Abstract
We investigated whether adding community scheduled malaria screening and treatment (CSST) with artemether-lumefantrine by community health workers (CHWs) to standard intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) would improve maternal and infant health. In this 2-arm cluster-randomized, controlled trial, villages in Burkina Faso, The Gambia, and Benin were randomized to receive CSST plus IPTp-SP or IPTp-SP alone. CHWs in the intervention arm performed monthly CSST during pregnancy. At each contact, filter paper and blood slides were collected, and at delivery, a placental biopsy was collected. Primary and secondary endpoints were the prevalence of placental malaria, maternal anemia, maternal peripheral infection, low birth weight, antenatal clinic (ANC) attendance, and IPTp-SP coverage. Malaria infection was detected at least once for 3.8% women in The Gambia, 16.9% in Benin, and 31.6% in Burkina Faso. There was no difference between study arms in terms of placenta malaria after adjusting for birth season, parity, and IPTp-SP doses (adjusted odds ratio, 1.06 [95% confidence interval, .78-1.44]; P = .72). No difference between the study arms was found for peripheral maternal infection, anemia, and adverse pregnancy outcomes. ANC attendance was significantly higher in the intervention arm in Burkina Faso but not in The Gambia and Benin. Increasing number of IPTp-SP doses was associated with a significantly lower risk of placenta malaria, anemia at delivery, and low birth weight. Adding CSST to existing IPTp-SP strategies did not reduce malaria in pregnancy. Increasing the number of IPTp-SP doses given during pregnancy is a priority. NCT01941264; ISRCTN37259296.
Highlights
We investigated whether adding community scheduled malaria screening and treatment (CSST) with artemether-lumefantrine by community health workers (CHWs) to standard intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) would improve maternal and infant health
Laboratory Methods Giemsa-stained thick blood films were read by 2 experienced microscopists, with discrepancies resolved by a third one [12]
Loss to follow-up was low in The Gambia (113/1960 [5.8%]) and in Burkina Faso (62/1800 [3.4%]) but high in Benin (290/971 [29.9%])
Summary
In this 2-arm cluster-randomized, controlled trial, villages in Burkina Faso, The Gambia, and Benin were randomized to receive CSST plus IPTp-SP or IPTp-SP alone. Filter paper and blood slides were collected, and at delivery, a placental biopsy was collected. The study was implemented in 3 West African countries: Burkina Faso (Nanoro health district), The Gambia (Upper River region), and Benin (Glo-Djigbe, Zinvie, and Ze districts). In Burkina Faso and The Gambia, malaria is highly seasonal (July–December), whereas in Benin it is perennial with peaks during the rainy seasons (April–July and October– November). Placental biopsy slides were read by trained microscopists and classified as infected (acute: parasites and malaria pigment absent; chronic: parasites and malaria pigment; or past: only malaria pigment) or not infected (no parasites or pigment) [16].
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