Comparative study of proguanil and sulphadoxine–pyrimethamine in the prevention of malaria in pregnancy

Abstract

Background: Intermittent preventive treatment of malaria in pregnancy with sulphadoxine–pyrimethamine (SP) is recommended for prevention of malaria in pregnancy. However, chemoprophylaxis with proguanil (PG) is being used in pregnancy for preventing malaria in selected cases. Objective: To compare the efficacy of daily PG and intermittent monthly SP in preventing malaria and its complications during pregnancy. Patients and Methods: This was a prospective comparative study conducted among 270 consenting pregnant women with parity ≤2 at gestational age of 18–24 weeks. Participants were enrolled and randomized to PG or SP group following a baseline hemoglobin estimation and blood film negative for malaria parasite. At 36 weeks of gestation, maternal blood sample was checked for hemoglobin concentration and malaria parasitaemia, and the infant birth weight was assessed at delivery. Statistical Analysis: Appropriate univariate, and bivariate analysis employed and level of significance set at P Results: One hundred and thirty-five participants in each group (246) completed the study. Ten (8.5%) had malaria parasitaemia in the PG group at 36 weeks compared to 15 (11.7%) in the SP group (P = 0.40); 5 (4.3%) in the PG compared with 6 in SP group (4.7%) had anemia (Hb Conclusion: PG and SP were comparable in efficacy and outcome for malaria prevention during pregnancy. IPT-SP is recommended for prevention of malaria in pregnancy. However, PG is beneficial in selected patients with known adverse reactions to sulphonamide.