High uptake of Intermittent Preventive Treatment of malaria in pregnancy is associated with improved birth weight among pregnant women in Ghana

Abstract

Despite the clinically proven advantages of intermittent preventive treatment of malaria in pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP), utilisation has been low in many African countries. To increase uptake and achieve the desired effect, the World Health Organization revised the policy to a monthly administration. Assessing the coverage and impact of the revised policy on pregnancy and neonatal outcomes is, therefore, a necessity. A 2-parallel cross-sectional hospital-based study was carried out among pregnant women attending first antenatal care (ANC) and delivery. Maternal and cord blood samples were assayed for malaria parasites by quantitative PCR targeting both the 18S rDNA and the acidic terminal segment of Plasmodium falciparum var genes, and plasma SP levels were measured by liquid chromatography coupled to tandem mass spectrometry. Parasite prevalence was similar between the two study sites but decreased significantly between the first ANC (9% or 43%) and delivery (4% or 11%) based on the qPCR target. At delivery, 64.5% of women received ≥3 IPTp-SP dose, 15.5% received 2 doses and 6% had 1 dose. Taking ≥3 IPTp-SP doses was associated with an average birth weight increase of more than 0.165 kg. IPTp-SP uptake was associated with plasma SP level at delivery (OR = 32.3, p ≤ 0.005, 95% CI (13.3;78.4) for those that reported ≥3 IPTp-SP doses) while the same trend of improved birth weight was observed with high plasma SP levels. The new IPTp policy is well implemented and well utilised by women in the sites considered in this study and translates to the improved birth weight observed. This study confirms the interest and the clinical benefit expected from this policy change.

Effectiveness of Sulfadoxine–Pyrimethamine for Intermittent Preventive Treatment of Malaria and Adverse Birth Outcomes in Pregnant Women

“…Significantly, IPTp-SP 3+ was associated with improved birth weight and reduced the risk of LBW compared to lower doses of SP taken during pregnancy. Similar studies have reported dose-dependent IPTp-SP impact on birth weight [11,30,35]. The effect of malaria on LBW is well known and has been one of the reasons for IPTp-SP use in endemic areas.…”

Determinants of Low birthweight and Preterm Delivery in the Volta Region of Ghana: Evidence from birth records

“…We found that more than 3 doses of SP/IPTp signi cantly reduced the odds of LBW. This is in conformity with several studies conducted in Tanzania (41,42), Cameroon (43), Nigeria (44) and Ghana (45). The protective nature of SP against LBW could be explained by its therapeutic effect against both malaria and non-malaria infections.…”

Poor Birth Outcomes in Malaria in Pregnancy: Recent Insights Into Mechanisms and Prevention Approaches

“…Currently, all pregnant women residing in areas with high malaria transmission are recommended to receive three or more treatment courses of IPTp with SP, where each course should be administered at least one month apart, starting in the second trimester (67). This replaces the original recommendation of two doses of SP, following substantial data that demonstrated reduced risk of preterm birth and LBW as well as improved birth weight when three or more courses were administered (68)(69)(70). In mathematical modeling studies, it was estimated that three or more doses of IPTp-SP uptake would lead to a 30% relative reduction in LBW occurrence (70)(71)(72)(73).…”