Comparative efficacy of uncontrolled and controlled intermittent preventive treatment during pregnancy (IPTp) with combined use of LLTNs in high resistance area to sulfadoxine-pyrimethamine in Côte d’Ivoire

Abstract

IntroductionIn recent years, intermittent preventive treatment for pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) has become policy in much of sub-Saharan Africa. But resistance to SP has been spreading across sub-Saharan Africa and thus the effectiveness of IPTp-SP has been questioned. The present study therefore sought to assess the incidence of placental malaria, low birth weight, and anemia of two IPTp-SP approaches (directly observed treatment scheme versus no directly observed treatment) in Anonkoua-Kouté and Samo, Côte d’Ivoire where the reported prevalence of dfr single mutant 108 was 62% and 52.2%, respectively.MethodsThe study was a longitudinal design involving pregnant women and was conducted in Anonkoua-Kouté, a suburban area, and Samo, a rural area, from January 2008 through March 2009. Women of a pregnancy less than 28 weeks duration were randomized to receive SP (1.5 g/0.075 g SP) in a single intake twice and were followed up monthly until delivery. Doses were administered under supervision in the controlled IPTp group, while SP was given free to women in the uncontrolled IPTp group with a recommendation to take it at home. The primary end point was the proportion of low birth weight infants (body weight < 2500 g) and the secondary end point was the rate of severe anemia and placental malaria detected at delivery.ResultsA total of 420 pregnant women were enrolled (212 and 208, respectively, in the controlled and uncontrolled groups). Delivery outcome was available for 378 women. In the modified intention-to-treat analysis, low birth weight infants were born from 15.5% of women of the uncontrolled IPTp group and from 11.9% of women in the controlled IPTp group (P = 0.31). The per-protocol population analysis showed consistent results. The proportion of women with placental malaria infection, moderate anemia (hemoglobin < 11 g/dL), and severe anemia (hemoglobin < 8 g/dL) at delivery were similar between the two groups (P > 0.05).ConclusionThe study showed that the two approaches were equivalent, suggesting that unsupervised IPTp-SP free of charge should be used in areas where implementation of the directly observed treatment scheme suffers from many constraints.

The efficacy of intermittent preventive therapy in the eradication of peripheral and placental parasitemia in a malaria‐endemic environment, as seen in a tertiary hospital in Abuja, Nigeria

“…2,4,5 Similarly, the effect of the practice on outcome of pregnancy has also not been evaluated. 2,4,5 Similarly, the effect of the practice on outcome of pregnancy has also not been evaluated.…”

“…Although this practice has been adopted in Nigeria, which is a sub-Saharan malaria-endemic country, its efficacy in preventing or eliminating either or both peripheral parasitemia and placental parasitization has not been determined in our locality, even as the practice is being threatened by resistance of the parasite against sulfadoxinepyrimethamine. 2,4,5 Similarly, the effect of the practice on outcome of pregnancy has also not been evaluated. Therefore, the aim of the present study was to determine the efficacy of IPTp in preventing or eliminating peripheral parasitemia and placental parasitization as well as evaluating the impact on outcome of pregnancy.…”