Interactions of Ascorbic Acid with Intermittent Preventive Treatment with Sulphadoxine Pyrimethamine in Parturients and their Controls

Abstract

Background: Malaria deaths in the world have remained worrisome for many decades to centuries now. The issue of its prevention pre pregnancy, during pregnancy and post pregnancy periods needs continuous emphasis especially in our endemic areas. This will help us achieve the desired goals of eliminating malaria menace in Sub-Saharan Africa. The benefits of malaria prevention in helping to reduce the problems of malaria in pregnancy though proven needs continuous emphasis. The problems of prolonged maternal malaria illnesses especially if left untreated during pregnancy may include but not limited to preterm labours / births, pregnancy anaemias, small for date babies, high rates of admissions into special care baby units (SCBU) and intrauterine deaths. The above have been greatly reduced by concurrent practice of preventive measures like the now in use, Intermittent Preventive Treatment with Sulphadoxine Pyrimethamine (IPT-SP). It has also been noted that optimal levels of antioxidant status like Ascorbic acid (Vitamin C), Superoxide Dismutase, Glutathione Peroxidase have shown great promises in assisting our pregnant women enjoy uneventful pregnancies as well as avert most other pregnancy associated problems. Top on the list of which are maternal and neonatal anaemias, preterm labours and births, intrauterine growth restrictions (IUGR), increased admissions into special care baby units and even neonatal deaths to mention but a few. Objectives: This study made a comparative assessment of the plasma Ascorbic acid levels in parturients who judiciously received IPT-SP during their current confinements and their controls. Method: We carried out this study at the Federal Medical Centre (FMC) which is located in Owerri, the state capital of Imo state Nigeria. Owerri is noted to have a typical malaria endemic setting as with most parts of our African sub rejoin. Ethical certification was sought for and obtained from the ethics committee of the hospital enabling the commencement of a longitudinal participant recruitment after adequate counseling and informed consent. This involved both groups. The study was a laboratory based, cross-sectional descriptive study that involving 296 participants that satisfied set out inclusion criteria for one of the groups as allotted. Participants were followed up following recruitment throughout their antenatal course till delivery. This enabled a dutiful collection of blood samples for the estimation of Ascorbic acid. Vitamin C estimation was done using the Omaye, Turabull & Sanberlish method, 1979. The methodology principle is based on the fact that Ascorbic acid is oxidized by copper to form dehydroascorbic acid. The product when treated with 2, 4 dinitrophenyl hydrazine forms tris 2, 4 dinitrophenyl hydrazone which undergoes rearrangement to form a product with the absorption maximum at 520 nm in spectrophotometer. Data analysis: Computer Software Package for Social Science (SPSS) version 20.0 (SPSS, Chicago) was used to analyze obtained data. The descriptive statistics (mean, standard deviation, range, percentages etc) were determined for continuous variables, while a P-value less than (<0.05) at 95% confidence interval was considered statistically significant. Result: The mean ascorbic acid value was lower among the study group than the control. Mean ascorbic acid value for the study group was 1.75 ± 0.67 while the minimum and maximum serum ascorbic acid levels were 0.064 and 3.29 respectively. From the control group, the mean ascorbic acid level was 2.03 ± 0.68 while the minimum and maximum serum ascorbic acid levels were 0.056 and 3.75 respectively. From the results above, the mean difference of 0.28 was found to be statistically significant with (p value= 0.001) with an odds ratio of 0.54 (95% CI =0.380 – 0.771).