Scientists have advanced the search for a safer drug that will be used to prevent and manage malaria in pregnant women.
Researchers at the Kenya Medical Research Institute (Kemri) have identified an anti-malarial drug, dihydroartemisinin-piperaquine (DP), as a viable option to replace fansidar (sulphadoxine and pyrimethamine, also known as SP), which is currently being used to prevent malaria in pregnancy.
Trials done in Siaya County and Uganda show that when DP is administered during pregnancy, it is well-tolerated and more effective than Fansidar.
Trial study coordinator Hellen Barsosio reported that the two exploratory trials proved that the drug was superior, better tolerated and more effective in preventing malaria in pregnancy.
Earlier studies indicate that women, especially in Western and Nyanza regions, were still getting malaria despite being given Fansider as a preventive drug.
This shows that malaria parasites have developed resistance to the drug, enhancing the need to find another solution to prevent pregnant women from getting the disease that is listed as one of the top killers in Kenya.
Premature births
Dr Barsosio, however, said the two trials were not big enough to evaluate the impact of DP on the pregnancy outcome and the health of the new-born including miscarriages, stillbirths, premature births and low birth weight.
“World Health Organisation reviewed the evidence and concluded that DP is a promising alternative and recommended that a larger confirmatory trial is needed before it can consider whether to recommend this drug as an alternative to fansidar in areas of high resistance,” said Barsosio.
The researchers now want to try dihydroartemisinin-piperaquine in 10 sites in Kenya, Tanzania and Malawi.
The study, which is expected to take about two years, will then influence change, if DP is found to pass all the tests of a preventive drug.
The new research study, titled Improving Pregnancy Outcomes with Intermittent Preventive Treatment in Africa, will enroll 4,680 women participants in the three countries - Kenya, Malawi and Tanzania - with 1,404 in Kenya for the next 17 months.
“The study is targeting HIV-negative women with singleton pregnancies in their second trimester of 16 to 28 weeks of pregnancy and willing to deliver in a health facility,” said Barsosio.
In Kenya, the trials will be carried out at the Ahero County Hospital, Rabuor Health Centre in Kisumu and Homa-Bay Referral Hospital.
The participants will be picked randomly.
The doctor explained that the women would undergo monthly tests, and each visit would involve screens and treatment for malaria and other standard care provided in line with national guidelines for care of pregnant mothers.
This trial aims to address the gaps regarding efficacy, safety and cost-effectiveness of DP for malaria prevention in pregnancy.
“Malaria in pregnancy has devastating consequences for the mother and unborn child if left undetected and untreated,” said Barsosio.
The researchers said alternative strategies for malaria prevention in HIV positive pregnant women were yet to be explored.