Evaluation of sulphadoxine-pyrimethamine for intermittent preventive treatment of malaria in pregnancy: a retrospective birth outcomes study in Mansa, Zambia

Abstract

BackgroundIntermittent preventive treatment of malaria in pregnancy (IPTp) with sulphadoxine-pyrimethamine (SP) decreases placental parasitaemia, thus improving birth outcomes. Zambian policy recommends monthly SP-IPTp doses given presumptively during pregnancy at each antenatal examination, spaced one month apart after 16 weeks of gestation. The effectiveness of SP-IPTp was evaluated in Zambia where a recent study showed moderate prevalence of Plasmodium falciparum parasites with genetic mutations that confer SP resistance.MethodsHIV-negative women were enrolled at the time of delivery at two facilities in Mansa, Zambia, an area of high malaria transmission. Women were interviewed and SP exposure was determined by antenatal card documentation or self-reports. Using Poisson regression modelling, the effectiveness of SP-IPTp was evaluated for outcomes of parasitaemia (microscopic examination of maternal peripheral, cord, and placental blood films), maternal anaemia (Hb < 11 g/dl), placental infection (histopathology), and infant outcomes (low birth weight (LBW), preterm delivery, and small for gestational age) in women who took 0–4 doses of SP-IPTp.ResultsParticipants included 435 women, with a median age of 23 years (range 16–44). Thirty-four women took zero doses of SP-IPTp, while 115, 142 and 144 women took one, two, or ≥ three doses, respectively. Multivariate Poisson regression models considering age, mosquito net usage, indoor residual spraying, urban home, gravidity, facility, wet season delivery, and marital status showed that among paucigravid women ≥ two doses of SP-ITPp compared to one or less doses was associated with a protective effect on LBW (prevalence ratio (PR) 0.33, 95% confidence interval (CI) 0.12–0.91) and any infection (PR 0.76, CI 0.58–0.99). Multivariate models considering SP-IPTp as a continuous variable showed a protective dose–response association with LBW (paucigravid women: PR 0.54, CI 0.33–0.90, multigravid women: PR 0.63, CI 0.41–0.97).ConclusionsIn Mansa, Zambia, an area of moderate SP resistance, ≥ two doses of SP-IPTp were associated with a protective effect from malaria in pregnancy, especially among paucigravid women. Each dose of SP-IPTp contributed to a 46 and 37% decrease in the frequency of LBW among paucigravid and multigravid women, respectively. SP-IPTp remains a viable strategy in this context.

Burden of Placental Malaria among Pregnant Women Who Use or Do Not Use Intermittent Preventive Treatment at Mulago Hospital, Kampala

“…This finding suggests that SP may still be beneficial in preventing placental malaria and its associated adverse outcomes. This finding is consistent with clinical outcomes from several recent studies that assessed the efficacy of SP-IPTp in settings with a high prevalence of SP resistance mutations [13, 23, 24, 26–28]. SP-IPTp works by the clearance of asymptomatic parasitemia followed by posttreatment prophylaxis (PTP) [38].…”

Impact of Sulfadoxine-Pyrimethamine Resistance on Effectiveness of Intermittent Preventive Therapy for Malaria in Pregnancy at Clearing Infections and Preventing Low Birth Weight

“…The studies were conducted between 2009 and 2013 at 8 sites in 6 countries: 2 countries in West Africa (Mali [2 sites] and Burkina Faso [16]) and 4 in eastern and southern Africa (Zambia [19, 20], Malawi [2 sites] [15, 17, 21], Uganda [14], and Kenya [18]).…”

Determinants of preterm birth among mothers who gave birth in East Africa: systematic review and meta-analysis

“…Use of at least 2 doses of SP (sulphadoxinepyrimethamine) for IPT during pregnancy (AOR 0.1, 95% CI: 0.05-0.4) [42], two or more doses compared to 0-1 dose reduced preterm delivery (OR, 0.42; 95% CI: 0.27, 0.67) [75]. Among multigravida women, at least two or more doses of SP-IPTp SPIPTp (sulphadoxinepyrimethamine for IPT remained significantly associated with protection from PTB (AOR 0.28, 95% CI: 0.13-0.60) [77]. Last SP time lapse ≤4 weeks reduced the PTB (AOR 0.38, 95% CI: 0.15, 0.97) [44].…”