Abstract
BackgroundIntermittent preventive treatment during pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) is widely recommended in sub-Saharan Africa to reduce the risk of malaria and improve birth outcomes. However, there are reports that the efficacy of IPTp with SP is waning, especially in parts of Africa where antimalarial resistance to this drug has become widespread.Methodology/Principal FindingsWe conducted a cross-sectional study of 565 HIV-uninfected women giving birth at Tororo District Hospital in southeastern Uganda. The primary objective of the study was to measure associations between use of SP during pregnancy from antenatal records and the risk of adverse outcomes including placental malaria, low birth weight, maternal parasitemia and maternal anemia. The proportion of women who reported taking 0, 1, 2, and 3 doses of SP during pregnancy was 5.7%, 35.8%, 56.6% and 2.0% respectively. Overall, the prevalence of placental malaria was 17.5%, 28.1%, and 66.2% by placental smear, PCR, and histopathology, respectively. In multivariate analyses controlling for potential confounders, ≥2 doses of SP was associated with non-significant trends towards lower odds of placental malaria by placental smear (OR = 0.75, p = 0.25), placental malaria by PCR (OR = 0.93, p = 0.71), placental malaria by histopathology (OR = 0.75, p = 0.16), low birth weight (OR = 0.63, p = 0.11), maternal parasitemia (OR = 0.88, p = 0.60) and maternal anemia (OR = 0.88, p = 0.48). Using a composite outcome, ≥2doses of SP was associated with a significantly lower odds of placental malaria, low birth weight, maternal parasitemia, or maternal anemia (OR = 0.52, p = 0.01).Conclusions/SignificanceIn this area of Uganda with intense malaria transmission, the prevalence of placental malaria by histopathology was high even among women who reported taking at least 2 doses of SP during pregnancy. The reported use of ≥2 doses of SP was not associated with protection against individual birth and maternal outcome measures but did protect against a composite measure of any adverse outcome.
Highlights
Malaria in pregnancy remains a widespread problem in subSaharan Africa, where approximately one in four pregnant women has evidence of infection with Plasmodium falciparum at the time of delivery [1]
Placental malaria is associated with several adverse outcomes including intrauterine growth restriction, preterm delivery, low birth weight (LBW), stillbirth, early neonatal death, and maternal anemia [1]
Receiving $2 doses of SP was not significantly associated with protection against placental malaria, LBW, maternal parasitemia, or maternal anemia, there was significant protection when using a composite including any of these adverse outcomes
Summary
Malaria in pregnancy remains a widespread problem in subSaharan Africa, where approximately one in four pregnant women has evidence of infection with Plasmodium falciparum at the time of delivery [1]. To reduce the burden of malaria and improve birth outcomes, intermittent preventive treatment in pregnancy (IPTp) with the drug sulfadoxine-pyrimethamine (SP) is recommended by the World Health Organization and has been widely adopted as a cornerstone of malaria control in most African countries. Sulfadoxine-pyrimethamine is no longer recommended for treatment of malaria and recent studies have shown poor efficacy when used for the prevention of malaria in pregnant women and infants in Tanzania [9,10] and school aged children in Uganda [11]. Intermittent preventive treatment during pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) is widely recommended in sub-Saharan Africa to reduce the risk of malaria and improve birth outcomes. There are reports that the efficacy of IPTp with SP is waning, especially in parts of Africa where antimalarial resistance to this drug has become widespread
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