Effectiveness of intermittent preventive treatment in pregnancy with sulphadoxine-pyrimethamine (IPTp-SP) in Ghana

Dosoo, David; Malm, Kezia; Oppong, Felix Boakye; Gyasi, Richard K.; Oduro, Abraham; Williams, John E.; Atibilla, Dorcas; Peprah, Nana Yaw; Twumasi, Mieks; Owusu‐Agyei, Seth; Greenwood, Brian; Chandramohan, Daniel; Asante, Kwaku Poku

doi:10.1136/bmjgh-2021-005877

Cited by 16 publications

(15 citation statements)

References 28 publications

(31 reference statements)

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“…Our results are in line with other studies that have shown a positive impact of monthly SP on maternal malaria during pregnancy compared with the two-dose SP regimen. 11 , 23 , 24 We have not found studies that looked at the impact of monthly SP during the second and third trimesters separately, but there is no biological reason to believe the results would differ from our findings. Although azithromycin has some antimalarial activity, 25 previous results about the impact of azithromycin on malaria are mixed, with some studies indicating a reduction in malaria 26 – 28 and some studies suggesting no impact.…”

Section: Discussioncontrasting

confidence: 80%

The Impact of Antenatal Azithromycin and Monthly Sulfadoxine-Pyrimethamine on Maternal Malaria during Pregnancy and Fetal Growth: A Randomized Controlled Trial

Hallamaa

Ashorn

Cheung

et al. 2023

The American Journal of Tropical Medicine and Hygiene

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Maternal malaria and infections during pregnancy are risk factors for fetal growth restriction. We assessed the impact of preventive treatment in pregnancy on maternal malaria and fetal growth. Between 2003 and 2006, we enrolled 1,320 pregnant Malawian women, 14–26 gestation weeks, in a randomized trial and treated them with two doses of sulfadoxine-pyrimethamine (SP, control) at enrollment and between 28–34 gestation weeks; with monthly SP from enrollment until 37 gestation weeks; or with monthly SP and azithromycin twice, at enrollment and between 28 and 34 gestation weeks (AZI-SP). Participants were seen at 4-week intervals until 36 completed gestation weeks and weekly thereafter. At each visit, we collected dried blood spots for real-time polymerase chain reaction diagnosing of malaria parasitemia and, in a random subgroup of 341 women, we measured fetal biparietal diameter and femur length with ultrasound. For the monthly SP versus the control group, the odds ratios (OR) (95% CI) of malaria parasitemia during the second, third, and both trimesters combined were 0.79 (0.46–1.37), 0.58 (0.37–0.92), and 0.64 (0.42–0.98), respectively. The corresponding ORs for the AZI-SP versus control group were 0.47 (0.26–0.84), 0.51 (0.32–0.81), and 0.50 (0.32–0.76), respectively. Differences between the AZI-SP and the monthly SP groups were not statistically significant. The interventions did not affect fetal biparietal diameter and femur length growth velocity. The results suggest that preventive maternal treatment with monthly SP reduced malaria parasitemia during pregnancy in Malawi and that the addition of azithromycin did not provide much additional antimalarial effect.

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Section: Discussioncontrasting

confidence: 80%

The Impact of Antenatal Azithromycin and Monthly Sulfadoxine-Pyrimethamine on Maternal Malaria during Pregnancy and Fetal Growth: A Randomized Controlled Trial

Hallamaa

Ashorn

Cheung

et al. 2023

The American Journal of Tropical Medicine and Hygiene

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“…This difference can be due to the low distribution of mosquito nets to pregnant women during Antenatal Consultation and the absence of mosquito net distribution campaigns. These results are higher than the 35.5% obtained by Dosoo DK, et al [29] 2021 in Ghana.…”

Section: Association Between Anemia and Characteristics Of The Study ...contrasting

confidence: 59%

Effects of Intermittent Preventive Treatment (IPT) of Malaria on the Birth Weight of Babies at Delivery in Dschang, West Region of Cameroon

Lynda¹,

M²,

Romeo³

et al. 2023

Int J Trop Dis

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Background: Malaria is an important public health concern among pregnant women, approximately 32 million of them are at risk annually. According to the World Health Organization (WHO), malaria represents annually more than 10.000 maternal deaths and 200.000 neonatal deaths too. Intermittent Preventive Treatment (IPT) is used to reduce disease in pregnancy and their effects on the newborn. Today the WHO recommends that at least three doses of IPT should be taken by pregnant women during Antenatal Care Visit (ANC), this should be taken every month from the sixteenth week of pregnancy till parturition. This study aimed to assess the effect of IPT on the birth weight of the babies of mothers delivering in Dschang District Hospital. Methodology:The study was conducted at the maternity unit of Dschang District Hospital located in Dschang (west region of Cameroon). In order to achieve this, a total of 380 participants, constituted essentially of women coming for delivery in the hospital were necessary. Data on the number of ANC, total dose of IPT taken have been taken from their health books. Moreover, information on socio demographic characteristics and obstetrics history of each participant were also recorded through an interview. Furthermore, blood was collected from the maternal side of placenta into EDTA tubes for assessment of maternal anemia. After all these, birth outcomes were then recorded. Results:At the end of this study we found that 98.7% of participant had made at least one ANC while 65% of them had taken at least three doses of IPT. The uptakes of IPT vary according to the number of ANC (P < 0.05). Furthermore, it appeared that 13.9% of new born had low birth weight, although the prevalence of malaria during pregnancy was (25.3%) and maternal anemia (24.5%) were important. majority of pregnant women were those aged between 24-34 years-old (59.2%) and having secondary level of education (58.8%). Conclusion:Although the majority of women took more than 3 doses of IPT, after delivery the prevalence of anemia and Low birth weight was 24 and 13 percent. Otherwise, studies are needed to assess the real efficacy of IPT in preventing malaria during pregnancy and the causes of maternal anemia.

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“…This reduction in infection numbers itself (i.e. about 20% prevalence of parasitaemia prior to commencement of IPTp-SP [28] against about 3% prevalence at delivery [30] in the study area) suggests the effectiveness of IPTp-SP in clearing P. falciparum infections during pregnancy. Also, DNA could not be amplified in a substantial number of DBS, possibly due to DNA degradation.…”

Section: Plos Onementioning

confidence: 81%

“…This study was part of a trial that evaluated the effectiveness of four or more doses of IPTp-SP in the middle belt of Ghana. Dried blood spot (DBS) samples from a cohort of pregnant women were collected at their first antenatal care (ANC) clinic visit (prior to administration of IPTp-SP) [28] and at delivery [30] to determine the prevalence of molecular markers of resistance to SP.…”

Section: Study Area Participants and Sample Collectionmentioning

confidence: 99%

The prevalence of molecular markers of resistance to sulfadoxine-pyrimethamine among pregnant women at first antenatal clinic attendance and delivery in the forest-savannah area of Ghana

et al. 2022

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Intermittent preventive treatment during pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) is used to prevent malaria and associated unfavorable maternal and foetal outcomes in pregnancy in moderate to high malaria transmission areas. Effectiveness of IPTp-SP is, however, threatened by mutations in the Plasmodium falciparum dihydrofolate reductase (Pfdhfr) and dihydropteroate synthase (Pfdhps) genes which confer resistance to pyrimethamine and sulfadoxine, respectively. This study determined the prevalence of molecular markers of SP resistance among pregnant women in a high malaria transmission area in the forest-savannah area of Ghana. Genomic DNA was extracted from 286 P. falciparum-positive dried blood spots obtained from pregnant women aged ≥18 years (255 at first Antenatal Care (ANC) clinic visit and 31 at delivery from 2017 to 2019) using Chelex 100. Mutations in Pfdhfr and Pfdhps genes were detected using molecular inversion probes and next generation sequencing. In the Pfdhfr gene, single nucleotide polymorphisms (SNPs) were detected in 83.1% (157/189), 92.0% (173/188) and 91.0% (171/188) at codons 51, 59, and 108 respectively in samples collected at first ANC visit, while SNPs were detected in 96.6 (28/29), 96.6% (28/29) and 96.8% (30/31) in isolates collected at delivery. The Pfdhfr triple mutant N51I, C59R and S108N (IRN) was carried by 80.5% (128/159) and 96.5% (28/29) of the typed isolates collected at ANC visit and at delivery respectively. In the Pfdhps gene, SNPs were detected in 0.6% (1/174), 76.2% (138/181), 33.2% (60/181), 1.2% (2/174), 0% (0/183), and 16.6% (27/173) at codons 431, 436, 437, 540, 581 and 613 respectively in samples collected at ANC, and 0% (0/25), 72% (18/25), 40% (10/25), 3.6% (1/25), 0% (0/29) and 7.4% (2/27) in samples collected at delivery. Quadruple mutant Pfdhfr N51I, C59R, and S108N + Pfdhps A437G (IRN-GK) was present in 25.8% (33/128) and 34.8% (8/23) of isolates at ANC and at delivery respectively. Quintuple mutant alleles Pfdhfr N51I, C59R, and S108N + Pfdhps A437G and K540E (IRN-GE) were detected in 0.8% (1/128) and 4.4% (1/23) of samples collected at ANC and at delivery respectively. No mutations were identified at Pfdhfr codons 16 or 164 or Pfdhps 581. There is a high prevalence of Pfdhfr triple mutant P. falciparum infections among pregnant women in the study area. However, prevalence of the combined Pfdhfr/Pfdhps quadruple and quintuple mutants IRN-GK and IRN-GE respectively prior to commencement of IPTp-SP were low, and no Pfdhps A581G mutant was detected, indicating that SP is still likely to be efficacious for IPTp-SP in the forest-savannah area in the middle belt of Ghana.

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Effectiveness of intermittent preventive treatment in pregnancy with sulphadoxine-pyrimethamine (IPTp-SP) in Ghana

Cited by 16 publications

References 28 publications

The Impact of Antenatal Azithromycin and Monthly Sulfadoxine-Pyrimethamine on Maternal Malaria during Pregnancy and Fetal Growth: A Randomized Controlled Trial

The Impact of Antenatal Azithromycin and Monthly Sulfadoxine-Pyrimethamine on Maternal Malaria during Pregnancy and Fetal Growth: A Randomized Controlled Trial

Effects of Intermittent Preventive Treatment (IPT) of Malaria on the Birth Weight of Babies at Delivery in Dschang, West Region of Cameroon

The prevalence of molecular markers of resistance to sulfadoxine-pyrimethamine among pregnant women at first antenatal clinic attendance and delivery in the forest-savannah area of Ghana

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