Abstract
Prevention and treatment of malaria during pregnancy is crucial for reduction of malaria in pregnancy and its adverse outcomes. The spread of parasite resistance to Sulphadoxine-Pyrimethamine (SP) used for Intermittent Preventive Treatment for malaria in pregnancy (IPTp), particularly in East Africa has raised concerns about the usefulness and the reliability of the IPTp regimen. We aimed to assess the effectiveness of two doses of SP in treating and preventing occurrence of adverse pregnancy outcomes. The study was an analytical cross sectional study which enrolled 350 pregnant women from Kibiti Health Centre, South Eastern Tanzania. Structured questionnaires were used to obtain previous obstetrics and medical history of participants and verified by reviewing antenatal clinic cards. Maternal placental blood samples for microscopic examination of malaria parasites were collected after delivery. Data was analyzed for associations between SP dosage, risk for PM and pregnancy outcome. Sample size was estimated based on precision. Prevalence of placental maternal (PM) was 8% among pregnant women (95%CI, 4.4-13.1%). Factors associated with increased risk of PM were primigravidity (P<0.001) and history of fever during pregnancy (P= 0.02). Use of at least 2 doses of SP for IPTp during pregnancy was insignificantly associated with reducing the risk PM (P=0.08), low birth weight (P=0.73) and maternal anemia (P=0.71) but associated significantly with reducing the risk of preterm birth (P<0.001). Two doses of SP for IPTp regime are ineffective in preventing and treating PM and adverse pregnancy outcome. Hence a review to the current IPTp regimen should be considered with possibility of integrating it with other malaria control strategies.
Highlights
Despite integrated efforts to control malaria in endemic areas, placental maternal (PM) remains a significant cause of maternal and infant mortality and morbidity
P.falciparum parasites are known to invade the placenta in semi-immune women to cause PM, a condition associated with stillbirth, spontaneous abortion, fetal pre-maturity, and maternal anemia[15], low birth weight (LBW)
It is understood from previous studies that primigravida are at a higher risk of PM because of the absence of previous exposure to P.falciparum and they have not yet developed protective antibodies that block the adhesion of parasitized erythrocytes to chondroitin sulfate A (CSA) in the placental intervillous space to promote clearance of parasites[6,11]
Summary
Despite integrated efforts to control malaria in endemic areas, PM remains a significant cause of maternal and infant mortality and morbidity. P.falciparum parasites are known to invade the placenta in semi-immune women to cause PM, a condition associated with stillbirth, spontaneous abortion, fetal pre-maturity, and maternal anemia[15], low birth weight (LBW). Most of these pregnancy outcomes are important risk factors for neonatal mortality and retarded growth regardless of the factors that affect malaria epidemiology in a given location[5,15,22,23,29]. Risk factors for placental malaria and associated adverse pregnancy outcomes in Rufiji, Tanzania: a hospital based cross sectional study.
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