Abstract
BackgroundIntermittent preventive treatment with sulphadoxine-pyrimethamine (IPTp-SP) is being implemented in most malaria endemic countries as a standard two-doses regimen as it reduces the risk of low birth weight (LBW) and the prevalence of maternal anaemia. Nevertheless, where the risk of infection close to delivery is high because of intense transmission, a third IPTp-SP dose may further reduce the negative effects of malaria on pregnancy outcome.MethodsPregnant women in the 2nd or 3rd trimester were randomized to receive either 2 (SP2) or 3 doses (SP3) of SP. Trained field workers paid home visits to the women for drug administration according to a predefined drug delivery schedule. Women were encouraged to attend their scheduled ANC visits and to deliver at the health facilities where the new-born was weighed. The prevalence of LBW (<2500 g), severe anaemia (Hb < 8 g/dL) and premature birth was analysed using intention-to-treat (ITT) and per-protocol (PP) analysis.ResultsData from 1274 singleton pregnancies were analysed (641 in the SP3 and 633 in the SP2 group). The uptake of the intervention appeared to be low. Though the prevalence of LBW in both intervention groups was similar (adjusted Incident Rate Ratio, AIRR = 0.92, 95%CI: 0.69-1.24) in the ITT analysis, the risk of severe anaemia was significantly lower in the SP3 group compared to the SP2 group (AIRR = 0.38, 95%CI: 0.16 - 0.90). The PP analysis showed a trend of reduced risk of LBW, severe anaemia and premature delivery in the SP3 group, albeit the difference between two and three IPTp-SP did not reach statistical significance.ConclusionThe risk of LBW and severe anaemia tended to be lower in the SP3 group, though this was not statistically significant, probably due to the low uptake of the intervention which reduced the power of the study. Further studies are needed for establishing whether a third SP dose has a real benefit in preventing the negative effects of malaria in pregnancy in settings where transmission is markedly seasonal.
Highlights
Intermittent preventive treatment with sulphadoxine-pyrimethamine (IPTp-SP) is being implemented in most malaria endemic countries as a standard two-doses regimen as it reduces the risk of low birth weight (LBW) and the prevalence of maternal anaemia
Though malaria infection during pregnancy is often asymptomatic where transmission is moderate to high, it increases the risk of maternal anaemia and low-birth-weight (LBW) [2,3,4,5], the greatest risk factor for neonatal mortality and an important contributor to infant mortality [6]
Poor adherence to a weekly schedule and, more importantly, the widespread resistance to CQ [7,8,9], prompted its replacement with the intermittent preventive treatment with sulphadoxinepyrimethamine (IPTp-SP) that can reduce the risk of maternal anaemia, placental malaria and LBW [10,11,12]
Summary
Intermittent preventive treatment with sulphadoxine-pyrimethamine (IPTp-SP) is being implemented in most malaria endemic countries as a standard two-doses regimen as it reduces the risk of low birth weight (LBW) and the prevalence of maternal anaemia. Though malaria infection during pregnancy is often asymptomatic where transmission is moderate to high, it increases the risk of maternal anaemia and low-birth-weight (LBW) (birth weight < 2500 g) [2,3,4,5], the greatest risk factor for neonatal mortality and an important contributor to infant mortality [6] To prevent such adverse events, weekly chemoprophylaxis with chloroquine (CQ) has been used until recently. In settings where HIV prevalence is greater than 10%, a three-dose regimen is recommended [13] The latter may be beneficial where malaria transmission is markedly seasonal as women receiving the second IPTp-SP dose more than one month before delivery can still be re-infected [14]. The two- and three-IPTp-SP doses regimens were evaluated and compared in two peripheral health centres in Burkina Faso and results are reported below
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