High uptake of Intermittent Preventive Treatment of malaria in pregnancy is associated with improved birth weight among pregnant women in Ghana

Isabella Quakyi,Julius Fobil,Nicaise Tuikue Ndam,Nathaniel Coleman,Philippe Deloron,Gilles Cottrell,Abraham K Anang,Bernard Tornyigah,Pascal Houze,Kwadwo A Kusi,Guillaume Escriou,Amos Laar,Gloria Quansah Asare,Michel Cot,Michael F Ofori

doi:10.1038/s41598-019-55046-5

Abstract

Despite the clinically proven advantages of intermittent preventive treatment of malaria in pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP), utilisation has been low in many African countries. To increase uptake and achieve the desired effect, the World Health Organization revised the policy to a monthly administration. Assessing the coverage and impact of the revised policy on pregnancy and neonatal outcomes is, therefore, a necessity. A 2-parallel cross-sectional hospital-based study was carried out among pregnant women attending first antenatal care (ANC) and delivery. Maternal and cord blood samples were assayed for malaria parasites by quantitative PCR targeting both the 18S rDNA and the acidic terminal segment of Plasmodium falciparum var genes, and plasma SP levels were measured by liquid chromatography coupled to tandem mass spectrometry. Parasite prevalence was similar between the two study sites but decreased significantly between the first ANC (9% or 43%) and delivery (4% or 11%) based on the qPCR target. At delivery, 64.5% of women received ≥3 IPTp-SP dose, 15.5% received 2 doses and 6% had 1 dose. Taking ≥3 IPTp-SP doses was associated with an average birth weight increase of more than 0.165 kg. IPTp-SP uptake was associated with plasma SP level at delivery (OR = 32.3, p ≤ 0.005, 95% CI (13.3;78.4) for those that reported ≥3 IPTp-SP doses) while the same trend of improved birth weight was observed with high plasma SP levels. The new IPTp policy is well implemented and well utilised by women in the sites considered in this study and translates to the improved birth weight observed. This study confirms the interest and the clinical benefit expected from this policy change.

Highlights

Www.nature.com/scientificreports and prevent pregnancy-associated malaria (PAM) in sub-Sahara Africa
Despite the recommendation and implementation of IPTp-SP in some countries in tropical Africa some decades ago, pregnant women are still affected by malaria disease and its effect on their neonates
This is partly due to the low utilisation of the IPTp policy irrespective of high coverage of antenatal care (ANC) visits[5,19]

Summary

Introduction

Www.nature.com/scientificreports and prevent pregnancy-associated malaria (PAM) in sub-Sahara Africa. Despite the several established advantages of IPTp-SP, even across regions with a wide range of SP-resistant parasites[6,7,8,9,10,11], uptake of the service by pregnant women was still low compared to ANC visits[6,12,13]. This persistently low coverage in part resulted in a call to action by WHO and its partners, intended to increase coverage to meet the 2010 target of 80% IPTp-SP coverage[14,15]. Like most malaria-endemic countries in Africa, Ghana adopted and implemented this revised policy, and this has presented an opportunity for a preliminary assessment of the coverage achieved by the new policy and its impact on maternal and neonatal birth outcomes

Methods

Results

Conclusion