Background Despite decades of prevention efforts, the burden of malaria in pregnancy (MiP) remains a great public health concern. Sulfadoxine-pyrimethamine (SP), used as intermittent preventive treatment in pregnancy (IPTp-SP) is an important component of the malaria prevention strategy implemented in Africa. However, IPTp-SP is under constant threat from parasite resistance, thus requires regular evaluation to inform decision-making bodies. Methods In two malaria endemic communities in the Volta region (Adidome and Battor), a cross-sectional hospital-based study was conducted in pregnant women recruited at their first antenatal care (ANC) visit and at delivery. Basic clinical and demographic information were documented and their antenatal records were reviewed to confirm IPTp-SP adherence. Peripheral and placental blood were assayed for the presence of Plasmodium falciparum parasites by quantitative polymerase chain reaction (qPCR). One hundred and twenty (120) positive samples were genotyped for mutations associated with SP resistance. Results At first ANC visit, P. falciparum prevalence was 28.8% in Adidome and 18.2% in Battor. At delivery, this decreased to 14.2% and 8.2%, respectively. At delivery, 66.2% of the women had taken at least the recommended 3 or more doses of IPTp-SP and there was no difference between the two communities. Taking at least 3 IPTp-SP doses was associated with an average birth weight increase of more than 360 g at both study sites compared to women who did not take treatment (p = 0.003). The Pfdhfr/Pfdhps quintuple mutant IRNI-A/FGKAA was the most prevalent (46.7%) haplotype found and the nonsynonymous Pfdhps mutation at codon A581G was higher at delivery among post-SP treatment isolates (40.6%) compared to those of first ANC (10.22%). There was also an increase in the A581G mutation in isolates from women who took 3 or more IPTp-SP. Conclusions This study confirms a positive impact following the implementation of the new IPTp-SP policy in Ghana in increasing the birth weight of newborns. However, the selection pressure exerted by the recommended 3 or more doses of IPTp-SP results in the emergence of parasites carrying the non-synonymous mutation on codon A581G. This constant selective pressure calls into question the time remaining for the clinical utility of IPTp-SP treatment during pregnancy in Africa.

Background Soil Transmitted helminths and schistosomiasis may have implications for pregnancy outcomes especially, in rural communities. In Adidome (a rural community) and Battor (a semi-rural community), soil and water contact activities expose inhabitants to helminth infections. There is, however, limited information on the prevalence and determinants among pregnant women in these areas. The present study was conducted to access the prevalence, knowledge and perceptions about helminthiasis among pregnant women accessing obstetric care at Adidome Government Hospital and Battor Catholic Hospital in the Volta region of Ghana. Methodology/Principal Findings A cross-sectional survey was conducted by recruiting 1,295 pregnant women out of which only 616 representing 47.5% provided stool samples for analysis. Sociodemographic characteristics and participant knowledge on helminth infection transmission, symptoms and prevention were collected by questionnaire and analyzed using STATA. Preserved stool specimen were processed and examined for helminth eggs by Kato Katz, and genomic DNA extracted from aliquots, was tested for S. mansoni and N. americanus. Prevalence of helminths and participant knowledge were expressed in proportions. Chi-square and Fisher’s exact test were used to show association at P < 0.05 significant level. Intestinal helminth infections found among participants at ANC were T. trichiura (0.4%), N. americanus (0.4%) and S. mansoni (0.4%). At delivery, a PCR prevalence of 5% was observed for S. mansoni. A high proportion of study participants, 82.5% in Adidome and 87.1% in Battor do not take dewormers on regular basis. Also, a high proportion of participants did not receive any dewormer prior to sample collection. Although knowledge on helminth transmission, risks and prevention were low, levels of prevalence of infection with helminths were also low. Conclusion/Significance Intensifying health education as community-based interventions is necessary for the total and effective control and elimination of schistosomiasis and STH in the study area.