Abstract
BackgroundThe World Health Organization (WHO) recommends using insecticide-treated mosquito nets (ITNs) and intermittent preventive treatment with sulphadoxine-pyrimethamine (IPT-SP) to prevent malaria in sub-Saharan Africa. Data on IPT-SP coverage and factors associated with placental malaria parasitaemia and low birth weight (LBW) are scarce in Côte d'Ivoire.MethodsA multicentre, cross-sectional survey was conducted in Côte d'Ivoire from March to September 2008 at six urban and semi-urban antenatal clinics. Standardized forms were used to collect the demographic information and medical histories of women and their offspring. IPT-SP coverage (≥2 doses) as well as placental and congenital malaria prevalence parasitaemia were estimated. Regression logistics were used to study factors associated with placental malaria and LBW (birth weight of alive babies < 2,500 grams).ResultsOverall, 2,044 women with a median age of 24 years were included in this study. Among them 1017 (49.8%) received ≥2 doses of IPT-SP and 694 (34.0%) received one dose. A total of 99 mothers (4.8%) had placental malaria, and of them, four cases of congenital malaria were diagnosed. Factors that protected from maternal placental malaria parasitaemia were the use of one dose (adjusted odds ratio (aOR), 0.32; 95%CI: 0.19-0.55) or ≥2 doses IPT-SP (aOR: 0.18; 95%CI: 0.10-0.32); the use of ITNs (aOR: 0.47; 95%CI: 0.27-0.82). LBW was associated with primigravidity and placental malaria parasitaemia.ConclusionIPT-SP decreases the rate of placental malaria parasitaemia and has a strong dose effect. Despite relatively successful IPT-SP coverage in Côte d'Ivoire, substantial commitments from national authorities are urgently required for such public health campaigns. Strategies, such as providing IPT-SP free of charge and directly observing treatment, should be implemented to increase the use of IPT-SP as well as other prophylactic methods.
Highlights
The World Health Organization (WHO) recommends using insecticide-treated mosquito nets (ITNs) and intermittent preventive treatment with sulphadoxine-pyrimethamine (IPT-SP) to prevent malaria in sub-Saharan Africa
The objective of this study was to evaluate the coverage of IPT-SP, the prevalence of congenital malaria parasitaemia, and to determine the factors associated with placental malaria and low birth weight (LBW) in six health facilities in Côte d’Ivoire
The proportion of babies with LBW was 10.6%, with a larger proportion among babies born to women with placental malaria parasitaemia (22.2%) than among those born to women without placental malaria parasitaemia (10.1%)
Summary
The World Health Organization (WHO) recommends using insecticide-treated mosquito nets (ITNs) and intermittent preventive treatment with sulphadoxine-pyrimethamine (IPT-SP) to prevent malaria in sub-Saharan Africa. Strategies for controlling malaria during pregnancy in sub-Saharan Africa often include treatment of the disease and resulting anaemia as well as chemoprophylaxis [1,11]. Since 2004, the WHO recommends a more effective strategy for preventing malaria during pregnancy, which includes insecticide-treated mosquito nets (ITNs) and intermittent preventive treatment (IPT) [2,12]. IPT for pregnant women consists of two doses of sulphadoxinepyrimethamine (SP) (1500/75 mg), administered at scheduled clinic visits at least one month apart, starting in the second trimester [2]. The proportion of pregnant women who receive ≥two doses of IPT-SP in sub-Saharan Africa remains relatively low, at rates varying between 3% and 66% [1]
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