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Malaria Prevention Timika
Malaria Prevention Timika
Malaria Prevention Timika
&
Chemoprophylaxis
Agung Nugroho
Department of Internal Medicine
Tropical & Infectious Disease Division
Sam Ratulangi University Manado
Introduction
• “ ABCD “ approach :
– Awareness of risk
– Bite prevention
– Chemoprophylaxis
– Diagnosis promptly and treat without delay
• Education : all about malaria
benefit of prevention measures
benefit and risks of chemoprophylaxis
Awareness of risk
• Breastfeeding women :
– Chloroquin and mefloquin are safe
– Alternative : atovaquone – proguanil ( infant weigh > 5 kg )
– Infant who are breastfeed need his own chemoprophylaxis
• For pregnant women who lived in stable endemic area :
Intermitten Preventive Treatment of pregnancy ( IPTp ) :
– Give treatment dose of antimalaria ( Sulfadoxine – pyrimethamine / SP )
in asymptomatic pregnant women for prevention
– Indications : all pregnant women in areas of stable malaria transmission
– 2 or 3 doses of SP at least 1 month apart start from second trimester,
given during antenatal visit under direct observation
Prevention of malaria in pregnant women
• Disadvantage of IPTp :
– Increased resistance to SP
• Systemic review by Feike O, et al revealed even in area
with resistance to SP, IPTp still provide benefit
– Low coverage and acceptance in some area
• Indonesia : no IPTp program
Intermitten Screening and Treatment of pregnancy ( ISTp )
– Screening pregnant women with RDT during antenatal visit
and treat those who are positive with ACT.
– Performed in low endemic area or as alternatif to IPTp
– ISTp at least as effective as IPTp
Feike O, et al. JAMA 2007 ; 297 (23 ) : 2603
Tagbor H, Cairn M, et al. PloS ONE 2015 : doi : 10.1371/journal.pone.0132247
Prevention of vivax malaria