Clinical malaria among pregnant women on combined insecticide treated nets (ITNs) and intermittent preventive treatment (IPTp) with sulphadoxine-pyrimethamine in Yaounde, Cameroon.

Robinson Enow Mbu,Rebecca Tonye,William Ako Takang,Florent Ymele Fouelifack,Hortence Jeanne Fouedjio,Florence Ndikum Tumasang

doi:10.1186/1472-6874-14-68

Abstract

BackgroundMalaria remains a burden for pregnant women and the under 5. Intermittent preventive treatment of pregnant women (IPTp) for malaria with sulfadoxine – pyrimethamine (SP) has since replaced prophylaxis and legislation has been reinforced in the area of insecticide treated mosquito nets (ITNs) in Cameroon. Clinical malaria despite all these measures remains a problem. We compared the socio-obstetrical characteristics of women who developed clinical malaria and those who did not though in the same regimen.MethodsA 5 – year nested cohort study (2007 – 2011 inclusive) at the tertiary level hospitals in Yaounde. Pregnant women who willingly accepted to participate in the study were enrolled at booking and three doses of SP were administered between 18 – 20 weeks of gestation, between 26–28 weeks and between 32 – 34 weeks. Those who developed clinical malaria were considered as cases and were compared for socio – obstetrical characteristics with those who did not. Venous blood was drawn from the women in both arms for parasite density estimation and identification and all the clinical cases were treated conventionally.ResultsEach arm had 166 cases and many women who developed clinical malaria were between 15 and 19 years (OR 5.5, 95% CI 3.9 – 5.3, p < 0.001). They were of low gravidity (OR 6.5, 95% CI 3.8 – 11.3, p < 0.001) as well as low parity (OR 4.6, 95% CI 2.7 – 7.9, p < 0.001). The cases were single women (OR 4.58, 95% CI 2.54 – 8.26, p < 0.001) and had attained only primary level of education (OR 4.6, 95% CI 2.8 – 7.9, p < 0.001). Gestational ages were between 20 to 30 weeks during clinical malaria (OR 6.8, 95% CI 4.1 – 11.7, p < 0.001). The time between the first and second dose of SP was longer than ten weeks in the cases (OR 5.5, 95% CI 3.2 – 9.3, p < 0.001) and parasite density was higher also among the cases (OR 6.9, 95% CI 5.9 – 12.1, p < 0.001).ConclusionLong spacing between the first and second dose of SP seemed to be responsible for clinical malaria in the cases.

Highlights

Malaria remains a burden for pregnant women and the under 5
Management of malaria in pregnancy combines multiple approaches [9,10,11]. Some of these approaches include intermittent preventive treatment of pregnant women (IPTp) for malaria using a bimolecular formulation of sulphadoxine – pyrimethamine combined with sleeping in insecticide treated nets (ITNs) [12,13,14,15]
Greater proportions of cases were between 15 and 19 years and were of low gravidity as well as low parity

Summary

Introduction

Malaria remains a burden for pregnant women and the under 5. Management of malaria in pregnancy combines multiple approaches [9,10,11] Some of these approaches include intermittent preventive treatment of pregnant women (IPTp) for malaria using a bimolecular formulation of sulphadoxine – pyrimethamine combined with sleeping in insecticide treated nets (ITNs) [12,13,14,15]. These two approaches have been recommended for pregnant women living in endemic areas and are still in use today [16,17,18]. Effort is being made to scale – up these procedures in Cameroon

Objectives

Methods

Results

Discussion

Conclusion