MALARIA CHEMOSUPPRESSION IN PREGNANCY .5. PLACENTA MALARIAL CHANGES AMONG 3 DIFFERENT PROPHYLAXIS GROUPS

The effect of malaria chemoprophylaxis during pregnancy on placenta ma larial changes (PMCs) was investigated in 170 tissue sections. Women o f 63 sections received daily proguanil (PROG), 61 once weekly chloroqu ine (CQ) and 46 the two drug combination (CQ+PROG). All were residents of a malaria hyperendemic area in Muheza District, Tanzania. Supervis ed prophylaxis started early in pregnancy till delivery. Parasitaemias and clinical episodes were detected early and radically treated. Over all, PMCs were mostly infrequent and light viz: fibrinous deposits (98 %), fibrinoid necrosis (60%), leucocytic infiltrations (59%), macropha ge containing pigment (16%), and malaria parasites (8%), The type, pre valence, and severity of the PMCs in the three prophylaxis groups were comparable. This was despite the fact that PROG and CQ+PROG were prop hylactically more efficacious than CQ and despite the expectation that the prevalence and severity of the PMCs would be high in the CQ group , Prompt diagnosis and effective treatment of parasitaemias in this gr oup contributed to the low prevalence and less severity, It is conclud ed that effective malaria chemoprophylaxis or prompt diagnosis and eff ective treatment of malaria parasitaemias have significant impact on t he prevalence of PMCs, Due to various operational constraints in most developing countries, chemoprophylaxis remains the only feasible broad option for malaria control in pregnancy.