The risk of malaria in Ghanaian infants born to women managed in pregnancy with intermittent screening and treatment for malaria or intermittent preventive treatment with sulfadoxine/pyrimethamine.

Timothy Awine,Abraham R. Oduro,Brian Greenwood,Sunny Oyakhirome,Mark M. Belko,John E. Williams,Paul Milligan,Daniel Chandramohan,Harry Tagbor,Matthew Cairns

doi:10.1186/s12936-016-1094-z

Abstract

BackgroundSeveral studies have reported an association between malaria infection of the placenta and the risk of malaria in young children in the first year of life, but it is not known if this is causal, or influenced by malaria control measures during pregnancy. This paper compares the incidence of malaria in infants born to mothers who received either intermittent preventive treatment with sulfadoxine/pyrimethamine (IPTp-SP) or screening with a rapid diagnostic test and treatment with artemether–lumefantrine (ISTp-AL) during their pregnancy.MethodsFrom July 2011 to April 2013, 988 infants of women enrolled in a trial of IPTp-SP versus ISTp-AL in the Kassena-Nankana districts of northern Ghana were followed to determine the risk of clinical malaria during early life, and their risk of parasitaemia and anaemia at 6 and 12 months of age. In addition, the incidence of clinical malaria in infants whose mothers had malaria infection of the placenta was compared with that in infants born to women free of placental malaria.ResultsThe incidence of clinical malaria was 0.237 and 0.211 episodes per child year in infants whose mothers had received ISTp-AL or IPTp-SP, respectively. The adjusted incidence rate ratio and the adjusted rate difference were 0.94 (95 % CI 0.68, 1.33) and 0.029 (95 % CI −0.053, 0.110) cases per child year at risk respectively. The incidence of clinical malaria was similar in infants born to women with placental malaria (0.195 episodes per child year) and in infants of women without placental malaria (0.224 episodes per child year) (rate ratio = 0.86 [95 % CI 0.54, 1.37]).ConclusionInfants born to women managed with ISTp-AL during pregnancy were not at greatly increased risk of malaria compared with infants born to women who had received IPTp-SP. The incidence of malaria in infants was similar whether or not their mother had had placental malaria.Electronic supplementary materialThe online version of this article (doi:10.1186/s12936-016-1094-z) contains supplementary material, which is available to authorized users.

Highlights

Several studies have reported an association between malaria infection of the placenta and the risk of malaria in young children in the first year of life, but it is not known if this is causal, or influenced by malaria control measures during pregnancy
Screening of women at routine antenatal clinics with a rapid diagnostic test (RDT) and treatment of those who are positive with an artemisinin-based combination therapy (ACT), an approach termed intermittent screening and treatment (ISTp), is an alternative approach to IPTp-SP that is being evaluated
It is not known if infants whose mothers were managed with ISTp using artemether– lumefantrine (ISTp-AL) during pregnancy might be at increased risk of malaria and co-morbidities during their first year of life compared to infants born to mothers who received IPTp-SP

Summary

Introduction

Several studies have reported an association between malaria infection of the placenta and the risk of malaria in young children in the first year of life, but it is not known if this is causal, or influenced by malaria control measures during pregnancy. This paper compares the incidence of malaria in infants born to mothers who received either intermittent preventive treatment with sulfadoxine/pyrimethamine (IPTp-SP) or screening with a rapid diagnostic test and treatment with artemether–lumefantrine (ISTp-AL) during their pregnancy. A pilot trial of ISTp using artemether– lumefantrine (ISTp-AL) in Ghana [15], and a further trial in four West African countries (Burkina Faso, Ghana, Mali, The Gambia) where Plasmodium falciparum is still sensitive to SP [16], have shown that ISTp-AL is non-inferior to IPTp-SP in preventing low birth weight, maternal anaemia and PM It is not known if infants whose mothers were managed with ISTp-AL during pregnancy might be at increased risk of malaria and co-morbidities during their first year of life compared to infants born to mothers who received IPTp-SP. This study investigated the incidence of malaria, anaemia and co-morbidities in infants born to women in KassenaNankana district, northern Ghana, who participated in a multicentre trial of ISTp-AL versus IPTp-SP

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