BACKGROUND: Malaria during pregnancy contributes to maternal anemia and low birth weight. In East Africa, several studies have demonstrated that intermittent preventive treatment (IPT) with sulfadoxine-pyrimethamine (SP) is more efficacious than weekly chloroquine (CQ) chemoprophylaxis in preventing these adverse consequences. To our knowledge, there are no published trials evaluating IPT in West Africa. METHODS: We undertook a randomized controlled trial of weekly CQ chemoprophylaxis, 2-dose IPT with CQ, and 2-dose IPT with SP; 1163 women were enrolled. RESULTS: In multivariate analyses, when compared with weekly CQ, IPT/SP was associated with a reduction in third-trimester anemia (adjusted odds ratio [AOR], 0.49; P<.001), placental parasitemia (AOR, 0.69; P=.04), and low birth weight (<2500 g) (AOR, 0.69; P=.04). The prevalence of placental infection remained unexpectedly high, even in the IPT/SP group (24.5%), possibly because of the intensity of seasonal transmission. There were no significant differences in stillbirths, spontaneous abortions, or neonatal deaths among the 3 groups. CONCLUSIONS: In Mali, IPT with SP appears more efficacious than weekly chloroquine chemoprophylaxis in preventing malaria during pregnancy. These data support World Health Organization recommendations to administer at least 2 doses of IPT during pregnancy. In intensely seasonal transmission settings in Mali, >2 doses may be required to prevent placental reinfection prior to delivery.
RCT Entities:
BACKGROUND:Malaria during pregnancy contributes to maternal anemia and low birth weight. In East Africa, several studies have demonstrated that intermittent preventive treatment (IPT) with sulfadoxine-pyrimethamine (SP) is more efficacious than weekly chloroquine (CQ) chemoprophylaxis in preventing these adverse consequences. To our knowledge, there are no published trials evaluating IPT in West Africa. METHODS: We undertook a randomized controlled trial of weekly CQ chemoprophylaxis, 2-dose IPT with CQ, and 2-dose IPT with SP; 1163 women were enrolled. RESULTS: In multivariate analyses, when compared with weekly CQ, IPT/SP was associated with a reduction in third-trimester anemia (adjusted odds ratio [AOR], 0.49; P<.001), placental parasitemia (AOR, 0.69; P=.04), and low birth weight (<2500 g) (AOR, 0.69; P=.04). The prevalence of placental infection remained unexpectedly high, even in the IPT/SP group (24.5%), possibly because of the intensity of seasonal transmission. There were no significant differences in stillbirths, spontaneous abortions, or neonatal deaths among the 3 groups. CONCLUSIONS: In Mali, IPT with SP appears more efficacious than weekly chloroquine chemoprophylaxis in preventing malaria during pregnancy. These data support World Health Organization recommendations to administer at least 2 doses of IPT during pregnancy. In intensely seasonal transmission settings in Mali, >2 doses may be required to prevent placental reinfection prior to delivery.
Authors: Nana O Wilson; Fatou K Ceesay; Samuel A Obed; Andrew A Adjei; Richard K Gyasi; Patricia Rodney; Yassa Ndjakani; Winston A Anderson; Naomi W Lucchi; Jonathan K Stiles Journal: Am J Trop Med Hyg Date: 2011-07 Impact factor: 2.345
Authors: Stephen Rulisa; Pètra F Mens; Corine Karema; Henk D F H Schallig; Nadine Kaligirwa; Joseph Vyankandondera; Peter J de Vries Journal: Malar J Date: 2009-08-10 Impact factor: 2.979
Authors: Alfred B Tiono; Alphonse Ouedraogo; Edith C Bougouma; Amidou Diarra; Amadou T Konaté; Issa Nébié; Sodiomon B Sirima Journal: Malar J Date: 2009-10-07 Impact factor: 2.979
Authors: Olugbenga A Mokuolu; Catherine O Falade; Adeola A Orogade; Henrietta U Okafor; Olanrewaju T Adedoyin; Tagbo A Oguonu; Hannah O Dada-Adegbola; O A Oguntayo; Samuel K Ernest; Davidson H Hamer; Michael V Callahan Journal: Infect Dis Obstet Gynecol Date: 2009-07-20