Abstract
BackgroundThe weekly chemoprophylaxis of malaria during pregnancy with chloroquine (CQ) has become problematic with the increasing resistance of Plasmodium falciparum to this drug. There was a need to test the benefits of new strategies over the classical chemoprophylaxis. This study was conducted to provide data to the National Malarial Control Programme for an evidence-based policy change decision making process. It compares the efficacy of two IPT regimens, using chloroquine (CQ) or sulphadoxine/pyrimethamine (SP), with the classical chemoprophylaxis regimen using CQ in reducing the adverse outcomes of malaria infection, for the mother and the foetus.MethodsPregnant women attending the first antenatal care visit were randomly assigned to one of the three treatment regimens. They were subsequently followed up till delivery. Maternal, placental and cord blood samples were obtained upon delivery to check for P. falciparum infection.ResultsA total of 648 pregnant women were enrolled in the study. Delivery outcome were available for 423 of them. Peripheral maternal P. falciparum infection at delivery was found in 25.8% of the women. The proportion of women with maternal infection was significantly lower in the IPTp/SP group than in the CQ group (P << 0.000). The prevalence of placental malaria was 18.8% in the CWC/CQ group; 15.9% in the IPTp/CQ group and 10.6% in the IPTp/SP group. The incidence of LBW (weigth < 2,500 g) was significantly higher among infants of mothers in the CWC/CQ group (23.9%) as compared with those of mothers in the IPTp/CQ (15.6%) and IPTp/SP (11.6%) groups (p = 0.02)ConclusionIntermittent preventive treatment with SP has shown clear superiority in reducing adverse outcomes at delivery, as compared with intermittent preventive treatment with CQ and classical chemoprophylaxis with CQ.
Highlights
The weekly chemoprophylaxis of malaria during pregnancy with chloroquine (CQ) has become problematic with the increasing resistance of Plasmodium falciparum to this drug
The study has assessed the efficacy of three possible approaches being considered at the time of the study initiation. It compares the efficacy of two intermittent preventive treatment (IPT) regimens with the classical chemoprophylaxis regimen using CQ in reducing the adverse outcomes of malaria infection for the mother and the foetus
The proportion of women with maternal infection was significantly lower in the IPTp/SP group than in the CQ group (P
Summary
The weekly chemoprophylaxis of malaria during pregnancy with chloroquine (CQ) has become problematic with the increasing resistance of Plasmodium falciparum to this drug. This study was conducted to provide data to the National Malarial Control Programme for an evidence-based policy change decision making process It compares the efficacy of two IPT regimens, using chloroquine (CQ) or sulphadoxine/pyrimethamine (SP), with the classical chemoprophylaxis regimen using CQ in reducing the adverse outcomes of malaria infection, for the mother and the foetus. Pregnant women, along with children under five years, represent the most vulnerable group to Plasmodium falciparum infection [1,2] Such infection often increases the risk of morbidity and mortality for the mother and her child. Over 26% of anaemia in pregnancy is attributable to malaria, and malaria-related maternal deaths are reaching an unacceptable rate of 23%[5] These adverse outcomes have been described as the consequences of placental sequestration of P. falciparum. Because of this sequestration, peripheral blood film microscopy usually underestimates the prevalence of placental malaria [6,7]
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