of uncomplicated malaria in the second and third trimesters of pregnancy. The study objective was to determine the degree to which presumed episodes of uncomplicated symptomatic malaria in pregnancy were treated with a recommended anti-malarial regimen in a region of Uganda.

Methods

Utilizing a population-based random sample, we interviewed women living in Jinja, Uganda who had been pregnant in the past year.

Results

Self-reported malaria during the index pregnancy was reported among 67% (n = 334) of the 500 participants. Among the 637 self-reported episodes of malaria, an anti-malarial drug was used for treatment in 85% of the episodes. Use of a currently recommended treatment in the first trimester was uncommon (5.6%). A contraindicated anti-malarial drug (sulphadoxine-pyrimethamine and/or artemether-lumefantrine) was involved in 70% of first trimester episodes. Recommended anti-malarials were used according to the guidelines in only 30.1% of all second and third trimester episodes.

Conclusions

Self-reported malaria was extremely common in this population and adherence to treatment guidelines for the management of malaria in pregnancy was poor. Use of artemether-lumefantrine combined with non-recommended anti-malarials was common practice. Overuse of anti-malarial drugs, especially ones that are no longer recommended, undermines malaria control efforts by fueling the spread of drug resistance and delaying appropriate treatment of non-malarial febrile illnesses. Improved diagnostic capacity is essential to ultimately improving the management of malaria-like symptoms during pregnancy and appropriate use of currently available anti-malarials.