Intermittent Preventive Treatment Research Articles

Spatial distribution and determinants of intermittent preventive treatment for malaria during pregnancy: a secondary data analysis of the 2019 Ghana malaria indicators survey

BackgroundMalaria during pregnancy is associated with poor maternal, foetal, and neonatal outcomes. To prevent malaria infection during pregnancy, the World Health Organization recommended the use of intermittent preventive therapy with sulfadoxine-pyrimethamine (IPTp-SP) in addition to vector control strategies. Although Ghana’s target is to ensure that all pregnant women receive at least three (optimal) doses of SP, the uptake of SP has remained low; between 2020 and 2022, only 60% of pregnant women received optimal SP during their most recent pregnancy. This study sought to map the geospatial distribution and identify factors associated with SP uptake during pregnancy in Ghana.MethodsSecondary data analysis was conducted using the 2019 Ghana Malaria Indicator Survey dataset. The data analysed were restricted to women aged 15–49 years who reported having a live birth within the two years preceding the survey. A modified Poisson regression model was used to determine factors associated with SP uptake during pregnancy. Geospatial analysis was employed to map the spatial distribution of optimal SP uptake across the ten regions of Ghana using R software.ResultsThe likelihood that pregnant women received optimal SP correlated with early initiation of first antenatal care (ANC), number of ANC contacts, woman’s age, region of residence, and family size. Overall, the greater the number of ANC contacts, the more likely for pregnant women to receive optimal SP. Women with four or more ANC contacts were 2 times (aPR: 2.16; 95% CI: [1.34–3.25]) more likely to receive optimal SP than pregnant women with fewer than four ANC contacts. In addition, early initiation and a high number of ANC contacts were associated with a high number of times a pregnant woman received SP. Regarding spatial distribution, a high uptake of optimal SP was significantly observed in the Upper East and Upper West Regions, whereas the lowest was observed in the Eastern Region of Ghana.ConclusionsIn Ghana, there were regional disparities in the uptake of SP during pregnancy, with the uptake mainly correlated with the provision of ANC services. To achieve the country’s target for malaria control during pregnancy, there is a need to strengthen intermittent preventive treatment for malaria during pregnancy by prioritizing comprehensive ANC services.

Predictors of placental malaria in HIV-positive and HIV- negative pregnant women in Enugu, South-Eastern Nigeria

Background: Placental malaria has long been recognized as a complication of malaria in pregnancy with serious adverse outcome. Recognition of possible predictors is an effort in the right direction. Aim of the study: The study determined and compared the Predictors of placental malaria in HIV-positive and HIV- negative pregnant women attending antenatal clinics in Poly General Hospital, South-Eastern Nigeria. Material and method: A cross-sectional descriptive study, carried out on 200 HIV positive and 200 HIV negative pregnant women attending antenatal clinics in Poly General Hospital, Enugu, selected using simple random sampling technique between May to December 2023. Placenta blood samples were collected and thick blood films were examined for malaria parasite using Giemsa expert microscopy. A structured self-administered questionnaire was used for data collection and the data analysed using SPSS version 23. Results: The prevalence of malaria in HIV positive and negative pregnant women were 83.5% (167/200) and 75.5%(151/200) respectively (P < 0.001). The HIV positive and HIV negative participants were between 16-45 years of age with majority in the age range of 31-35 years. Mean gestational age of HIV positive and HIV negative participants were 24.3±1.1 and 24.4±1.3 weeks respectively. Placental malaria was significantly associated with rural residence, hemoglobin genotype AA, not receiving intermittent preventive treatment in pregnancy (IPTp), and not sleeping under insecticide-treated bed nets (ITN) ((P<0.001)). Conclusion: The study showed that Placental malaria was significantly associated with rural residence, hemoglobin genotype AA, not receiving intermittent preventive treatment in pregnancy (IPTp), and not sleeping under insecticide-treated bed nets (ITN). Recognition of these significant predictors will enhance review and implementation of strategies for the prevention of malaria in pregnancy.

Level of and factors associated with optimal uptake of intermittent preventive treatment for malaria in pregnancy at private-not-for-profit health facilities in Kasese district.

Malaria in pregnancy poses a high risk of poor maternal and neonatal outcomes and WHO recommends IPTp. However, its uptake has remained sub-optimal among mothers who attend antenatal care at private-not-for-profit health facilities. This study determined the level of and factors associated with uptake Intermittent preventive treatment of malaria for pregnant women (IPTp) at private-not-for-profit (PNFP) health facilities in Kasese District, Uganda. This was a cross-sectional study involving 396 postpartum mothers in the postnatal wards of 8 PNFP health facilities in Kasese district was conducted in September 2022. One hospital and 2 Health Centre IVs were purposively selected and 5 Health Centre IIIs selected randomly. Mothers were consecutively selected and interviewer administered semi-structured questionnaires were used to collect the data. Data were entered in epi-data version 3.1, cleaned and analyzed using STATA version 14. Data were adjusted for clustering & modified poison regression was used to determine associations of the factors and the outcome. From the analysis, level of optimal uptake of IPTp was 51.5% CI = (46.6-56.4). Being married (aPR = 1.35, 95% CI = 1.06-1.7, p = 0.014), attending ANC more than 4 Visits (aPR = 1.29, 95%CI = 1.09-1.54, p<0.001) positively influence optimal uptake while not taking IPTp at recommended time intervals (aPR = 0.49, 95%CI = 0.39-0.62 p<0.001) and mothers paying for IPTp drugs themselves (aPR = 0.74, 95%CI = 0.57-0.97, p = 0.031) negatively influence optimal uptake. This moderate uptake of IPTp among pregnant mothers suggests insufficient protection of pregnant mothers against malaria. Efforts to improve Antenatal care attendance, taking IPTp at recommended time intervals, not paying for ITPp drugs and encouraging marriages should be intensified.

Sustained clinical benefit of malaria chemoprevention with sulfadoxine-pyrimethamine (SP) in pregnant women in a region with high SP resistance markers

The effectiveness of intermittent preventive treatment of malaria in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) is threatened by increasing SP-resistance in Africa. We assessed the level of SP-resistance markers, and the clinical and parasitological effectiveness of IPTp-SP in southern Mozambique. P. falciparum infection, antimalarial antibodies and dhfr/dhps SP-resistance mutants were detected by quantitative polymerase chain reaction (qPCR), suspension array technology and targeted deep sequencing, respectively, among 4016 HIV-negative women in Maputo province (2016-2019). Univariate and multivariate regression models were used to assess the association between taking the recommended three or more IPTp-SP doses (IPTp3+) and parasitological and clinical outcomes. 84.3% (3385/4016) women received three or more IPTp-SP doses. The prevalence of quintuple mutants at first antenatal care (ANC) visit was 94.2%. IPTp3+ was associated with a higher clearance rate of qPCR-detected infections from first ANC visit to delivery (adjusted odds ratio [aOR]=5.9, 95% CI: 1.5-33.3; p=0.012), lower seroprevalence at delivery of antibodies against the pregnancy-specific antigen VAR2CSADBL34 (aOR=0.72, 95% CI: 0.54-0.95; p=0.022), and lower prevalence of low birth weight deliveries (aOR: 0.61, 95% CI: 0.41-0.90; p=0.013). A sustained parasitological effect of IPTp-SP contributes to the clinical effectiveness of IPTp3+ in areas with high prevalence of SP-resistance markers.

Factors associated with the uptake of intermittent preventive treatment for malaria during pregnancy in Cameroon: An analysis of data from the 2018 Cameroon Demographic and Health Survey.

Malaria in pregnancy is a major public health concern that contributes to a significant increase in maternal and child mortality and morbidity. Intermittent preventive treatment of malaria during pregnancy using sulfadoxine-pyrimethamine (IPTp-SP) is a key intervention recommended by the World Health Organization (WHO) and implemented in Cameroon to reduce the morbidity associated with malaria during pregnancy. This study aimed to assess the distribution of the poor uptake of IPTp-SP (i.e. fewer than three doses) in Cameroon and the factors associated. We conducted a secondary analysis of data extracted from the 2018 Cameroon Demographic and Health Survey. Data was collected using a face-to-face questionnaire administered to mothers with at least one child under the age of five. The participants were selected using a two-stage stratified sampling process. We estimated the frequencies of mothers receiving fewer than three doses of IPTp-SP. Multilevel logistic regression modeling was used to assess the associations between key suspected determinants and uptake of fewer than three doses of IPTp-SP. Crude and adjusted Odds-Ratio (ORs) were estimated. A total of 13,527 women of childbearing age were interviewed, of whom 5,528 (40.9%) met our selection criteria. Among them, 845 (15.3%) women had no antenatal consultation (ANC) visit, 1,109 (20%) had 1-3 visits, 3,379 (61.1%) had 4-7 visits, and only 195 (3.5%) had at least eight visits. Moreover, 3,398 (61.5%, CI: 60.2-62.8) had received fewer than three doses of IPTp-SP. Our findings show that the predictors of poor uptake of IPTp-SP include attending the first ANC visit after the third month of pregnancy (aOR = 1.52, CI: 1.30-1.77), attending fewer than four ANC visits (aOR = 1.29, CI: 1.06-1.56), and not being attended to by a healthcare professional during the prenatal period (aOR = 4.63, CI: 2.81-7.64). Residing in the Sahelian regions was not increasing the risk of poor IPTp-SP uptake on its own but was positively modifying the effect of not being attended by a healthcare professional (p < 0.001). We did not find a significant association between a higher level of education and the uptake of IPTp-SP (aOR = 1.10, CI: 0.90-1.32). Nearly two third of the pregnant women in Cameroon have a poor uptake of IPTp-SP. Interventions focused on ANC provision ought to be explored and tested to address this gap, with priority assigned to the Sahelian region.

Experiences of young mothers with the uptake of Sulfadoxine-Pyrimethamine for intermittent preventive treatment of malaria in pregnancy: a cross-sectional study in the Lake endemic region, Kenya.

A substantial proportion of the world population is affected by malaria with 241 million malaria cases reported globally. Intermittent Preventive Treatment in pregnancy (IPTp) with Sulfadoxine-Pyrimethamine (SP) is an effective chemotherapy but its utilisation has not been optimised. Few studies focus on young mothers and their experiences regarding the optimal uptake of IPTp-SP. The study design was cross-sectional with data derived from six focus group discussions with mothers aged 15-24 years who had a pregnancy and gave birth to a live baby within the last two years in Kisumu and Migori counties, Kenya. Inductive analysis was used to identify themes and patterns. Young mothers were motivated to take IPTp-SP during pregnancy if they had prior knowledge about SP and its associated benefits and if they were knowledgeable about the consequences of malaria infection during pregnancy. Perceived side effects of SP, lack of awareness of SP as a malaria prevention therapy, lack of knowledge on the benefits of SP, dosage and frequency of uptake, poor communication by health providers towards young mothers, and inconsistent supply of SP at health facilities inhibited young mothers from attaining the recommended 3+ doses of IPTp-SP. There is a need for health literacy programmes that focus on increasing knowledge of IPTp-SP dosage, timing and benefits for both the young pregnant mother and her foetus. Community engagement through dialogue with mentor mothers and male partners will be an important complementary approach in establishing a support system for young women for positive health outcomes including attaining the recommended 3+ doses of IPTp-SP.

Knowledge, Practices and Attitudes of Traditional Birth Attendants towards Intermittent Preventive Treatment for Malaria Prevention among Pregnant Women within Ondo West Local Government Area of Ondo State, Nigeria

Intermittent preventive treatment (IPT) for malaria among pregnant women is a recommendation of the World Health Organization (WHO) to combat the various adverse outcomes of malaria in pregnant women. This adverse outcomes includes low birth weight, preterm delivery, severe anemia, maternal morbidity and mortality especially among primigravids. Traditional Birth Attendants (TBAs) has emerged as a significant influence in our society, particularly in the realm of maternal care and childbirth. Several economic, religious and socio-cultural factors have contributed to the preference of some pregnant women for the services of TBAs over medical facilities. Therefore, the study was carried out to assess the knowledge, practices and attitudes of traditional birth attendants within Ondo West Local Government area towards IPT for pregnant women reporting to them for care and delivery. The design employed in the study was descriptive cross-sectional survey. Data were collected by means of an adapted semi-structured interviewer administered-questionnaire. The analysis of the data was done using SPSS version 26.0. Demographic parameters were summarized with simple percentages and non-parametric chi-square test was used to determine the different associations of the variables. P values less than 0.05 were considered statistically significant. The findings indicated that most of the TBAs have good knowledge of the malaria vector and factors promoting the transmission of malaria. Majority (mean=82.9%) also demonstrated excellent understanding of the symptoms associated with malaria in pregnancy however, their knowledge on the risk associated with malaria in a pregnant woman remains comparably low (mean=61.1%) thereby affecting significantly their attitudes and practice to intermittent preventive treatment for malaria prevention. This is because 50% of the TBA have not heard about IPT (P=0.01) and therefore do not administer treatment to asymptomatic pregnant women as recommended by WHO (P=0.00) and report of this study shows that majority (57.40%) of them attend to more than 31 pregnant women in a year. There is need for a government-sponsored partnership between formal health workers and TBAs in this study to ensure they are trained, retrained and equipped. The integration of the TBAs into maternal health care will ensure the sustenance of government policy on the free treatment of all pregnant women intermittently for malaria as recommended by WHO.

Enhancing IPTp Program Implementation: Provider Practices, Challenges, and Malaria Prevalence among Pregnant Women in Uganda

Malaria remains a formidable public health threat, particularly in sub-Saharan Africa, where pregnant women face heightened vulnerability. Intermittent Preventive Treatment in pregnancy with Sulfadoxine Pyrimethamine (IPTp-SP) stands as a pivotal strategy in malaria prevention efforts. However, its full potential is hindered by challenges in implementation. This study, conducted at Bushenyi Health Centre IV in Uganda, scrutinized provider practices, challenges encountered, and malaria prevalence among pregnant women attending antenatal care services. Through a descriptive cross-sectional approach involving 151 pregnant mothers and 15 antenatal care providers, analysis revealed noteworthy insights. While a majority of pregnant women received IPTp-SP, adherence to WHO guidelines regarding administration timing and frequency was suboptimal. Notably, over half of the providers reported stockouts of IPTp-SP, leading to significant delays in replenishment and impeding service delivery. Moreover, providers identified a crucial link between women's knowledge and IPTp uptake. The study also uncovered a malaria prevalence of 7.9% among pregnant women. These findings underscore the urgent need to address implementation challenges, particularly in supply chain management and health education, to fortify malaria prevention strategies for pregnant women in Uganda. Keywords: Malaria, Pregnant women, IPTp-SP, Antenatal care, Implementation challenges, Supply chain management, Health education, Uganda.

Monthly Sulfadoxine-Pyrimethamine During Pregnancy Prevents Febrile Respiratory Illnesses: A Secondary Analysis of a Malaria Chemoprevention Trial in Uganda.

Trials evaluating antimalarials for intermittent preventive treatment in pregnancy (IPTp) have shown that dihydroartemisinin-piperaquine (DP) is a more efficacious antimalarial than sulfadoxine-pyrimethamine (SP); however, SP is associated with higher birthweight, suggesting that SP demonstrates "nonmalarial" effects. Chemoprevention of nonmalarial febrile illnesses (NMFIs) was explored as a possible mechanism. In this secondary analysis, we leveraged data from 654 pregnant Ugandan women without HIV infection who participated in a randomized controlled trial comparing monthly IPTp-SP with IPTp-DP. Women were enrolled between 12 and 20 gestational weeks and followed through delivery. NMFIs were measured by active and passive surveillance and defined by the absence of malaria parasitemia. We quantified associations among IPTp regimens, incident NMFIs, antibiotic prescriptions, and birthweight. Mean "birthweight for gestational age" Z scores were 0.189 points (95% CI, .045-.333) higher in women randomized to IPTp-SP vs IPTp-DP. Women randomized to IPTp-SP had fewer incident NMFIs (incidence rate ratio, 0.74; 95% CI, .58-.95), mainly respiratory NMFIs (incidence rate ratio, 0.69; 95% CI, .48-1.00), vs IPTp-DP. Counterintuitively, respiratory NMFI incidence was positively correlated with birthweight in multigravidae. In total 75% of respiratory NMFIs were treated with antibiotics. Although overall antibiotic prescriptions were similar between arms, for each antibiotic prescribed, "birthweight for gestational age" Z scores increased by 0.038 points (95% CI, .001-.074). Monthly IPTp-SP was associated with reduced respiratory NMFI incidence, revealing a potential nonmalarial mechanism of SP and supporting current World Health Organization recommendations for IPTp-SP, even in areas with high-grade SP resistance. While maternal respiratory NMFIs are known risk factors of lower birthweight, most women in our study were presumptively treated with antibiotics, masking the potential benefit of SP on birthweight mediated through preventing respiratory NMFIs.

Epidemiology and risk factors of malaria among pregnant women attending antenatal clinics in Osun State, Nigeria

Globally, malaria in pregnancy leads to severe complications such as abortion, stillbirth, premature delivery, low birth weight, and fetal underdevelopment. This study examined the prevalence and risk factors of malaria among pregnant women attending antenatal care in Osun State, Nigeria. Between July and December 2020, 555 pregnant women from ten primary health centres in Osogbo, Ejigbo and Ilobu Local Government Areas participated in the study. Employing pre-tested questionnaires, qualitative data on the demographic and risk behaviours of participants were obtained. Malaria prevalence, determined by rapid diagnostic tests and blood smear microscopy was 15% caused by Plasmodium falciparum. The highest malaria prevalence was found among women who didn't use insecticides (23.1%), followed by those who did not use insecticide-treated nets (16.5%). The lowest prevalence was among women in their second and third trimesters who had taken Intermittent Preventive Treatment (IPT) (6.3%). The highest prevalence occurred among women aged 17-24 years (17.4%), while the lowest was among women aged 25-34 years (12.9%). All participants were aware of malaria but their knowledge about transmission (67%), symptoms (64%) and prevention (44%) varied. The study highlights the vulnerability of pregnant women who do not use insecticide-treated nets and emphasizes the need for improved malaria preventive practices. Control efforts should focus on the distribution of insecticide-treated nets, health education during antenatal visits and increased usage of IPT as recommended by the World Health Organization.

Malaria Parasitaemia, Risk Perception, and Preventive Practices Among Women Attending Ante-Natal Clinics in Ogun State

Malaria contributes over 10% of all deaths among pregnant women. The prevalence of malaria in pregnancy in Nigeria particularly in Ogun State is high. The coverage and uptake of Intermittent Preventive Treatment with Sulphodoxine Pyrimethamine (IPT-SP) and Long-Lasting Insecticidal Nets (LLINs) in Southwest Nigeria is still very low despite their proven cost effectiveness in improving maternal and infant health. This study therefore determined the malaria parasitaemia, risk perception, preventive practices and associated factors among women attending Ante-natal Clinics (ANCs) in Ogun state. A cross-sectional study was carried out using mixed methods. An estimated sample size of 426 was computed and selected from ANCs across the state through multistage sampling technique. Pre-tested semi-structured interviewer administered questionnaire was used to collect information. Also, focused group discussions (FGDs) were conducted among women attending ANC and blood samples were taken from asymptomatic women for laboratory analysis to determine prevalence of malaria parasitaemia. Measures of association between the dependent and independent variables were tested using Chi-square. All tests of significance were done based on a ɑ-level of 0.05. Response rate was 100% for this study. The mean age of respondents was 27.9 ±5.5 years. Risk perception of malaria was observed to be good. Malaria parasitaemia was 2.7% and was 100% due to &amp;lt;i&amp;gt;Plasmodium falciparum&amp;lt;/i&amp;gt;. Maternal age was significantly associated with malaria parasitaemia. Therefore, it is recommended that malaria elimination programmes should be sustained; access and affordability of ANC care should be ensured by the Government.

Use of Supervision Data to Improve Quality of Care for Malaria in Pregnancy: Experience in Six African Countries.

Malaria in pregnancy (MiP) intervention coverage, especially intermittent preventive treatment in pregnancy (IPTp), lags behind other global malaria indicators. In 2020, across Africa, only 32% of eligible pregnant women received at least three IPTp doses, despite high antenatal care attendance. We conducted a secondary analysis of data collected during Outreach Training and Supportive Supervision visits from 2019 to 2020 to assess quality of care and explore factors contributing to providers' competence in providing IPTp, insecticide-treated nets, malaria case management, and respectful maternity care. Data were collected during observations of provider-patient interactions in six countries (Cameroon, Cote d'Ivoire, Ghana, Kenya, Mali, and Niger). Competency scores (i.e., composite scores of supervisory checklist observations) were calculated across three domains: MiP prevention, MiP treatment, and respectful maternity care. Scores are used to understand drivers of competency, rather than to assess individual health worker performance. Country-specific multilinear regressions were used to assess how competency score was influenced by commodity availability, training, provider gender and cadre, job aid availability, and facility type. Average competency scores varied across countries: prevention (44-90%), treatment (78-90%), and respectful maternity care (53-93%). The relative association of each factor with competency score varied. Commodity availability, training, and access to job aids correlated positively with competency in multiple countries. To improve MiP service quality, equitable access to training opportunities for different cadres, targeted training, and access to job aids and guidelines should be available for providers. Collection and analysis of routine supervision data can support tailored actions to improve quality MiP services.

Understanding Antenatal Care Service Quality for Malaria in Pregnancy through Supportive Supervision Data in Tanzania.

Malaria in pregnancy (MiP) is associated with maternal anemia, spontaneous abortion, and infant and maternal death. In Tanzania, MiP service data are collected through routine Malaria Services and Data Quality Improvement (MSDQI) supportive supervision rounds at antenatal care (ANC) facilities. Using structured assessment tools, the U.S. President's Malaria Initiative Impact Malaria Project reviewed two annual rounds of MSDQI data (492 facilities in 2021 and 522 facilities in 2022), including ANC records and client satisfaction interviews. We assessed coverage of key MiP care components, used logistic regression to analyze uptake of the recommended three or more doses of intermittent preventive treatment in pregnancy (IPTp3+), and assessed client satisfaction. Coverage of most MiP care components exceeded 80%; however, only 38% of women received all components. Odds of receiving IPTp3+ were much lower among late ANC initiators than among those who initiated ANC during their first trimester (odds ratio [OR], 0.46; 95% CI, 0.38-0.57). Uptake of IPTp3+ increased almost exponentially by number of ANC visits. Women with seven visits were 30 times more likely than those with three visits to receive IPTp3+ (OR, 30.71; 95% CI, 11.33-83.22). Just 54% of clients had anemia screening and only 46% received IPTp3+. Client satisfaction with services and provider communication was high (98% and 97%, respectively); only 8% of client visits exceeded 3 hours. Increased ANC visits could boost IPTp3+ coverage. Routine MSDQI supportive supervision data are useful to assess quality of care, identify service delivery gaps, and guide policies to improve quality of MiP services.

AB008. The impact of readiness of malaria services on uptake of intermittent preventive treatment in pregnancy provided during antenatal care visits

AB008. The impact of readiness of malaria services on uptake of intermittent preventive treatment in pregnancy provided during antenatal care visits

Assessment of Implementation of Malaria Control Strategies among Pregnant Mothers Attending Antenatal Care at Bumanya Health Centre IV in Kaliro District

Although a high proportion of pregnant women had an antenatal care (ANC) visit at least once during pregnancy, the coverage level of intermittent preventive treatment of malaria in pregnancy (IPTp-SP) and insecticide-treated bednets (ITNs) remains low in Sub-Saharan Africa. A hospital-based descriptive cross-sectional study was carried out. The outcome of the survey revealed that the majority of participants, 79%, were above 20 years old, with a mean (+/-SD) age of 25.6 (+/-SD) years. The survey also revealed that 62.67% of the participants knew about IPTp; the biggest number of participants (86.67%) reported utilizing IPTp during their current pregnancy, while 13.33% did not take IPTp. Occupation, gestational age, several ANC visits, and information about IPTp were significantly associated with IPTp uptake. The current study explored malaria IPTp uptake among pregnant women attending ANC at Bumanya HCIV. It established that an increased number of ANC visits, providing IPTp information to pregnant women, and the gestational age of pregnancy resulted in increased uptake of IPTp and thus reduced incidences of malaria cases. Keywords: Pregnancy, Women, ANC, IPTp, Malaria, Gestational age.

Increased Uptake of Intermittent Preventive Treatment for Prevention of Malaria in Pregnancy and Scale-Up of Group Antenatal Care in Nasarawa State, Nigeria

Increased Uptake of Intermittent Preventive Treatment for Prevention of Malaria in Pregnancy and Scale-Up of Group Antenatal Care in Nasarawa State, Nigeria

Safety and efficacy of dihydroartemisinin–piperaquine for intermittent preventive treatment of malaria in pregnant women with HIV from Gabon and Mozambique: a randomised, double-blind, placebo-controlled trial

The cornerstone of malaria prevention in pregnancy, intermittent preventive treatment (IPTp) with sulfadoxine-pyrimethamine, is contraindicated in women with HIV who are receiving co-trimoxazole prophylaxis. We assessed whether IPTp with dihydroartemisinin-piperaquine is safe and effective in reducing the risk of malaria infection in women with HIV receiving co-trimoxazole prophylaxis and antiretroviral drugs. For this randomised, double-blind, placebo-controlled clinical trial, women with HIV attending the first antenatal care clinic visit, resident in the study area, and with a gestational age up to 28 weeks were enrolled at five sites in Gabon and Mozambique. Participants were randomly assigned (1:1) to receive either IPTp with dihydroartemisinin-piperaquine at each scheduled antenatal care visit plus daily co-trimoxazole (intervention group) or placebo at each scheduled antenatal care visit plus daily co-trimoxazole (control group). Randomisation was done centrally via block randomisation (block sizes of eight), stratified by country. IPTp was given over 3 days under direct observation by masked study personnel. The number of daily IPTp tablets was based on bodyweight and according to the treatment guidelines set by WHO (target dose of 4 mg/kg per day [range 2-10 mg/kg per day] of dihydroartemisinin and 18 mg/kg per day [range 16-27 mg/kg per day] of piperaquine given once a day for 3 days). At enrolment, all participants received co-trimoxazole (fixed combination drug containing 800 mg trimethoprim and 160 mg sulfamethoxazole) for daily intake. The primary study outcome was prevalence of peripheral parasitaemia detected by microscopy at delivery. The modified intention-to-treat population included all randomly assigned women who had data for the primary outcome. Secondary outcomes included frequency of adverse events, incidence of clinical malaria during pregnancy, and frequency of poor pregnancy outcomes. All study personnel, investigators, outcome assessors, data analysts, and participants were masked to treatment assignment. This study is registered with ClinicalTrials.gov, NCT03671109. From Sept 18, 2019, to Nov 26, 2021, 666 women (mean age 28·5 years [SD 6·4]) were enrolled and randomly assigned to the intervention (n=332) and control (n=334) groups. 294 women in the intervention group and 308 women in the control group had peripheral blood samples taken at delivery and were included in the primary analysis. Peripheral parasitaemia at delivery was detected in one (<1%) of 294 women in the intervention group and none of 308 women in the control group. The incidence of clinical malaria during pregnancy was lower in the intervention group than in the control group (one episode in the intervention group vs six in the control group; relative risk [RR] 0·12, 95% CI 0·03-0·52, p=0·045). In a post-hoc analysis, the composite outcome of overall malaria infection (detected by any diagnostic test during pregnancy or delivery) was lower in the intervention group than in the control group (14 [5%] of 311 women vs 31 [10%] of 320 women; RR 0·48, 95% CI 0·27-0·84, p=0·010). The frequency of serious adverse events and poor pregnancy outcomes (such as miscarriages, stillbirths, premature births, and congenital malformations) did not differ between groups. The most frequently reported drug-related adverse events were gastrointestinal disorder (reported in less than 4% of participants) and headache (reported in less than 2% of participants), with no differences between study groups. In the context of low malaria transmission, the addition of IPTp with dihydroartemisinin-piperaquine to co-trimoxazole prophylaxis in pregnant women with HIV did not reduce peripheral parasitaemia at delivery. However, the intervention was safe and associated with a decreased risk of clinical malaria and overall Plasmodium falciparum infection, so it should be considered as a strategy to protect pregnant women with HIV from malaria. European and Developing Countries Clinical Trials Partnership 2 (EDCTP2) and Medicines for Malaria Venture. For the Portuguese and French translations of the abstract see Supplementary Materials section.

Prevalence of Malaria among Pregnant Women Attending Muhammad Abdullahi Wase Teaching Hospital Kano State, Nigeria

Malaria in pregnant women remains a major public health problem especially in sub-Saharan Africa. Approximately twenty five million pregnant women in sub-Saharan Africa live at risk of malaria. The study was carried out between July and August 2021, to determine the prevalence of malaria parasite among pregnant women attending Mohammad Abdullahi Wase Teaching Hospital Kano. Microscopic examinations of both thick and thin smears were made using Giemsa Stained solution. Out of one hundred and forty blood samples examined, 60(42.9%) were positive for plasmodium falciparum parasite infection. Age group 18-22 years recorded the highest prevalence rate of (17.90%) and the difference between the age group of the pregnant women was statistically significant (P&lt;0.05) .Primigravida women recorded highest infection rate (23.60%). However, those in first trimester recorded the highest prevalence of (25%) followed by those in the second trimester (13.57%). These results show that pregnant women are more predisposed to malaria infection as they are immunosuppressed especially at early stage and as a primigravida and as teenage mothers than multigravida and older mothers. The problem of P. falciparum in pregnant women can be prevented by the preventive package of intermittent preventive treatment (IPT) with sulfadoxine pyrimethamine (SP) at 2 doses given to the pregnant women during their antenatal clinical visits. During this study, the prevalence of malaria infection among pregnant women attending Muhammad Abdullahi Wase Teaching Hospital was notably higher. P. falciparum is the most common Plasmodium parasite in this region therefore, more special attention should be directed towards pregnant women who exhibit identified risk factors for malaria infection.

The impact of home-based management of malaria on clinical outcomes in sub-Saharan African populations: a systematic review and meta-analysis

BackgroundMalaria remains a significant cause of morbidity and mortality globally and continues to disproportionately afflict the African population. We aimed to evaluate the effect of home management of malaria intervention on health outcomes.MethodsIn our systematic review and meta-analysis, six databases (Pubmed, Cochrane CENTRAL, EMBASE, CAB s and Global Health, CINAHL Complete, and BIOSIS) were searched for studies of home management of malaria from inception until November 15, 2023. We included before–after studies, observational studies, and randomised controlled trials of home management intervention delivered in community settings. The primary outcomes were malaria mortality and all-cause mortality. The risk of bias in individual observational studies was assessed using the ROBINS-I tool, whilst randomised controlled trials were judged using a revised Cochrane risk of bias tool and cluster-randomised controlled trials were evaluated using an adapted Cochrane risk of bias tool for cluster-randomised trials. We computed risk ratios with accompanying 95% confidence intervals for health-related outcomes reported in the studies and subsequently pooled the results by using a random-effects model (DerSimonian–Laird method).ResultsWe identified 1203 citations through database and hand searches, from which 56 articles from 47 studies encompassing 234,002 participants were included in the systematic review. All studies were conducted in people living in sub-Saharan Africa and were rated to have a low or moderate risk of bias. Pooled analyses showed that mortality rates due to malaria (RR = 0.40, 95% CI = 0.29–0.54, P = 0.00001, I2 = 0%) and all-cause mortality rates (RR = 0.62, 95% CI = 0.53–0.72, P = 0.00001, I2 = 0%) were significantly lower among participants receiving home management intervention compared to the control group. However, in children under 5 years of age, there was no significant difference in mortality rates before and after implementation of home management of malaria. In terms of secondary outcomes, home management of malaria was associated with a reduction in the risk of febrile episodes (RR = 1.27, 95% CI = 1.09–1.47, P = 0.002, I2 = 97%) and higher effective rates of antimalarial treatments (RR = 2.72, 95% CI = 1.90–3.88, P < 0.00001, I2 = 96%) compared to standard care. Home malaria management combined with intermittent preventive treatment showed a significantly lower incidence risk of malaria than home management intervention that exclusively provided treatment to individuals with febrile illness suggestive of malaria. The risks for adverse events were found to be similar for home management intervention using different antimalarial drugs. Cost-effectiveness findings depicted that home malaria management merited special preferential scale-up.ConclusionsHome management of malaria intervention was associated with significant reductions in malaria mortality and all-cause mortality. The intervention could help decrease health and economic burden attributable to malaria. Further clinical studies are warranted to enable more meaningful interpretations with regard to wide-scale implementation of the intervention, settings of differing transmission intensity, and new antimalarial drugs.

Increasing the uptake of Intermittent Preventive Treatment of malaria in pregnancy using Sulfadoxine-Pyrimethamine (IPTp-SP) through seasonal malaria chemoprevention channel delivery: protocol of a multicenter cluster randomized implementation trial in Mali and Burkina Faso

BackgroundThe uptake of Intermittent Preventive Treatment of malaria in pregnancy using Sulfadoxine-Pyrimethamine (IPTp-SP) remains unacceptably low, with more than two-thirds of pregnant women in sub-Saharan Africa still not accessing the three or more doses recommended by the World Health Organisation (WHO). In contrast, the coverage of Seasonal Malaria Chemoprevention (SMC), a more recent strategy recommended by the WHO for malaria prevention in children under five years living in Sahelian countries with seasonal transmission, including Mali and Burkina-Faso, is high (up to 90%). We hypothesized that IPTp-SP delivery to pregnant women through SMC alongside antenatal care (ANC) will increase IPTp-SP coverage, boost ANC attendance, and increase public health impact. This protocol describes the approach to assess acceptability, feasibility, effectiveness, and cost-effectiveness of the integrated strategy.Methods and analysisThis is a multicentre, cluster-randomized, implementation trial of IPTp-SP delivery through ANC + SMC vs ANC alone in 40 health facilities and their catchment populations (20 clusters per arm). The intervention will consist of monthly administration of IPTp-SP through four monthly rounds of SMC during the malaria transmission season (July to October), for two consecutive years. Effectiveness of the strategy to increase coverage of three or more doses of IPTp-SP (IPTp3 +) will be assessed using household surveys and ANC exit interviews. Statistical analysis of IPT3 + and four or more ANC uptake will use a generalized linear mixed model. Feasibility and acceptability will be assessed through in-depth interviews and focus group discussions with health workers, pregnant women, and women with a child < 12 months.DiscussionThis multicentre cluster randomized implementation trial powered to detect a 45% and 22% increase in IPTp-SP3 + uptake in Mali and Burkina-Faso, respectively, will generate evidence on the feasibility, acceptability, effectiveness, and cost-effectiveness of IPTp-SP delivered through the ANC + SMC channel. The intervention is designed to facilitate scalability and translation into policy by leveraging existing resources, while strengthening local capacities in research, health, and community institutions. Findings will inform the local national malaria control policies.Trial registrationRetrospectively registered on August 11th, 2022; registration # PACTR202208844472053.Protocol v4.0 dated September 04, 2023.Trail sponsor: University of Sciences Techniques and Technologies of Bamako (USTTB), Mali.