National programmes: malaria treatment in pregnancy: practice question

A PSM question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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PSM · National programmes: malaria treatment in pregnancy

Sample item

A woman at 20 weeks of gestation has uncomplicated Plasmodium falciparum malaria confirmed on rapid diagnostic test, in an area where artesunate plus sulfadoxine-pyrimethamine remains effective. Which treatment is appropriate?

AArtemisinin-based combination therapy for 3 days, with no primaquineBChloroquine for 3 days plus primaquine for 14 daysCQuinine alone for 7 days, since artemisinin drugs are contraindicated in the second trimesterDArtemisinin-based combination therapy for 3 days plus single-dose primaquine

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Artemisinin-based combination therapy for 3 days, with no primaquine

In the second and third trimesters uncomplicated falciparum malaria is treated with the standard artemisinin-based combination therapy for 3 days. The single gametocidal dose of primaquine is withheld in pregnancy because of the risk of haemolysis in a fetus of unknown G6PD status. Chloroquine alone is not enough for falciparum malaria.

Option by option

A. Artemisinin-based combination therapy for 3 days, with no primaquine (correct)
Correct. ACT is used without primaquine in pregnancy.
B. Chloroquine for 3 days plus primaquine for 14 days
Chloroquine is not effective against most falciparum, and 14-day primaquine is for vivax and contraindicated in pregnancy.
C. Quinine alone for 7 days, since artemisinin drugs are contraindicated in the second trimester
ACT is recommended in the second and third trimesters, so quinine alone is not required.
D. Artemisinin-based combination therapy for 3 days plus single-dose primaquine
Primaquine is contraindicated in pregnancy, so it cannot be added.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this PSM question

What is the answer to this PSM question?

The best answer is A, Artemisinin-based combination therapy for 3 days, with no primaquine. In the second and third trimesters uncomplicated falciparum malaria is treated with the standard artemisinin-based combination therapy for 3 days.

Why is "Chloroquine for 3 days plus primaquine for 14 days" not the answer?

Chloroquine is not effective against most falciparum, and 14-day primaquine is for vivax and contraindicated in pregnancy.

Why is "Quinine alone for 7 days, since artemisinin drugs are contraindicated…" not the answer?

ACT is recommended in the second and third trimesters, so quinine alone is not required.

Why is "Artemisinin-based combination therapy for 3 days plus single-dose pri…" not the answer?

Primaquine is contraindicated in pregnancy, so it cannot be added.

What concept does this question test?

It tests National programmes: malaria treatment in pregnancy in PSM. The single gametocidal dose of primaquine is withheld in pregnancy because of the risk of haemolysis in a fetus of unknown G6PD status. Chloroquine alone is not enough for falciparum malaria.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study National programmes: malaria treatment in pregnancy?

Practise biostatistics with small calculations until sensitivity, predictive values and risk measures are automatic. Then use the flashcards and the other PSM questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.