Training Manual for Preventive Malaria - Ministry of Health

CASE STUDY – MANAGEMENT OF A PREGNANT WOMAN WITH COMPLICATED
MALARIA
Directions
The participants should go into small groups. The participants should read and analyse this case
study individually and then answer the case study questions as a group. The groups should then
share their answers.
Scenario:
Victoria Ablor is 24 years old and reported at the antenatal clinic looking ill and weak. During
history taking she told the midwife that she was three months pregnant and had been ill for the
past week and although she had taken some medication she had not improved. On examination,
she had yellowish discolouration of the eyes and temperature was 39 o C.
Questions for discussion:
1. If you were the midwife, what important physical examination would you carry out?
2. What tests would you carry out and why?
3. How will you treat her if there are malaria parasites in the blood?
4. What advice would you give to Victoria after treatment and why?
5. What measures would you take to ensure that Victoria recovers completely?
Answers
1. Let her lie down and be comfortable.
a. Assess: Ascertain if she is pregnant and check her gestational period.
b. Examine: Check her BP, temperature, Pulse and respiration and record it.
2. Laboratory Investigation: A blood test can be done to isolate malaria parasites in a blood film
examination.
b. Other tests can be done to exclude other conditions that can cause fever like;
• Bladder infection
• Pneumonia
• Typhoid
• Intra uterine infections (Chorioamnionitis)
3. Call the medical officer, if she is suspected to be suffering from complicated malaria. The
doctor will put her on quinine through any of the following routes;
Intravenous Administration Of Quinine
Quinine Hydrochloride, 10mg/kg body weight of salt (max. 600mg) IV 8 hourly in 5-10ml/Kg of
4.3% dextrose in 0.18% normal saline or in 5% dextrose over 4 - 8 hours.
IM Administration of Quinine
Deep IM injection at a dose of 10 mg/Kg body weight of Quinine 8 hourly using a dilution of;-
100mg/ml Quinine in sterile water for injection or normal saline
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