Impact of Intermittent Presumptive Treatment for Malaria in Pregnancy on Hospital Birth Outcomes on the Kenyan Coast

Abstract

Background Intermittent preventive treatment (IPTp) to pregnant women with sulfadoxine–pyrimethamine (SP) is widely implemented for the prevention of malaria in pregnancy and adverse birth outcomes. The efficacy of SP is declining and there are concerns that IPTp may have reduced impact in areas of high resistance. Here we sought to determine the protection afforded by SP as part of IPTp against birth outcomes in an area with high levels of SP resistance on the Kenyan coast. Methods A secondary analysis of surveillance data on deliveries at the Kilifi County hospital between 2015 and 2021 was undertaken in an area of low malaria transmission and high parasite mutations associated with SP resistance. A multivariable logistic regression model was developed to estimate the effect of SP doses on the risk of low birthweight (LBW) deliveries and stillbirths. Results Among 27,786 deliveries, three or more doses of IPTp-SP were associated with a 27% reduction in the risk of LBW (adjusted odds ratio (aOR): 0.73; 95% CI: 0.64, 0.83; p < 0.001) compared to no-dose. A dose-response association was observed with increasing doses of SP from the second trimester linked to increasing protection against LBW deliveries. Three or more doses of IPTp-SP were also associated with a 21% reduction in stillbirth deliveries (aOR: 0.79; 95% CI: 0.65, 0.97; p= 0.044) compared to women who did not take any dose of IPTp-SP. Conclusions The continued, significant association of SP on LBW deliveries suggests that the intervention may have a non-malaria impact on pregnancy outcomes.

Characteristics and Predictors of Stillbirths at the West Gonja Catholic Hospital, Ghana: A Retrospective Analysis Using Birth Registry Data

“…This con rms earlier ndings from Sunyani, Ghana, where mothers who had taken 3 or more doses of IPTp had 68% reduced odds of having a stillbirth [14]. An impact analysis of IPTp on pregnancy outcomes also found that stillbirth is reduced by 21% among women who took 3 or more doses in pregnancy compared to mothers who took less than 3 doses [29]. IPTp is strongly recommended as a priority intervention to reduce stillbirth in low and middle-income countries most especially in the rst 2 pregnancies [30].…”

Spatial heterogeneity of low-birthweight deliveries on the Kenyan coast

“…This study was a retrospective analysis of routine data collected at Kilifi County Hospital [ 26 , 27 ], matched to the Kilifi Health and Demographic Surveillance System (KHDSS) [ 28 ]. The KHDSS is located on the Kenyan Coast and subdivided into 37 sub-locations (an administrative unit covering ~ 39,000 people), which are further subdivided into 186 enumeration zones (EZ) each consisting of approximately 226 homesteads [ 28 ].…”

“…Data was obtained from the maternity ward surveillance system at KCH established in January 2011 to standardize maternal admission procedures and improve standard of care under the Kilifi Perinatal and Maternity research (KIPMAT) study [ 26 ]. Registration of all admissions for mothers who present in labour is undertaken by trained fieldworkers present at the maternity ward 24 h, seven days a week [ 26 , 27 ]. Clinical assessment and documentation were undertaken by nursing and medical staff as part of routine care using a structured maternal admission record form.…”

“…All still born babies were excluded. In addition, all multiple births were excluded, that have intrinsically increased odds of LBW [ 27 , 32 ]. Finally, newborns with missing or erroneous birth weight records were also excluded from the analysis (Fig.…”