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Malaria in pregnant women Thai-Burmese border 1986 - 2003

Malaria in pregnant women Thai-Burmese border 1986 - 2003. Shoklo Malaria Research Unit Mae Sot Wellcome-Mahidol University-Oxford Tropical Medicine Research Programme. Shoklo camp 1986-1998. CHIANG MAI. TAK. BANGKOK. Maela camp Since 1987. Tha Song Yang. Mae Ramat. TAK. Mae Sot.

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Malaria in pregnant women Thai-Burmese border 1986 - 2003

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  1. Malaria in pregnant women Thai-Burmese border1986 - 2003 Shoklo Malaria Research Unit Mae Sot Wellcome-Mahidol University-Oxford Tropical Medicine Research Programme

  2. Shoklo camp 1986-1998 CHIANG MAI TAK BANGKOK Maela camp Since 1987 Tha Song Yang Mae Ramat TAK Mae Sot Phop Phra N SMRU first settings Myanmar

  3. Cure rate (%) AM 100 QT 80 Q M25 60 M15 SP 40 CQ 20 1975 1980 1985 1990 1995 2000 The problem of multi-drug resistance

  4. The dangers of malaria in pregnancy • For the mother: • Increase susceptibility to malaria, risk of complications and death • Aggravation of anaemia • For the foetus: • Low birth weight • Abortion and stillbirth • For the infant: • Increase infant mortality

  5. Malaria as first cause of maternal death • Malaria = 1st cause of maternal death in Thailand until the years 1970’s (Trans R Soc Trop Med Hyg, 1979; 73:427-431) • Malaria related maternal mortality in the camps: 1% of all pregnant women per year in the late 1980’s (Trans R Soc Trop Med Hyg, 1991; 85:424-429)

  6. WHO recommendations • Personal protection measures (impregnated bednets, repellent) • Chemoprophylaxis / Intermittent preventive treatment • Early diagnosis and treatment

  7. Weekly malaria smear

  8. Treatment and follow-up of positive malaria patients

  9. PF PV Malaria incidence in MLA-camp 3.50 3.00 2.50 2.00 Infection pregnant woman-1 year-1 1.50 1.00 0.50 0.00 1989 1991 1993 1987 1995 1997 1999 2001 2003

  10. In refugee camps: • MFQ+ART 3 days has reduced the number of PF infections in the population • Weekly ANC was feasible, and well accepted • It is the only strategy to reduce maternal mortality and morbidity Question: • Are these results reproducible in a migrant population with high malaria prevalence?

  11. CHIANG MAI TAK Maela camp Since 1987 BANGKOK Tha Song Yang Wang Pha Since 2004 Mae Ramat TAK Myanmar Mawker Thai Since 1998 Mae Sot Mun Ru Chai Since 1999 Phop Phra N Wa Ley Since 1999 SMRU – Antenatal Care activities

  12. ANC attendance, overview 1998 -2003

  13. Maternal malaria

  14. 18.00 16.00 PF PV 14.00 12.00 10.00 8.00 6.00 4.00 2.00 0.00 1998 1999 2000 2001 2002 2003 Malaria incidence in the migrants Infection pregnant woman-1 year-1

  15. Conclusion (1) • Maternal malaria burden is decreasing but remains significant in migrants PW • Malaria maternal mortality has been considerably reduced • Anemia is common in pregnancy and aggravated by malaria • Weekly ANC with EDT is well accepted in highly mobile migrant population

  16. Conclusion (2) • Weekly malaria smear for pregnant women is presently the only effective measure to reduce maternal mortality and morbidity due to malaria in this area • New safe and effective treatments are urgently needed

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