Efficacy of sulfadoxine-pyrimethamine for prevention of placental malaria in an area of Kenya with a high prevalence of malaria and human immunodeficiency virus infection.

Parise, Monica E.; Ayisi, John; Nahlen, Bernard L.; Schultz, Linda J.; Roberts, Jacquelin M.; Misore, Ambrose; Muga, Richard; Oloo, Aggrey J.; Steketee, Richard W.

doi:10.4269/ajtmh.1998.59.813

Cited by 345 publications

(335 citation statements)

References 37 publications

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“…Malaria pros s phylaxis may not be effective in this situation because placental parasitaemia was more common in HIVspositive than in HIVsnegative pregnant women treated with sulfadoxine-pyrimethamine in Kenya. 38 Similar findings have been reported from Malawi. 40 In developing countries, maternal anaemia is usually the result of iron deficiency and/or malaria.…”

Section: Discussionsupporting

confidence: 80%

“…36 However, an assos s ciation between HIV status and both peripheral and placental malaria and higher parasite densities in HIVsinfected individuals was seen in this study as well as in several previous studies. [37][38][39] Paritys specific immunity appears to be reduced in HIVspositive women; women of all parities have a higher relative risk for malaria if they are HIVspositive. 27,37,39,40 This in turn may lead to an even higher rate of adverse pregnancy outcomes, als s though we did not observe this, with the exception of a univariate effect of HIV on stillbirth.…”

Section: Discussionmentioning

confidence: 99%

“…2,42,44,45 Malaria prophylaxis in pregnancy can reduce the incidence of thirdstrimester anaemia 38 and is geners s ally recommended as a part of prenatal care in malariasendemic areas. 46 This has been effective in reducing the incidence of LBW infants, especially those born to primigravidae, and in reducing maternal anaemia.…”

Section: Discussionmentioning

confidence: 99%

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Adverse birth outcomes in United Republic of Tanzania - impact and prevention of maternal risk factors

Watson-Jones

Weiss

Changalucha

et al. 2007

Bull World Health Organ

130

121

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Objective To determine risk factors for poor birth outcome and their population attributable fractions. Methods 1688 women who attended for antenatal care were recruited into a prospective study of the effectiveness of syphilis screening and treatment. All women were screened and treated for syphilis and other reproductive tract infections (RTIs) during pregnancy and followed to delivery to measure the incidence of stillbirth, intrauterine growth retardation (IUGR), low birth weight (LBW) and preterm live birth. Findings At delivery, 2.7% of 1536 women experienced a stillbirth, 12% of live births were preterm and 8% were LBW. Stillbirth was independently associated with a past history of stillbirth, short maternal stature and anaemia. LBW was associated with short maternal stature, ethnicity, occupation, gravidity and maternal malaria whereas preterm birth was associated with occupation, age of sexual debut, untreated bacterial vaginosis and maternal malaria. IUGR was associated with gravidity, maternal malaria, short stature, and delivering a female infant. In the women who had been screened and treated for syphilis, in between 20 and 34% of women with each outcome was estimated to be attributable to malaria, and 63% of stillbirths were estimated as being attributable to maternal anaemia. Screening and treatment of RTIs was effective and no association was seen between treated RTIs and adverse pregnancy outcomes. Conclusion Maternal malaria and anaemia continue to be significant causes of adverse pregnancy outcome in sub-Saharan Africa. Providing reproductive health services that include treatment of RTIs and prevention of malaria and maternal anaemia to reduce adverse birth outcomes remains a priority. Voir page 16 le résumé en français. En la página 16 figura un resumen en español.

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Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

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Adverse birth outcomes in United Republic of Tanzania - impact and prevention of maternal risk factors

Watson-Jones

Weiss

Changalucha

et al. 2007

Bull World Health Organ

130

121

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“…The World Health Organization recommends that women living in sub-Saharan Africa receive at least two doses of intermittent preventive treatment (IPTp) with sulfadoxinepyrimethamine (SP) to prevent malaria and improve pregnancy outcomes (1)(2)(3)(4)(5) and this advice is widely followed. However, the rapid spread of SP-resistant parasites might undermine the efficacy of SP-IPTp, although it still confers benefits in areas with low to moderate levels of drug resistance (6).…”

mentioning

confidence: 99%

Competitive facilitation of drug-resistant Plasmodium falciparum malaria parasites in pregnant women who receive preventive treatment

Harrington

Mutabingwa

Muehlenbachs

et al. 2009

Proc. Natl. Acad. Sci. U.S.A.

189

244

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Intermittent preventive treatment in pregnancy (IPTp) is used to prevent Plasmodium falciparum malaria. However, parasites resistant to the IPTp drug sulfadoxine-pyrimethamine (SP) have emerged worldwide, and infections with mixed resistant and susceptible parasites are exacerbated by pyrimethamine in mice. In a prospective delivery cohort in Muheza, Tanzania, we examined the effects of SP IPTp on parasite resistance alleles, parasite diversity, level of parasitemia, and inflammation in the placenta. IPTp use was associated with an increased fraction of parasites carrying the resistance allele at DHPS codon 581, an increase in the level of parasitemia, and more intense placental inflammation. The lowest mean level of parasite diversity and highest mean level of parasitemia occurred in women after recent IPTp use. These findings support a model of parasite release and facilitation, whereby the most highly resistant parasites out-compete less fit parasite populations and overgrow under drug pressure. Use of partially effective anti-malarial agents for IPTp may exacerbate malaria infections in the setting of widespread drug resistance.evolution of drug resistance ͉ intermittent preventive treatment in pregnancy ͉ malaria drug resistance ͉ pregnancy malaria M alaria during pregnancy causes both maternal and fetal morbidity and mortality, including the deaths of an estimated 100,000 infants each year because of malaria-related low birth weight. The World Health Organization recommends that women living in sub-Saharan Africa receive at least two doses of intermittent preventive treatment (IPTp) with sulfadoxinepyrimethamine (SP) to prevent malaria and improve pregnancy outcomes (1-5) and this advice is widely followed. However, the rapid spread of SP-resistant parasites might undermine the efficacy of SP-IPTp, although it still confers benefits in areas with low to moderate levels of drug resistance (6). The effect of SP IPTp in areas where resistant parasites are more widespread has not been studied.Pyrimethamine and sulfadoxine target the parasite proteins DHFR and DHPS, respectively, and increasing resistance is conferred by ordered accumulating point mutations, of which DHPS codon 581 is one of the final to occur (7). The mutation at DHPS codon 581 has been associated with high-level in vitro resistance (8), as well as treatment failure in children (9, 10). Single-dose treatment of children with SP has been associated with an increase in parasite resistance alleles (11, 12), but little work has been done to examine the relationship between IPTp and selection for drug resistance alleles. One recent study observed an increased prevalence of placental infections harboring the DHFR triple mutant in women who had received pyrimethamine prophylaxis during pregnancy, as compared with women who had not (13). In contrast, IPTp use was not related to increased prevalence of resistance alleles at the same study site (14). Modeling studies have proposed that IPTp is less likely to contribute to accumulating drug resistance as...

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“…In other studies, though higher mortality due to malaria was not recorded, morbidity was definitely higher in HIV positive adults [8,9]. Chemoprophylaxis for malaria is less effective in HIV-positive than HIV negative pregnant women [10]. Thus, HIV coinfection alters all the aspects of malarial infection.…”

Section: Case Reportmentioning

confidence: 90%

Malaria and Human Immunodeficiency Virus Infection

Mehta¹,

Swamy²,

Muthukrishnan³

et al. 2004

Medical Journal Armed Forces India

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Efficacy of sulfadoxine-pyrimethamine for prevention of placental malaria in an area of Kenya with a high prevalence of malaria and human immunodeficiency virus infection.

Cited by 345 publications

References 37 publications

Adverse birth outcomes in United Republic of Tanzania - impact and prevention of maternal risk factors

Adverse birth outcomes in United Republic of Tanzania - impact and prevention of maternal risk factors

Competitive facilitation of drug-resistant Plasmodium falciparum malaria parasites in pregnant women who receive preventive treatment

Malaria and Human Immunodeficiency Virus Infection

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