Risk management, Public health matters, risk communication and perspectives on the Sustainable Development Goals(SDGs2030)

Wednesday 26 July 2017

New guidelines for preventing and treating malaria in pregnancy

In 2016, the World Health Organization (WHO) released new antenatal care (ANC) guidelines with the aim of promoting evidence-based practices and improving women’s pregnancy experiences. Notably, the new WHO ANC guidelines include a recommended change from four visits to at least eight ANC contacts.
Addressing the issue of malaria in pregnancy (MiP) is a key component of providing high quality ANC, particularly in endemic areas. A group of experts representing a number of organizations recently published a brief containing guidelines for preventing and treating MiP in the context of the updated WHO ANC guidelines.

Key messages
1. All pregnant women living in areas at risk for malaria transmission should:
o    Sleep under an insecticide-treated net (ITN).
o   Seek prompt quality diagnosis when signs and symptoms of malaria are present and receive effective malaria case management with an appropriate drug at the correct dose.
2. Pregnant women living in moderate to high malaria transmission areas in Africa should also receive:
o   Intermittent preventive treatment in pregnancy using sulfadoxine-pyrimethamine (IPTp-SP) under directly observed therapy (DOT) starting as early as possible in the second trimester, with doses given at least one month apart until the time of delivery.
o   To enable pregnant women in endemic areas to start IPTp-SP at the beginning of the second trimester, policymakers should put in place supportive policies to ensure that women have an ANC contact at 13 weeks’ gestation.
o   IPTp-SP should be given to a pregnant woman at every ANC contact starting from 13 to 16 weeks, with each dose being given at least one month (four weeks) apart.
o   Pregnant women who have an ANC contact twice between 13 and 20 weeks, at least one month apart, should receive IPTp-SP by DOT at both contacts.
o   If a woman comes for her first second-trimester contact anytime between 13 and 20 weeks, she should receive IPTp-SP, and at every following contact, with doses one month apart.
o   Pregnant women can receive IPTp-SP safely starting as early as possible in their second trimester up until the end of pregnancy.
o   SP should not be administered to women living with HIV who are receiving co-trimoxazole.
3. Countries should only provide quality-assured SP for IPTp to ensure effective care for pregnant women.
o   Current procurement sources of quality-assured SP can be found on the Global Fund’s list of pharmaceutical products compliant with the quality assurance policy.
4. Iron and folic acid requirements increase during pregnancy.

o   Administer 30 to 60 mg of elemental iron and 400 mcg (0.4 mg) of folic acid.

By: Sarah Hodin, Project Coordinator II, Women and Health Initiative, Harvard T.H. Chan School of Public Health
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Tuesday 25 July 2017

Teenage girls are dying from unsafe abortion and risky pregnancies in Sierra Leone

I recently saw a girl in clinic with terrible complications following a caesarean section. The operation had been botched and she had an infection around her uterus. She was in terrible pain and critically unwell. This was in the children’s clinic; the girl was 14 years old.

Image credit: Issouf Sanogo/AFP/Getty Images
This scenario is all too common. She is just one of the thousands of adolescent girls estimated to have become pregnant this year in Sierra Leone. In 2013 the country had the 7th highest teenage pregnancy rate in the world, 38% of women aged 20-24 had their first baby before the age of 18. Sierra Leone is by no means an exception. Worldwide teenage pregnancy is a huge issue, 11% of births globally are to women aged 15-19, with the majority of these taking place in low- and middle-income countries.

From a medical point of view, teenage pregnancy is terribly risky. Teenage mothers are estimated to be 40-60% more likely to die in childbirth. Their babies are 50% more likely to be stillborn or die shortly after birth than babies born to mothers in their 20s.

Terrifying medical complications aside, it can be devastating socially and economically for adolescent mums. In 2015, when schools in Sierra Leone reopened after the Ebola crisis, the minister for education banned visibly pregnant girls from school and sitting exams. This discriminatory ban persists and has been strongly condemned by, among others, Amnesty International.

A “bridging system” was started where girls can seek alternative education elsewhere, but the disruption remains huge. Often girls will be prevented from sitting exams and need to repeat a whole year of school, meaning many will not go back at all. This discriminates against the girls, but not the men who get them pregnant. After giving birth they face continued problems reintegrating into their schools of choice.  Continue here

News credit: The guardian
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