Intermittent preventive treatment with sulfadoxine-pyrimethamine versus weekly chloroquine prophylaxis for malaria in pregnancy in Honiara, Solomon Islands: a randomised trial.

Abstract

Solomon Islands is a malarious nation in the Pacific with all four human Plasmodium species present. Although chloroquine prophylaxis is recommended for pregnant women, its effectiveness is uncertain because of chloroquine resistance. We conducted a parallel-group, open label, individually randomised superiority trial comparing weekly chloroquine prophylaxis (CQ) with intermittent preventive treatment (IPTp) with sulfadoxine-pyrimethamine (SP) between August 2009- June 2010 among pregnant women aged 15 to 49 years. Participants were randomised at the first antenatal visit using a computer-generated sequence and followed until delivery. Data on mosquito avoidance measures, and pregnancy outcomes were collected. Because of the low prevalence of malaria, enrolment was prematurely terminated. Among 660 participants (336 in CQ arm, and 324 in IPTp), 68% used a bednet, 53% used window-screens, and 26% lived in a house sprayed in the last 6 months; 91% used at least one of these methods. Peripheral parasitemia at enrolment was 1.5%. At delivery there were no differences between weekly CQ and IPTp in placental parasitemia (0/259 vs. 1/254) or peripheral parasitemia (2/281 vs. 1/267). There were no differences in maternal anaemia, birth outcomes or serious adverse events. A self-reported sulfa-allergy required non-inclusion for 199 of 771 ineligible women (26%). The use of SP for IPTp is not suitable for prevention of malaria in pregnancy in Solomon Islands, given the low malaria prevalence and the possible high prevalence of sulfa-allergy. Scaling up of transmission-reducing interventions has probably contributed to the malaria reduction in Honiara. NCT00964691 ClinicalTrials.gov.