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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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