Protection from placental malaria is acquired over successive pregnancies, with the prevalence of placental malaria being lower in multigravid than primigravid women. Although Ab to placental-type parasites have been associated with improved pregnancy outcomes (20, 45), it remains unclear to which part(s) of the VAR2CSA molecule protective Ab bind and whether protection from placental malaria requires a large repertoire of Ab to multiple domains and/or different allelic variants of VAR2CSA. Data from this study were obtained using samples collected prior to implementation of intermittent preventive treatment (IPTp). Today, IPTp is the standard of care in many African countries; therefore, studies similar to the one reported herein would be difficult to repeat. IPTp reduces the number of infections during pregnancy and the Ab response to placental isolates (3). Although the number of women followed was relatively small (n = 89 women), the sample set included parasitological data and serum samples ...
The incidence of malaria, including the incidence in pregnant women, is declining in many African countries. Thus, there is a need to re-examine the efficacy and cost effectiveness of giving intermittent preventive treatment with sulphadoxine-pyrimethamine in pregnancy (SP-IPTp) on several occasions during pregnancy, an intervention that is threatened by increasing resistance to SP. Possible alternatives to SP-IPTp need to be explored. This applies especially to areas with highly seasonal malaria transmission where women are at risk for only a short period of the year.. The goal of this project is to determine whether in pregnant women who sleep under a long lasting insecticide treated bed net, screening and treatment at each scheduled antenatal clinic visit is as effective in protecting them from anaemia, low birth weight and placental infection as SP-IPTp.. Primigravidae and secundigravidae who present at antenatal clinics in study sites in four West African countries (Burkina Faso, Ghana, ...
Zanzibar has transitioned from malaria control to the pre-elimination phase, and the continued need for intermittent preventive treatment during pregnancy (IPTp) has been questioned. We conducted a prospective observational study to estimate placental malaria positivity rate among women who did not receive IPTp with sulfadoxine-pyrimethamine. A convenience sample of pregnant women was enrolled from six clinics on the day of delivery from August of 2011 to September of 2012. Dried placental blood spot specimens were analyzed by polymerase chain reaction (PCR); 9 of 1,349 specimens (0.7%; precision estimate = 0.2-1.1%) were PCR-positive for Plasmodium falciparum. Placental infection was detected on both Pemba (N = 3) and Unguja (N = 6). Placental malaria positivity in Zanzibar was low, even in the absence of IPTp. It may be reasonable for the Ministry of Health to consider discontinuing IPTp, intensifying surveillance efforts, and promoting insecticide-treated nets and effective case management of ...
We assessed utilisation of health facilities and WHO-recommended maternal malaria control strategies in Kajiado County. A total of eleven health facilities were recruited, in which 6899 pregnant women were divided in three groups. Group 1 were women attending a clinic and used ITNs, group 2 did not attend a clinic but used ITNs and group 3, which did neither. 86% Of deliveries were assessed; 84% of these in clinics and 16% at home. Throughout pregnancy, data on abortion and premature births were collected. Upon delivery, data on stillbirths, birth weight and neonatal mortality was noted. Mothers cord and placental blood was examined for malaria parasites and parasitaemia using microscopy; haemoglobin levels were determined. 86% Of the women visited a health facility, 97% used an ITN. Only 3% went without visits or bednet usage. Although the number of cases was low, attending a clinic and using a bednet increased maternal Hb and reduced maternal mortality. Use of nets decreased maternal malaria ...
All pregnant women who came for delivery at a district hospital in Mandla and a civil hospital in Maihar were screened for Plasmodium falciparum (placental parasitemia using a rapid test and microscopy and peripheral and umbilical cord parasitemia using microscopy alone). Two rapid diagnostic tests (RDTs), Paracheck Pf and ParaHITf, were used. At Mandla, the sensitivity and specificity of the Paracheck Pf for P. falciparum were 93% and 84%, respectively. The positive predictive values (PPVs) and negative predictive values (NPVs) were 50% and 99%, respectively. At Maihar, the sensitivity and specificity of the ParaHITf for P. falciparum were 87.5% and 97%, respectively. The PPVs and NPVs were 75.4% and 98.7%, respectively. Placental infection was significantly associated with low birth weight. The RDTs for the identification of P. falciparum were more sensitive in placental blood than the placental blood smear by microscopy. Thus, the RDTs should be useful for rapid assessment of malaria at delivery.
The objective is to determine the possible additive, detrimental effect of maternal malaria in the placenta on the offspring in regard to epigenetic changes in skeletal muscle and subsequent risk of cardiometabolic disease in adulthood.. Data were collected in 2010-11 in 100 men and women 18-22 years of age. The study is a follow-up study on a malaria in pregnancy study conducted during the period 1988-92.. The study has been supported by the Cluster of International Health Grant at University of Copenhagen, the Novo Nordisk Foundation and Brdr. Hartmanns Foundation.. Partners & Participants/Results. ...
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Infertility is taking its toll on relationships in Ghana. New research shows Ghanaian women who have problems conceiving are more likely to experience
Congenital transmission (from mother to unborn child) of viruses can cause abnormal brain development in the fetus. Examples of viruses that can pass through the placenta and into the fetal brain include cytomegalovirus, ...
Purpose Breast cancer, the most common cancer worldwide, is the leading cause of cancer mortality in Ghanaian women. Previous studies find Ghanaian women are diagnosed at a younger age and at more advanced stages (III and IV), and have tumors with characteristics similar to African American women. We sought to remedy gaps in knowledge about breast cancer survival in Ghana and its relation to demographic and biologic factors of the tumors at diagnosis to assist in cancer control and registration planning. Methods Individuals with a breast cancer diagnosis who sought care at Komfo Anokye Teaching Hospital from 2009 to 2014 were identified via medical records ...
Malaria in pregnancy is characterised by the sequestration of Plasmodium falciparum-infected erythrocytes in placental intervillous spaces. Placental parasites express a specific phenotype, which allows them to cytoadhere to chondroitin sulfate A expressed by syncytiotrophoblasts. Malaria infection during pregnancy allows the acquisition of antibodies against placental parasites, these antibodies are thought to be involved in protection during subsequent pregnancies. To investigate the development of a cellular response to placental parasites during pregnancy, peripheral blood mononuclear cells were collected from women at the time of their confinement. The study was performed in Cameroon where malaria transmission is perennial. In vitro cell proliferation and cytokine production were measured in response to non-malarial activators (concanavalin A and PPD), a recombinant protein from P. falciparum MSP-1, and erythrocytes infected by two P. falciparum lines, RP5 and W2. Like placental parasites, the RP5
Pregnancy-associated malaria (PAM) or placental malaria is a presentation of the common illness that is particularly life-threatening to both mother and developing fetus. PAM is caused primarily by infection with Plasmodium falciparum, the most dangerous of the four species of malaria-causing parasites that infect humans. During pregnancy, a woman faces a much higher risk of contracting malaria and of associated complications. Prevention and treatment of malaria are essential components of prenatal care in areas where the parasite is endemic. While the average adult citizen of an endemic region possesses some immunity to the parasite, pregnancy causes complications that leave the woman and fetus extremely vulnerable. The parasite interferes with transmission of vital substances through the fetal placenta, often resulting in stillbirth, spontaneous abortion, or dangerously low birth weight. The tragedy of malaria in developing countries receives abundant attention from the international health ...
Oral HIV self-testing initiative currently under trial has seen more women embracing the idea than men with the research expected to conclude by June this year.
Placental infection measured by placental smear at delivery is a standard indicator, widely used to characterize malaria infection in pregnant women. However, a single measure can hardly reflect the entire history of infection during pregnancy. To investigate the relation between this indicator and peripheral infection during pregnancy, we used data collected in a randomized trial of malaria prophylaxis in 928 pregnant women in Burkina Faso, 1987-1988, during which repeated measures of peripheral infection were taken. We analyzed placental infection using a logistic model, with two methods for handling missing data. Peripheral infection during two periods of pregnancy was significantly related to placental infection at delivery, before the fifth month: OR = 2.9 [1.3; 6.3]; after 7 months: OR = 4.9 [2.7; 8.8]). Therefore, an early peripheral infection may persist throughout gestation, and placental infection is a good indicator of the womens parasitological status during pregnancy.
Malaria in pregnancy has been associated with maternal morbidity, placental malaria, and adverse birth outcomes. However, data are limited on the relationships between longitudinal measures of malaria during pregnancy, measures of placental malaria, and birth outcomes. This is a nested observational study of data from a randomized controlled trial of intermittent preventive therapy during pregnancy among 282 participants with assessment of placental malaria and delivery outcomes. HIV-uninfected pregnant women were enrolled at 12-20 weeks of gestation. Symptomatic malaria during pregnancy was measured using passive surveillance and monthly detection of asymptomatic parasitaemia using loop-mediated isothermal amplification (LAMP). Placental malaria was defined as either the presence of parasites in placental blood by microscopy, detection of parasites in placental blood by LAMP, or histopathologic evidence of parasites or pigment. Adverse birth outcomes assessed included low birth weight (LBW), preterm
Our objective was to study the effects of maternal body mass index (BMI) on the mode of delivery for primigravid and multigravid women. A retrospective cohort study was conducted at the University College Hospital Galway, Ireland, of 5162 women delivered from 2001 to 2003. BMI at the first antenatal appointment was calculated. Comparisons were made between each of the five BMI categories separately for primigravid and multigravid women in relation to gestation at delivery, age, mode of delivery, and birthweight. There were 5162 deliveries during the time period of the study; 2006 were primigravid and 3156 were multigravid women. Overall, 2.6% of women were underweight, 49.2% were normal weight, 22.8% were overweight, 19.8% were obese, and 5.6% were morbidly obese. In comparison with women of normal weight, for overweight and obese women, there was a progressive reduction in vaginal delivery rate with increasing BMI. For morbidly obese primigravida, this reduction was by 33.5% (from 83.1% to ...
Chan JA, Boyle MJ, Moore KA, Reiling L, Lin Z, Hasang W, Avril M, Manning L, Mueller I, Laman M, Davis T, Smith JD, Rogerson SJ, Simpson JA, Fowkes FJI, Beeson JG. Antibody Targets on the Surface of Plasmodium falciparum-Infected Erythrocytes That Are Associated With Immunity to Severe Malaria in Young Children. The Journal of infectious diseases 219 (5) : 819 - 828(2019) PubMed ...
There is dearth of information on perinatally acquired malaria, as well as its burden in Nigeria. We determined the prevalence of pregnancy-associated malaria and its burden among parturients in Abeokuta, Ogun State. Blood films from 211 parturients were prepared, stained with 10% Giemsa and examined using microscopy. Relevant demographic information was recorded from study participants. Chi-square tests were used to analyse data using SPSS version 20.0. Prevalence of maternal peripheral, placenta and cord blood parasitaemia were 40.8%, 19.0% and 5.7% respectively, and these were significantly correlated with age and gravidity. Prevalence of maternal anaemia was 45.0%, and was significantly associated with malaria infection. The occurrence of Low Birth Weight (LBW) was 10%. Maternal, placental and cord infections with malaria were associated with LBW, with the highest percentage of LBW occurring in babies with high placental malaria parasite density. Preterm delivery and stillbirth were ...
To compare the effect of medical versus surgical termination of pregnancy (TOP), performed in primigravid women, on subsequent delivery. Population-based register study. Finland 2000-2009. All primigravid women (n = 8294) who underw
Background Four studies previously indicated that the effect of malaria infection during pregnancy on the risk of low birthweight (LBW; ,2,500 g) may depend upon maternal nutritional status. We investigated this dependence further using a large, diverse study population. Methods and findings We evaluated the interaction between maternal malaria infection and maternal anthropometric status on the risk of LBW using pooled data from 14,633 pregnancies from 13 studies (6 cohort studies and 7 randomized controlled trials) conducted in Africa and the Western Pacific from 1996-2015. Studies were identified by the Maternal Malaria and Malnutrition (M3) initiative using a convenience sampling approach and were eligible for pooling given adequate ethical approval and availability of essential variables. Study-specific adjusted effect estimates were calculated using inverse probability of treatment-weighted linear and log-binomial regression models and pooled using a random-effects model. The adjusted risk ...
Malaria contributes significantly to maternal mortality and morbidity in Sub-Saharan Africa. Preventing malaria among pregnant women is an important strategy for reducing mortality and adverse maternal and neonatal health outcomes. The World Health Organization recommends intermittent preventive treatment for pregnant women (IPTp) at each scheduled antenatal care visit starting early in the second trimester as a key strategy for prevention. This study, conducted in two districts in Uganda, explored service delivery practices, missed opportunities, and barriers at the facility level that impede IPTp service provision.. ...
Anaemia, in particular due to iron deficiency, is common in pregnancy with associated negative outcomes for mother and infant. However, there is evidence of significant variation in management. The objectives of this review of systematic reviews were to analyse and summarise the evidence base, identify gaps in the evidence and develop a research agenda for this important component of maternity care. Multiple databases were searched, including MEDLINE, EMBASE and The Cochrane Library. All systematic reviews relating to interventions to prevent and treat anaemia in the antenatal and postnatal period were eligible. Two reviewers independently assessed data inclusion, extraction and quality of methodology. 27 reviews were included, all reporting on the prevention and treatment of anaemia in the antenatal (n = 24) and postnatal periods (n = 3). Using AMSTAR as the assessment tool for methodological quality, only 12 of the 27 were rated as high quality reviews. The greatest number of reviews covered antenatal
Pregnancy-associated malaria (PAM) is associated with the massive sequestration of erythrocytes infected with CSA-binding parasites in the placenta. Natural
Wassmer, Samuel C and Taylor, Terrie and MacLennan, Calman A. and Kanjala, Maxwell and Mukaka, Mavuto and Molyneux, Malcolm E. and Grau, Georges Emile (2008) Platelet-Induced Clumping of Plasmodium falciparum-Infected Erythrocytes from Malawian Patients with Cerebral Malaria-Possible Modulation In Vivo by Thrombocytopenia. The Journal of Infectious Diseases, 197. pp. 72-78. ISSN 0022-1899. ...
Share these steps to help people protect their families from lead poisoning. Children under age 6 and pregnant women are most at risk of lead poisoning.
Pregnant women are exposed to some risk by travelling abroad, especially to the tropics and when travelling under primitive conditions.
Background Sickle cell trait (HbAS) confers partial protection against malaria by reducing the adhesion of Plasmodium falciparum-infected erythrocytes to host receptors, but little is known about its potential protection against placental malaria. Methods Using flow cytometry, we assessed the recognition of HbAA and HbAS VAR2CSA-expressing infected erythrocytes, by plasma from 159 Beninese pregnant women with either HbAA (normal) or HbAS. Using multivariate linear models adjusted for gravidity, parasite infection at delivery, glucose-6-phosphate dehydrogenase deficiency, and α-thalassemia carriage, we observed significantly reduced cell surface antibody binding of HbAS-infected erythrocytes by plasma from HbAS compared with HbAA women (P , 10-3). Results The difference in cell surface antibody binding was only observed when infected erythrocytes and plasma were associated according to the same hemoglobin genotype. Similar levels of VAR2CSA-specific antibody were measured by enzyme-linked ...
Placental infection by Salmonella enterica typhimurium in a murine model : mechanisms of pathogenesis and role of inflammatory cell death
Malaria is a major contributor of disease burden in Sub-Saharan Africa, with pregnant women and children being the most vulnerable population. P. falciparum infection in pregnancy leads to parasite sequestration in placental vascular space, with increased risks of abortion, stillbirth, prematurity, intrauterine growth retardation, maternal anaemia, low birth weight (LBW), perinatal, neonatal and infant mortality. In low transmission areas, malaria can evolve towards severe disease with high risk of mortality. In endemic areas, it is still associated with maternal anaemia, LBW and stillbirth. For prevention and control of malaria in pregnancy, WHO recommends Intermittent Preventive Treatment (IPT), insecticide treated nets (ITNs) and case management for malaria and anemia.. HIV in pregnancy increases the risk of malaria, LBW, post-natal mortality and also anaemia, suggesting a synergistic interaction between HIV and malaria.. In pregnant women, HIV-1 infection decreases the efficacy of ...
It is still unclear how mother-to-child HCV transmission occurs in the perinatal period, and our present findings may help to shed some light on the route of infection. During the perinatal period, there are two possible major routes of HCV transmission from mother to child: placental infection and birth canal infection. Placental infection results from active transport of virus from mother to child, or from micro-transfusion of virus due to placental membrane damage. In all of the three brothers, blood exchange between the fetus and the mother through the placenta had been good, because anti-HCV antibody (immunoglobulin G) had been transferred to all fetuses and was detected in the umbilical blood at birth in all cases. However, only the second child had been infected with HCV. Negativity for HCV RNA in the umbilical blood of this child was different from the viral titer in the serum of his mother, which indicated a very high level of HCV RNA, as shown in Table 1. Thus placental infection by ...
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But you know, this is hazardous for pregnant women themselves. Often pregnant women do not realize when their teeth are pain no apparent reason. When pregnant women feel the complaints and postpone the examination to the dentist, the complaint would be heavier. If pain due to inflammation of the gums, then the inflamed gums will become swollen and bleed easily. It can make a pregnant woman have difficulty speaking and eating difficult. As a result, supply of required nutrients pregnant women disrupted. Not only pregnant women, fetal growth is conceived also be disrupted ...
Abstract: Purpose: to study efficiency of various methods of prevention of perinatal complications in mother and child. Material and methods. In three risk groups preventive treatment of intrauterine infected fetus (IUIF), gestosis, noncarrying of pregnancy and fetoplacental insufficiency has been carried out. In group I consisted of 71 pregnant women preventive treatment has included medication with application of antioxidants; stimulators of processes of carboxylation in cycle Krebs; endogenic synthesis prostaglandins, prostacyclin; drugs improving processes of microcirculation, stabilizing function of endothelium ofvessels, an exchange of homocysteine. In group II consisted of 67 pregnant women prevention of IUIF and complications has been carried out by means of physical exercises in combination with aqua aerobics. In group III consisted of 100 women prevention of IUIF has been standard. In the control group IV consisted of 70 women pregnancy has not been complicated. Parameters of oxidant ...
About 2,000 Malawian women Friday staged a protest against attacks on trouser-wearing women, who were stripped in the streets this week by a gang of unemployed youths and sidewalk vendors.
Less Than 1 in 5 Expectant Moms Knows the Three Main Benefits Designed to Support Breastfeeding, According to Research Commissioned by Byram Healthcare.
While most doctors encourage their patients to get a flu shot, it is even more important for pregnant women. Pregnant women are more at risk of getting
Malaria remains a burden for pregnant women and the under 5. Intermittent preventive treatment of pregnant women (IPTp) for malaria with sulfadoxine pyrimethamine (SP) has since replaced prophylaxis and legislation has been reinforced in the area of insecticide treated mosquito nets (ITNs) in Cameroon. Clinical malaria despite all these measures remains a problem. We compared the socio-obstetrical characteristics of women who developed clinical malaria and those who did not though in the same regimen. [Read More] ...
Researchers sought to determine the most effective regimen of intermittent preventive treatment (IPT) against malaria for schoolchildren in the Democratic Republic of Congo. The children were given sulfadoxine/pyrimethamine (SP), SP plus piperaquine (SP/PQ), or no intervention. The SP group saw a reduction in anemia (10%), malaria parasitemia (19%), and clinical malaria (25%),
GiveWell analyzed the evidence for intermittent preventive treatment of malaria during pregnancy. This is an interim intervention report; several major unanswered questions remain.
A randomized trial reported by Diadier Diallo and colleagues shows that intermittent preventive treatment for malaria in children who are protected from mosquitoes using insecticide-treated bednets provides substantial protection from malaria.
The level of access to intermittent preventive treatment for malaria in pregnancy (IPTp) in Nigeria is still low despite relatively high antenatal care coverage in the study area. This paper presents information on provider factors that affect the de
Plasmodium falciparum parasites causing placental malaria (PM) express the VAR2CSA type of the clonally variant antigen family PfEMP1. This enables evasion of pre-existing immunity and results in placental accumulation of infected erythrocytes (IEs). We present data on seasonal variation in levels of VAR2CSA-specific IgG and IgG specific for a PM-unrelated PfEMP1 protein among Ghanaian women at first antenatal visit. Our results indicate that PM does not require recent exposure to infected mosquitoes, in contrast to malaria in general. This has implications for the impact of insecticide-treated bed nets on PM incidence, and for antenatal care in woman with pre-existing immunity ...
Pregnancy-associated malaria (PAM) is associated with poor pregnancy outcomes. Hemoglobin S (HbS) and hemoglobin C (HbC) mutations are frequently encountered in malaria-endemic areas of Africa, where they protect children from severe and uncomplicated Plasmodium falciparum malaria. However, scant epidemiological data exist on the impact of these Hb variants on PAM. A prospective cohort of 635 Beninese pregnant women was recruited before 24 weeks of gestational age and followed until the end of pregnancy. HbAA, HbAC, and HbAS genotypes were determined and tested for association with pregnancy outcomes and PAM indicators using linear and logistic multivariate models. Newborns from HbAC mothers had higher birthweights than those from HbAA mothers among women infected at any time during pregnancy (mean difference 182.9 g, p = 0.08), or during the first half of pregnancy (654.3 g, p = 0.0006). No such birthweight differences were observed between newborns from HbAS and HbAA mothers. HbAC and HbAS were not
Background: Nutritional iron deficiency may limit iron availability to the malaria parasite reducing infection risk, and/or impair host immunity thereby increasing this risk. In pregnant women, there is evidence of an adverse effect with iron supplementation, but the few reported studies are strongly confounded. Methods: A case control study in pregnant Malawian women was undertaken in Chikhwawa southern Malawi in order to describe iron status in relation to placental malaria controlling for several confounding factors. Pregnancy characteristics were obtained and a blood sample at delivery. A full blood count was performed and serum ferritin and transferrin receptor quantified by enzyme-linked immunoassay. DNA analysis was used to identify genetic polymorphisms for ABO phenotype, hemoglobin HbS, and glucose 6 phosphate dehydrogenase deficiency. Placental tissue was obtained and malaria histology classified as active, past or no malaria infection. Results: 112 cases with placental malaria were ...
There were 52 histology-positive cases; 38 (73.1%) active (acute and chronic) and 14 past infections. Intervillous parasitaemia was low (60% had < 1% parasitaemia) and monocytosis mostly mild (63%). Compared with uninfected placentas, acute Plasmodium falciparum infections were associated with stillbirth (RR 3.8, 95% CI 1.2-12.1), lower maternal haemoglobin (mean difference: 1.5 g/dL, 95% CI 0.5-2.5), lower birth weight (mean difference 451 g, 95% CI 169-609) and shorter gestation (mean difference 0.8 weeks, 95% CI 0.2-1.4). Chronic or past infections were not associated with these outcomes. Among the 11 peripheral Plasmodium vivax cases, placental parasites were absent, but they were associated with increased placental polymorphonuclear cells ...
An observational study by Ruth Gilbert and colleagues finds that prenatal treatment of congenital toxoplasmosis could substantially reduce the proportion of infected fetuses that develop serious neurological sequelae.
Malaria in pregnancy. It is estimated that approximately 50 million pregnant women globally are at risk of contracting malaria each year, and that 10 000 mothers and 200 000 infants die annually as a result of malaria in pregnancy.[1] Studies conducted in malarious areas of Africa have shown that the burden of malaria in pregnant women is higher than in non-pregnant women. In pregnancy malaria results in anaemia, low birth weight (LBW), prematurity, miscarriage, stillbirth, and perinatal and maternal deaths,[2-4] these complications being particularly severe in pregnant women co-infected with HIV.[5]. Control policy for malaria in pregnancy. The World Health Assembly in 2005 set targets of more than 80% coverage with all the recommended malaria interventions for pregnant women living in malaria endemic areas. These include indoor residual spraying (IRS) of insecticide for households at risk of malaria. Thirty-three of the 45 African countries that are endemic for malaria had implemented an ...
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When she helped start the congenital toxoplasmosis study in 1981, optimal drug treatment regimens were unknown, said Dr. McLeod. Now, thanks in part to controlled clinical trials run under the auspices of the study, the condition can be successfully treated and many babies who are diagnosed before or shortly after birth and who are treated suffer few or no ill effects. When the researchers looked at the clinical histories of those children in the long-term study who had been diagnosed with congenital toxoplasmosis during gestation and whose mothers had received drug treatment prior to giving birth, the association between NE-II and severe disease at birth vanished. "Our study demonstrates that outcomes are equally good following postnatal treatment for type II and NE-II parasites, although not all outcomes are favorable for all children," she said.. In France, all pregnant women are screened for Toxoplasma infection. Prompt treatment is offered to any woman who becomes infected while pregnant, ...
Transforming Intermittent Preventive Treatment of Malaria in Pregnancy for Optimal Pregnancy, funded by Unitaid, 2017-2022: The introduction of IPTp in the early 2000s increased opportunities for pregnant women to protect themselves and their unborn babies from the detrimental consequences of...