Abstract
In most African countries, a good number of pregnant women make multiple antenatal visits providing a major opportunity for the prevention of malaria (associated with febrile illness) in infants through the use of intermittent preventive treatment in pregnancy (IPTp). This study assessed the association between maternal use of IPTp with sulphadoxine and pyrimethamine (SP) and the development of febrile illness in infants. This was a secondary data analysis of the 2013 Nigeria Demographic Health Survey (NDHS) data. Mother-child pairs where the mother was aged 15-49 years and the child was less than one year at the time of the survey were included. Variables such as the use of IPTp-SP and development of febrile illness as well as the socio-demographic and other control variable were analyzed. Chi-square testing and logistic regression were used to determine the association between the use of IPTp-SP and the development of febrile illness. Statistical analysis was done using SPSS version 21 and Statistical significance was set at P<0.05. A total of 6,212 mother-child pairs were analyzed. Chi-square test showed that there was a significant association between the use of IPTp-SP and report of fever in infants. A higher proportion of mothers that used IPTp-SP (15.8%) reported fever in their infants compared with those whose mother did not receive IPTp-SP (11.6%) (P<0.001). Logistic regression showed that mothers that used IPTp-SP were about one and half times more likely to report fever in their infants, before adjustment for confounding variables (OR = 1.46, 95% CI: 1.24 – 1.71, p<0.001). Following adjustment, there was a weaker (though still significant) association between IPTp-SP use and fever in the infants (OR = 1.26, 95% CI: 1.04 – 1.52, p = 0.019). This study found a significant association between the use of IPTp-SP and mothers' report of febrile illness among infants in the two weeks before the survey. This requires further evidence to confirm but highlights the complex relationship between maternal drug exposure and long term susceptibility to illness in offspring.
Highlights
Malaria is a key public health problem both in the tropical and subtropical regions of the world and constitutes a major challenge to development and health, especially in subSaharan Africa, where children and pregnant women are at the greatest risk
While these settings are presented as two distinct epidemiologic conditions, in reality, the intensity of transmission and immunity in pregnant women occurs on a continuum, with potentially different conditions occurring within a country
Malaria which often presents as a febrile illness accounts for about 214 million cases and 438,000 deaths in 2015 and most of the disease burden occurs in Sub-saharan Africa [16]
Summary
Malaria is a key public health problem both in the tropical and subtropical regions of the world and constitutes a major challenge to development and health, especially in subSaharan Africa, where children and pregnant women are at the greatest risk. The symptoms as well as the complications of malaria in pregnancy vary with the acquired immunity state of the pregnant woman and with the intensity of malaria transmission [1]. While these settings are presented as two distinct epidemiologic conditions, in reality, the intensity of transmission and immunity in pregnant women occurs on a continuum, with potentially different conditions occurring within a country. In areas of unstable malaria transmission where adult pregnant women have no immunity, malaria in pregnancy can lead to severe consequences to both mother and fetuses, including death [1]
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