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Le paludisme de la femme enceinte. Épidémiologie et prévention

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Le paludisme de la femme enceinte. Épidémiologie et prévention - Présentation du 4e édition du Cours international « Atelier Paludisme » - Germaine RETOFA - Médecin - Ministère de la Santé et du Planning Familial - Service de Lutte Contre le Paludisme - Madagascar

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Le paludisme de la femme enceinte. Épidémiologie et prévention

  1. 1. EVALUATION par les FACILITATEURS LE PALUDISME DE LA FEMME ENCEINTE:L Epidémiologie et PréventionLEPALIS Présenté par RETOFA Germaine Médecin chef CSB2 Soamanitra DRSPF ANDROY Atelier Paludisme 2006
  2. 2. I-INTRODUCTIONGENERALITE: -problème de santé publique majeursurvenant dans tous les pays endémiques. -système immunitaire de la femme enceinte -vulnérable à l’infection paludique -accroît le risque de maladie,d’anémie,de mort -enfant à naître : augmente le risqued’avortement spontané,de mortinatalité,deprématurité,de petit poids de naissance -le P.falciparum responsable en grande partiede ce problème
  3. 3. II E - PIDEMIOLOGIE- E ffets du paludisme sur la mère pendant la grossesse (Menendez, 1995)
  4. 4. Effets du paludisme sur le fœtus pendant la grossesse (Menendez, 1995)!"#
  5. 5. Effets du paludisme sur le nouveau n - é pendant la grossesse (Menendez, 1995)" $% &
  6. 6. - Selon d’une co infection par VIH/SIDA -Les femmes enceintes VIH+, quelque soit lenombre de grossesses, ont une prévalencepalustre et densité parasitaire plus élevés queles femmes enceintes VIH-.
  7. 7. III-PREVENTIONTPI:-Le Traitement Préventif Intermittent consiste àadministrer à toutes les femmes enceintes au moinsdeux doses de TPI avec la Sulfadoxine-Pyriméthamine(comprimé:S(500mg)-P(25mg) ) lors des consultationsprénatales régulières, pendant les 2 trimestre et 3trimestre de la grossesse. -première dose :16 semaines d’aménorrhée ou dèsla perception des mouvements actifs du fœtus par lamère. -une dose de TPI:3 comprimés de SP -prise directement observée par le prestataire
  8. 8. VIH +:-TPI est moins efficace(Kenya,Malawi) -fréquence du TPI devrait être augmentéeUne évaluation du TPI :-une baisse des infectionsplacentaires (32 à 23 %) et du nombre des cas de petitpoids de naissance (23 à 10%).-75% de toutes lesfemmes enceintes recourraient à ce TPI (Malawi)Madagascar a abandonné la chimioprophylaxiehebdomadaire par la Chloroquine et adapté le TPI selonla recommandation de l’OMS dans les zones àpaludisme stable (les long des côtes Est,Ouest et dansle subdésertique)Politique Nationale de Lutte contre le Paludisme 2005
  9. 9. MII:Moustiquaire Impréignée d’Insecticide -Toutes les femmes enceintes doivent dormirchaque nuit sous une MII. MII:-réduire à la fois le nombre des cas depaludisme et le taux de mortalité chez lesfemmes et leurs enfants. Zone de forte transmission au Kenya: lesfemmes enceintes (4 premières grossesses)sous MII ont quatre fois moins d’enfantsprématurés ou ayant un faible poids denaissance
  10. 10. Couverture de MII et TPI au KenyaDistricts Kissi Kwale Bondo Makueni Rurale Urbain ToutesNombre de 451 537 452 374 1637 177 1814femmesexaminéesNombre femmes 361 363 330 291 1198 147 1345avec plus d’une (80%) (68%) (73%) (78%) (73%) (83%) (74%)CPN (%)Dormi sous MII 1 15 61 12 75 14 89(%) (0.2%) (2.8%) (13%) (3.2%) (4.6%) (7.9%) (4.9%)Pris 2 TPI 38 25 22 4 83 6 89 (8.4%) (4.7%) (4.9%) (1%) (5.1%) (3.4%) (4.9%)
  11. 11. IV-CONCLUSIONSle paludisme pendant la grossesse est ungrand problème dans les pays d’endémicitéInterventions efficaces pour la prévention dupaludisme chez les femmes enceintesexistentLa couverture des ces interventions est faibledans plusieurs Pays AfricainsPlus d’effort sont nécessaire pour rendre lesMII et le TPI accessible à toutes les femmesenceintes.
  12. 12. REFERENCESRoll Back Malaria-Infosheet.Faire reculer le paludisme en 1998 par l’OMS,le PNUD,L’UNICEF et Malaria- l’ PNUD,L’la Banque mondiale.1-3 mondiale.1-Parise ME et al.Efficacity of Sulfadoxine-pyriméthamine for prevention of placental malaria in an Sulfadoxine- pyriméarea of Kenya with a higt prevalance of malaria and human immunodefficiancy virusinfection.American Jornal of Tropical medecine and hygiéne.1998,59:813-822 hygié ne.1998,59:813-Verhoeff FH et al.Increased prevalance of malaria in HIV-infected pregnant woman and its HIV-implication for malaria control.Journal of tropical medecine and international heaht,1999,4:5-2 heaht,1999,4:5-Steketee RW et al.Impairment of pregnant woman acquired ability to limit plasmodium by infectionwith human immunodeficiency virus type-1.American Journal of Tropical Medecine and ly type-.1996,55(1 suppl):42-49 suppl):42-MENENDEZ C,Malaria during pregnancy;A Priority Area of Malaria Research and pregnancy;AControl.Parasitology today .1995:178;-183 .1995:178;-H.L.Guyatt,A.M.Noor,S.A.Ochola and R.W.Snow.Use of intermittent presumptive treatement andH.L.Guyatt, A.M.Noor,insecticide treated bednets by pregnant woman in four Kenya districts.Tropical Medecine andInternational Health.2004,volume: 9 No 2, PP:255-261 PP:255-
  13. 13. MISAOTRA

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