CHAPTER ONE

INTRODUCTION

1.1 Brief Introduction of Client

This chapter consists of the introduction to the patient’s background, family background,

present medical state of the client, investigation and results, treatment plan and the objectives.

This case study was written on Mrs M.A a 37yrs old woman, who diagnosed with malaria in

pregnancy, living in Unguwan Tana Yola North LGA, Adamawa State.

The patient was admitted in specialist hospital Yola at ward 12 (Female medical ward) on 5 th

November, 2022 at 11am with the complain of fever, headache, Nausea and vomiting, abdominal

pain and chills for past two days.

1.2 Family Background

Name: Maryam Abdullahi

Age: 37 years

Occupation: Business

Marital Status: Married with three children

Tribe: Fulani

Religion: Islam.

Adress: Unguwan Tana Jimeta.

Hospital: Specialist Hospital Jimeta.

1
State of Origin: Adamawa state.

Nationality: Nigeria.

History Taking

Past medical History: patient has not been admitted before.

Past surgical History: nil

Medication History: nil

Family History: patient has husband with three children and all are alive

Sexual History: patient is sexually active.

1.3 Present Medical State Of Client

The patient was admitted in specialist hospital Yola, ward 12 (Female medical ward) on

5th November, 2022 at 11am with the complain of fever, headache, Nausea and vomiting,

abdominal pain and chills for past two days presenting the following vital signs;

 Temperature – 38OC

 Pulse – 111b/m

 Respiration – 27c/m

 Blood Pressure – 132/86 mmHg

2
1.4 Investigation and Result

Investigation Result

RDT Positive

PCV 28%

Malaria Parasite ++

1.5 Treatment Plan

 IVF N/S 1L 5% D/S 1L 8hourly x 24hrs

 IV Artesunate 120mg at 0, 12 and 24hrs

 Tabs Vit C ii x TDS x 5/7

 Educate the patient and family: Review the disease process and therapy, focusing on

patient’s concerns; discuss importance of adhering to therapy; go over medication,

purpose, frequency, dosage, and side effects; have a family member or trusted individual

listen to and understand guideline of treatment as the patient chooses.

1.6 Objectives Of The Study

To reduce increase in and regain normal body temperature

To eliminate the parasite causing malaria disease

To interrupt the transmission of malaria in areas where it is feasible

To prevent the infection of malaria

3
 CHAPTER TWO

LITERATURE REVIEW

2.0 INTRODUCTION

Malaria is caused by the parasite plasmodium which can be spread to humans through the bite of

an infected mosquito. Of the five types of plasmodium (P. Falciparium, P.Ovale, P. Malaria, P.

Vivax and P. Knowlesi), the plasmodium falciparium is the deadliest and affects the lives of

almost 40 per cent of the world’s population with pregnant women and children under-five

years of age being the most affected. This mini-review involved the collation of findings from

recent studies in regards to the prevalence of malaria infection among pregnant women and

infants. A systematic analysis of recent literature on the prevalence of malaria in pregnancy

from many authors was carried out and the facts synthesized to make an easy read. From the

analysis of literature, Ten Thousand women and 200,000 babies were reported to be dying

annually from complications of malaria in pregnancy which recorded a prevalence of 85 per cent

in sub-Saharan Africa. More so, Fifty per cent of pregnant women were discovered to be

carrying plasmodium falciparium in their placenta without even experiencing malaria signs/

symptoms, and this development was reported to have been responsible for Twenty per cent of

stillbirths and 11 per cent of all maternal deaths. Malaria infection is considered a major threat to

the lives and well-being of pregnant women and infants. Therefore, stakeholders should ensure

that every clinical diagnosis of malaria in pregnancy is confirmed with a laboratory plasmodium

falciparium-based diagnosis before the administration of antimalarial drugs. Furthermore there

should be a stepping –up on the distribution of insecticide treated nets alongside enlightenment

of pregnant women on ways of preventing mosquito bite. Instituting the aforementioned

4
approaches is key to improving the health- seeking behaviour of pregnant women in particular

and the wider population in general thus enabling them to stay malaria free throughout the period

of pregnancy and infancy.

Malaria affects the lives of almost 40 per cent of the world’s population, and the high-risk group

being pregnant women and young children (under 5-years of age) and about 10,000 women and

200,000 babies die annually because of malaria in pregnancy (Miller et al., 1977). Furthermore,

85 per cent of malaria cases in the world occur in sub-Saharan Africa, as there were 214 million

malaria cases and 438,000 malaria deaths globally in 2015. Also, in sub-Saharan Africa 20 per

cent of pregnant women attending ante natal clinic tested positive for the malaria parasite

(Plasmodium Falciparum) as 72 per cent of pregnant women had at some point during their

pregnancy suffered malaria infection, because 50 per cent of pregnant women carry the malaria

parasite in the placenta without noticing it, which makes them three (3) times more likely to

suffer from other severe diseases.

In Nigeria, overall malaria prevalence stood at 79.5 % , in Lagos and Enugu States the

prevalence during pregnancy was reported to be 52 and 99 per cent respectively, and having

devastating effects on pregnant women, the fetus and the new born.

2.1 EPIDEMIOLOGY

Malaria occurs primarily in tropical and some subtropical regions of Africa, Central and South

America, Asia, and Oceania. In areas where malaria occurs, there is tremendous variation in the

intensity of transmission and risk of infection. For example, over 90 percent of clinical malaria

infections and deaths occur in sub-Saharan Africa (World Health Organization, 1996a).

However, even there the risk varies widely. Highland (>1,500 m) and arid areas (<1,000 mm

5
rainfall/year) typically have less malaria, although these areas are prone to epidemic malaria if

climactic conditions become favorable to mosquito development (World Health Organization,

1996a). Although urban areas have typically been at lower risk, explosive unplanned population

growth has been a major factor in making urban or peri-urban transmission an increasing

problem (Knudsen and Sloof, 1992).

Human malaria is caused by one or more of four parasites: Plasmodium falciparum, P. vivax, P.

ovale, and P. malariae.Distribution of these parasites varies geographically, and not all species

of malaria are transmitted in all malarious areas. P. falciparum, the species most commonly

associated with fatal malaria, is transmitted at some level in nearly all areas where malaria

occurs. It accounts for over 90 percent of all malaria infections in sub-Saharan Africa, for nearly

100 percent of infections in Haiti, and causes two-thirds or more of the malaria cases in

Southeast Asia. P. vivax is a relatively uncommon infection in sub-Saharan Africa. Duffy

antigens, which are required by the parasite to invade red blood cells, are lacking in many ethnic

groups, especially in West Africa. Vivax malaria, however, is the predominant species in Central

America, most of malarious South America, and the Indian subcontinent (Miller et al., 1977).

Malaria is typically transmitted by the bite of an infective female Anophelesmosquito;

transmission can also occur transplacentally, as a result of blood transfusion, or by needle

sharing. Infective mosquitoes inject sporozoites into the bloodstream during feeding. These

sporozoites infect liver cells (b) where they undergo asexual reproduction (exoerythrocytic

schizogony), producing schizonts (c). In 6 to 14 days (sometimes longer), the schizonts rupture,

releasing merozoites into the bloodstream (d). Merozoites invade red blood cells and undergo a

second phase of asexual reproduction (erythrocytic schizogony), developing into rings (e),

trophozoites (f), and finally blood stage schizonts (g). The schizonts rupture, destroying the red

6
blood cell and releasing more merozoites into the bloodstream, starting another cycle of asexual

development and multiplication (h). This erythocytic cycle will continue until the infected

individual is successfully treated, mounts an immune response that clears the infection, or dies.

During this cycle, sexual forms called gametocytes are produced (i) and can be ingested by a

mosquito during a blood meal (j). Sexual reproduction occurs in the mosquito (k). Sporozoites

are formed (l), which migrate to the salivary glands, making the mosquito infective to humans.

Malaria transmission intensity, levels of acquired immunity in a population, and manifestations

of malaria illness are intimately linked (Snow et al., 1994; Slutsker et al., 1994). Understanding

this relationship should help in estimating the likely impact of malaria in a given population. An

important additional consideration is understanding the implications of differences between the

environment from which a displaced population comes and the environment in which that

population settles, even if only temporarily (Wongsrichanalai et al., 1999; Sahr et al., 2001).

Increased risk for malaria during pregnancy

Mosquito (the vector that transmits the malaria parasite) has affinity for pregnant women

because pregnancy causes women to release a greater than normal amount of Carbon Dioxide

(CO2) which adds to the odoriferous secretions during pregnancy, which attracts mosquitoes,

coupled with the increased body surface and increased blood flow in the skin, exposing the

pregnant woman to mosquito bite. Also, the accumulation of parasitized red blood cells in the

placental vessels triggers an inflammatory process which has been known to cause an immune

activation in the placental tissue which would not have occurred in a non-pregnant woman.

Black, J. M., & Hawks, J. H. (2005).

7
World Health Organization report shows a decline in malaria cases by 25 per cent globally and

33 per cent in Africa between 2000 and 2015, with a decrease in both the incidence and death

rates by 37 and 60 per cent respectively, a development associated with increased malaria

prevention mechanisms and health seeking behaviour in reducing the burden of malaria in

pregnancy. Further efforts include the use of insecticide treated net (ITN) and effective case

management of malaria and anaemia in pregnant women.

In Nigeria, a national programme to eliminate malaria was launched in 2015, meanwhile, in 2004

Nigeria adopted World Health Organization’s three (3) pronged strategy for combating malaria

in pregnancy (MiP), which are: (1) intermittent preventive treatment in pregnancy (IPTp)

through the directly observed therapy with Sulphadoxine-Pyrimethamine (SP), (2) distribution

and use of insecticide treated net (ITN), and (3) case management of MiP.

2.2 AETIOLOGY MALARIA IN PREGNANCY

Malaria is an acute febrile illness caused by Plasmodium parasites, which are spread to people

through the bites of infected female Anopheles mosquitoes. There are 5 parasite species that

cause malaria in humans, and 2 of these species – P. falciparum and P. vivax – pose the greatest

threat. P. falciparum is the deadliest malaria parasite and the most prevalent on the African

continent. P. vivax is the dominant malaria parasite in most countries outside of sub-Saharan

Africa.

The first symptoms – fever, headache and chills – usually appear 10–15 days after the infective

mosquito bite and may be mild and difficult to recognize as malaria. Left untreated, P.

falciparum malaria can progress to severe illness and death within a period of 24 hours.

8
In 2020, nearly half of the world's population was at risk of malaria. Some population groups are

at considerably higher risk of contracting malaria and developing severe disease: infants,

children under 5 years of age, pregnant women and patients with HIV/AIDS, as well as people

with low immunity moving to areas with intense malaria transmission such as migrant workers,

mobile populations and travellers.

2.3 PATHOPHYSIOLOGY OF MALARIA IN PREGNANCY

Malaria in pregnancy poses a great health risk to mother and her fetus and results into

complications, such as abortion, still birth, intra uterine growth retardation, and low birth weight.

The heavy infiltration of Plasmodium falciparum-infected RBCs in the intervillous spaces of

placenta seems to be responsible for all the complications observed. Infected RBCs in the

placenta cause an inflammatory environment with increase in inflammatory cells and cytokines

which is deleterious to the placenta. Increased inflammatory responses in the infected placenta

result into oxidative stress that in turn causes oxidative stress-induced placental cell death.

Moreover, heat shock proteins that are produced in high concentration in stressed cells to combat

the stress have been reported in fewer concentrations in malaria-infected placenta. Pathologies

associated with placental malaria seems to be the effect of a change in immune status from

antibody-mediated immune response to cell-mediated immune response resulting into excess

inflammation, oxidative stress, apoptosis, and decreased heat shock protein expression.

However, we also need to study other aspects of pathologies so that better drugs can be designed

with new molecular targets.

9
2.4 CLINICAL MANIFESTATION OF MALARIA IN PREGNANCY

for those infected with P. falciparum (P = 0.943). The classic triad of fever, chills, and sweating

was present in pregnant women; other symptoms present from the onset of the disease until the

time of consultation were headache musculoskeletal pain and asthenia and adynamia

2.5 LIFE CYCLE OF MALARIA

Life cycle of malaria parasite. An infected Anopheles mosquito bites and infects a human host

starting its new malaria life cycle. The cycle is completed when an uninfected mosquito bites an

infected human host, becoming infected by the transmission of gametocytes which then matures

into sporozites inside the mosquito.

10
STRUCTURE OF LIFE CYLE OF MALARIA

11
2.6 INCUBATION PERIOD AND PERIOD OF COMMUNICABILITY OF MALARIA

2.6.1 Incubation period of malaria

Plasmodium falciparum can cause severe infection and has the shortest incubation period

compared with all the other Plasmodium species. Incubation periods of 9–14 days for the

immune and 6–14 days for the nonimmune have been reported for P. falciparum.

2.6.2 Period of communicability in malaria

Gametocytes usually appear within 3 days of parasitaemia with P. vivax and P. ovale and after

10 - 14 days with P. falciparum.

2.7 LABORATORY INVESTIGATIONS AND FINDINGS OF MALARIA

Malaria parasites can be identified by examining under the microscope a drop of the patient's

blood, spread out as a “blood smear” on a microscope slide. Prior to examination, the

specimen is stained (most often with the Giemsa stain) to give the parasites a distinctive

appearance.

2.8 MEDICAL MANAGEMENT OF MALARIA IN PREGNANCY

The World Health Organization (WHO) now recommends that all women in the second or third

trimester of pregnancy who have uncomplicated P. falciparum malaria should be treated with

artemisinin-based combination therapy. The short-acting but potent artemisinin component (i.e.,

artemether, artesunate, or dihydroartemisinin) reduces the number of parasites substantially

during the first 3 days of treatment.

12
13
2.9 LIFE STYLE AND HOME REMEDIES OF MALARIA

1. Ginger

People suffering from malaria may experience symptoms like nausea and vomiting. Several

clinical studies show that ginger may be effective against these symptoms. Ginger tea is a famous

recipe effective in many conditions. You can make ginger tea by boiling some freshly crushed

ginger with a glass of water. Ginger tea goes well with some lemon juice or a spoonful of

honey.

2. Turmeric

Curcumin which is the main ingredient of turmeric, has shown antimalarial activity against

malaria-causing pathogens according to animal studies. Therefore, turmeric may help those

suffering from malaria recover fast. There are many ways to use turmeric. You can put turmeric

in a glass of warm milk to get the benefits. You can also put turmeric in your foods and dishes.

3. Cinnamon

Cinnamon is a common kitchen spice with many beneficial properties. For example, in several

labs and animal studies, Cinnamon has shown inhibitory action against malaria-causing

pathogens. You can add cinnamon powder to your herbal teas. You can also take the cinnamon

powder with a glass of warm water. You can also add a pinch of powdered black pepper and

honey to enhance the taste.

4. Tulsi

Tulsi is a famous herb used in the ayurvedic system of medicine. Tulsi is known to exert many

health effects. The antimalarial activity of tulsi is very well documented in many scientific

studies. Tulsi may also boost the immune response against infective pathogens. You can make

14
tulsi tea by boiling fresh tulsi leaves in water. Strain this mixture in a cup and your tulsi tea is

ready. You can add a drop of lemon juice or honey for additional taste.

5. Neem

Neem has been used against malaria for centuries. Compounds present in neem have shown

effectiveness against malarial parasites. Using neem leaves or drinking neem tea may also reduce

the chances of contracting malaria. Neem may also help lower the fever and boost the immune

system to fasten the recovery. You can drink neem tea or chew fresh neem leaves to get its

antimalaria effects. To make neem tea, boil a glass of water. Add some neem leaves to the

boiling water. Let it steep for a while. Strain the mixture into a cup. You can flavour it with

honey and your tea is ready to serve.

6. Guduchi

Guduchi juice may help boost immunity and help fight off infections. The immunity-boosting

property of guduchi has been observed in lab trials. You can make guduchi juice at home. First,

take fresh guduchi, and peel off the skin. Next, chop it into pieces and add a glass of water. You

can blend this mixture into a fine consistency. Strain the blend into a cup and your guduchi juice

is ready to drink.

7. Coconut water

People have been drinking coconut water to feel refreshed and energized. Intake of coconut

water may help maintain fluid balance in the body. You can drink coconut water to prevent the

dehydration induced by vomiting during malaria.

15
8. Krishna musali

Krishna musali, also called golden eye grass in English, is a medicinal herb with many beneficial

properties. The dried rhizome of this plant is known to boost immunity and protect against

diseases. You can consume Krishna musali powder with a glass of milk for a speedy recovery.

16
2.10 NURSING MANAGEMENT

 Improve body temperature. Warm water compress on forehead and both axilla

(not more than 15 minutes each time); maintain warm environment by using

warm blankets, adequate clothing); patient may sweat excessively, make sure to

avoid exposing patient to wet clothes and linens; administration of antipyretic

drugs as ordered.

 Improve tissue perfusion. Patient may need supplemental oxygen if condition is

severe; maintain a well-ventilated room; head of the bed at 30º.; lessen activities

that require moderate to high exertion.

 Improve fluid volume. Expect loss of fluid through sweat; provide information

about fluid balance and guideline for fluid replacement; encourage increase in

oral fluid intake; administer parenteral fluids as ordered.

 Educate the patient and family. Review the disease process and therapy,

focusing on patient’s concerns; discuss importance of adhering to therapy; go

over medication, purpose, frequency, dosage, and side effects; have a family

member or trusted individual listen to and understand guideline of treatment as

the patient chooses.

Evaluation

Nursing evaluation of patients with malaria includes meeting the following goals:

 Prevention of infection.

 Reduced increase in body temperature.

 Improved tissue perfusion.

17
  Improved fluid volume of the body.

 Gained and retained information on malarial disease process, treatment, and

prognosis.

2.11 PUBLIC HEALTH INTERVENTION OF MALARIA IN PREGNANCY

The 2 core interventions are insecticide-treated nets (ITNs) and indoor residual spraying (IRS).

Progress in global malaria control is threatened by emerging resistance to insecticides

among Anopheles mosquitoes. According to the latest World malaria report, 78 countries

reported mosquito resistance to at least 1 of the 4 commonly-used insecticide classes in the

period 2010–2019. In 29 countries, mosquito resistance was reported to all main insecticide

classes.

2.12 COMPLICATIONS OF MALARIA IN PREGNANCY

Malaria infection during pregnancy can have adverse effects on both mother and fetus, including

maternal anemia, fetal loss, premature delivery, intrauterine growth retardation, and delivery of

low birth-weight infants (<2500 g or <5.5 pounds), a risk factor for death.

18
 CHAPTER THREE

3.0 HOME VISIT

A home visit is one of the essential parts of the community health services because most of the

people are found in a home. Home visit fulfils the needs of individual, family and community in

general for nursing service and health counselling. A home visit is considered as the backbone of

community health service. A home visit is a family –nurse contact which allows the health

worker to assess the home and family situation in order to provide the necessary nursing care and

health-related activities.

3.1 FIRST HOME VISIT 21st Nov, 2022

3.1.1 OBJECTIVES OF THE VISIT

To create a good rapport between patient, relatives and nurse and ensure proper continuity of

medications

To ensure the safety of the patient and the unborn child

To evaluate the environment patient lives

3.1.2 OBSERVATIONS

On arrival to the client house at 10:30am, the client was lying down in the room weak and

looking dehydrated. The client presented the following vital signs

BP 129/88 mmHg

P= 106 b/c

19
T= 37oc

3.1.3 PROBLEMS IDENTIFIED

 Loss of weight

 Dehydration

3.1.4 NURSING DIAGNOSIS

Fluid volume deficit related to excessive sweating and dehydration evidenced by loss of weight

3.1.5 NURSING INTERVENTION

 Improve fluid volume of the body

 Encourage increase in oral fluid intake

 Inform about fluid balance and guideline for fluid replacement

3.1.6 SCIENTIFIC PRINCIPLE

Increase in fluid intake replaces the loss fluid

Information on fluid balance gives awareness to client on fluid replacement

3.1.7 EVALUATION

Improved fluid volume of the client body

20
3.2 SECOND HOME VISIT 28th Nov, 2022

3.2.1 OBJECTIVE OF THE HOME VISIT

To assess client health status

To check on client response to treatment

3.2.2 OBSERVATION

On my second visit there was gain in weight, though there was high body temperature. The client

presented the following vital signs;

BP 125/82 mmHg

P= 111 b/c

T= 37.5oc

3.2.3 NURSING DIAGNOSIS

Hyperthermia related to increased metabolic rate evidence by shivering

3.2.4 NURSING INTERVENTION

Improve body temperature: warm water compress on forehead and both axilla not kore than 15

minutes each time.

Maintain warm environment by using warm blankets and adequate clothing.

Administer antipyretic drugs as ordered.

21
3.2.5 SCIENTIFIC RATIONALE

Warm water compress on the forehead reduces increase in body temperature

Warm environment balance body temperature

Antipyretic drugs treat fever

3.2.6 EVALUATION

Reduced increased in body temperature.

22
3.3.0 THIRD HOME VISIT 2nd Nov, 2022

3.3.1 OBJECTIVE OF THE HOME VISIT

To give health education to client and relatives

To terminate home visit

3.3.2 OBSERVATION

On my third visit the client was doing ok and was able to eat well and had good time with her

husband and children

3.3.3 NURSING DIAGNOSIS

Knowledge deficit related to lack of exposure and information about the disease malaria in

pregnancy, its treatment and prognosis.

3.3.4 NURSING INTERVENTION

Educate the patient and family: Review the disease process and therapy, focusing on patient’s

concerns; discuss importance of adhering to therapy; go over medication, purpose,

frequency, dosage, and side effects; have a family member or trusted individual listen to and

understand guideline of treatment as the patient chooses.

Educate patient to take more on the use of insecticide and treated nets

3.3.5 SCIENTIFIC RATIONALE

Health education gives knowledge to client and family about the disease, its prevention and

treatment.

23
Use of insecticide to spray the environment which eliminates the breeding process of mosquitoes

Use of mosquito nets helps prevent and reduce the bites of female anopheles mosquitoes

3.3.6 EVALUATION

Gained and retained information on malaria in pregnancy disease process, treatment, prevention

and prognosis.

24
 CHAPTER FOUR

4.0 INTRODUCTION

This chapter comprises of the following subheadings: summary, conclusion and

recommendations.

The summary consists of the summary of chapter one, chapter two and chapter three; and

the conclusion conclude the chapter two while the recommendation bases on the preventive

measures to take in order to reduce the rate of the disease incidence

4.1 SUMMARY

This case study was carried out on miss M.A a 37 years old woman, who was diagnosed with

malaria in pregnancy. The client was seen at Specialist Hospital Jimeta.

Home visits was carried out as follows, first visit (11/7/2022), second visit (12/08/2022)

and the third visit (12/09/2022).

The first and second visit is aimed at observing the client response to treatment, give health and

modify treatment plan, while the third visit is meant to terminate the visits and give health

education to client and family on observing no further health problems identified during the visit.

4.2 CONCLUSION

Malaria infection during pregnancy is substantial health risk for the pregnant woman as well as

to her fetus and newborn. The general immune suppression during pregnancy makes women

more susceptible to many infections, including malarial infection especially during first

trimester. During pregnancy, cell-mediated immune response is very low that is required to

25
sustain the placenta, a new organ in first pregnancy. However, low cell-mediated immune

response in placenta makes it preferred site for the parasite to hide from host immune responses.

However, as malarial infection progresses, there is an increase in CMI response resulting in

massive recruitment of macrophages to intervillous spaces of placenta and increased

concentrations of TNF-α and IFN-γ to counteract the parasite iRBC. But this increase in CMI

response is deleterious to the placenta which causes oxidative stress and apoptotic cell death in

placenta, leading to poor pregnancy outcome, such as abortions, still birth, IUGR, and LBW.

Moreover, HSPs that are important for maintenance of normal morphology and physiology of the

placenta have been reported in low quantities in malaria-infected placenta. The low HSP levels

contribute indirectly to the observed placental pathology by not able to control the cell damage

caused by malarial infection. Therefore, placental cell damage and associated consequences in

fetus and newborn are accumulative effect of exacerbated inflammation, oxidative stress,

apoptosis, and low levels of HSPs in the infected placenta (Figure (Figure1).1). However, we

also need to study other aspects of placental pathologies, especially molecular pathways

governing immune responses so that therapies can be designed to modulate the immune response

in favor of the host.

4.3 RECOMMENDATIONS

Malaria infection during pregnancy poses substantial risks not only to the mother, but also to her

fetus and the newborn. Available evidence continues to show that intermittent preventive

treatment in pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) is a safe and highly cost-

effective strategy for reducing the disease burden in pregnancy as well as adverse pregnancy and

birth outcomes.

26
In updated guidance published today, WHO has reaffirmed its strong recommendation for the

use of IPTp-SP in areas of moderate to high P. falciparum malaria transmission. The

recommendation does not limit the delivery of IPTp-SP to antenatal care (ANC) settings; where

inequities in access to ANC services exist, other delivery methods, such as the use of community

health workers, may be explored. IPTp-SP is now recommended for all pregnant women,

regardless of the number of pregnancies; previously, it was recommended only during a

woman’s first and second pregnancies.

The WHO global malaria strategy urges all malaria-endemic countries to accelerate progress

towards the goal of elimination. In settings approaching elimination, interventions will be most

effective at reducing transmission if they are tailored to detect and treat the residual foci of

malaria transmission.

Stakeholders should ensure that clinical diagnosis must be confirmed by a laboratory parasite-

based diagnosis before the administration of antimalarials, and the distribution of insecticide

treated nets alongside health education to improve health–seeking behaviour with the aim of

preventing malaria infection among pregnant women and young children.

27
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