persistence of malaria in pregnancy as rwanda targets pre-elimination powerpoint

7/27/2019 Persistence of Malaria in Pregnancy as Rwanda Targets Pre-Elimination Powerpoint

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Persistence of Malaria in Pregnancy as

Rwanda Targets PreElimination

William Brieger1, Corine Karema2, Beata

Mukarugwiro1, Aline Uwimana2, Rachel Favero1,

Irenee Umulisa2

1. Maternal and Child Health Integrated Program (MCHIP),Jhpiego

2. Malaria and Other Parasitic Diseases Division, Rwanda

Biomedical Center, Ministry of Health


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Background

Malaria is decreasing inRwanda, and the country ispreparing for pre-elimination.

The 2010 Demographic andHealth Surveys (DHS)showed: Only 1.4% of children were

rapid diagnostic test positive(RDT+)

Only 0.7% of women wereRDT+

Malaria has dropped to the 8th

reason for outpatientattendance, but pockets ofdisease remain.

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Performance Review: Current Malaria

in Pregnancy (MIP) Strategies

In 2008, Rwanda discontinued the use of intermittentpreventive treatment in pregnancy (IPTp) based on studiesthat showed sulfadoxine-pyrimethamine (SP) therapeuticfailures and increasing resistanceat 65% in some areas.

There has been a strong focus on providing long-lasting

insecticide-treated nets (LLINs) during antenatal care(ANC) and through community mobilization: 72% of pregnant women use LLINs (2010 DHS).

Use of ANC laboratory testing of suspected malaria andtreatment with artemisinin-based combination therapies

(ACTs) is another strategy in place. Community maternal health agents follow pregnant women

and refer if malaria is suspected.

Is this enough to reach pre-elimination?

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Approaching Elimination Needs a Special

Strategy

Components:

Epidemiological surveillance, including case

detection

Entomological surveillance

Focused control

What is needed for MIP?

We must first learn about nature and extent ofproblem.

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Study Design and Methods

Prevalence at time of firstANC visit in currentpregnancy

Two districts each withrelatively high, moderateand low cases

Rapid diagnostic test (RDT),microscopy and polymerase

chain reaction (PCR) assay Existing ANC staff trained

Ethical review

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Six Health Centers and ~670 Clients

per Study District

7

High

Moderate

Low


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RDT, PCR and Microscopy

Prevalence

9

1.7%

9.8%

3.1%

1.3%

15.4%

2.7%

0.0%

4.0%

0.0%0.7%

9.5%

0.6%

0.0%

2.8%

0.0% 0.0%

6.3%

0.3%

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

Gakenke Gisagara Karongi Kicukiro Nyagatare Ruhango

PercentPos

itive

District

Malaria Test Results forP. falcip arumby District

% PCR % RDT % Microscopy

1.7%

9.8%

3.1%

1.3%

15.4%

2.7%

0.0%

4.0%

0.0% 0.7%

9.5%

0.6%0.0%

2.8%

0.0% 0.0%

6.3%

0.3%0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

Gakenke Gisagara Karongi Kicukiro Nyagatare Ruhango

PercentPositive

District

Malaria Test Results forP. falcip arumby District

% PCR % RDT % Microscopy


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Positive Predictive Value (PPV)

TestCompared

toTest PPV

RDT PCR 69%

Micro PCR 81%

Micro RDT 84%

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LLIN Use and Malaria Positivity

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8.5%

4.8%

2.8%

4.9%

1.9%

1.2%

0

1

2

3

4

5

6

7

8

9

PCR RDT Microscopy

Percentage/Pr

evalence

No Net Used Net


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Anemia/Hemocue Results and Test

Positivity

11.1

11.4

11.8

12.7 12.7 12.7

10.0

10.5

11.0

11.5

12.0

12.5

13.0

Microscopy RDT PCR

Positive Negative

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Other Factors Tested but Not

Associated with Test Results

Age

Parity

HIV status

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Implications for Action

Geographically-targetedinterventions

Intermittent screening andtreatment at ANC

Community health workers: Agent de Sant Maternelle

Intensified LLIN promotion

Surveillance: Passive

Active

Borders (highest prevalencedistricts on borders)

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MURAKOZE

CYANE

Thank You

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persistence of malaria in pregnancy as rwanda targets pre-elimination powerpoint

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