Correlates of uptake of optimal doses of sulfadoxine-pyrimethamine for prevention of malaria during pregnancy in East-Central Uganda

Mbonye, Martin Kayitale; Kirwana, Venantius Bbaale; Ndugga, Patricia; Kikaire, Bernard; Baleeta, Keith; Kabagenyi, Allen; Godfrey, Asiimwe; Twesigye, Rogers; Damazo, Kadengye T.; Byonanebye, Dathan Mirembe

doi:10.1186/s12936-020-03230-8

Cited by 13 publications

(13 citation statements)

References 35 publications

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“…That study [41] was consistent with ours in not nding an association between SP and urban/rural residence, but it differed in that it did not nd an association between maternal education or wealth and SP doses. Similar to our ndings, wealth was associated with ≥3 doses of SP in Uganda [54] and Nigeria [55].…”

Section: Discussionsupporting

confidence: 90%

Risk Factors for Placental Malaria, Sulfadoxine-pyrimethamine Doses, and Birth Outcomes in a Rural to Urban Prospective Cohort Study on the Bandiagara Escarpment and Bamako, Mali

Vincenz

Dolo²,

Saye³

et al. 2022

Preprint

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BackgroundMalaria in Mali remains a primary cause of morbidity and mortality, with women at high risk during pregnancy for placental malaria (PM). We evaluated risk for PM and its association with birth outcomes in a rural to urban longitudinal cohort on the Bandiagara Escarpment and the District of Bamako. MethodsWe collected placental samples (N = 317) from 249 mothers who were participants in our longitudinal cohort study. A placental pathologist and research assistant evaluated the samples by histology in blinded fashion to assess PM infection stage and parasite density. We used generalized estimating equations (GEE) to model the odds of PM infection.ResultsPregnancies in Bamako, beyond secondary education, births in the rainy season (instead of the hot dry season), births in later years of the study, and births to women who had > 3 doses of sulfadoxine-pyrimethamine (SP) instead of no doses of SP were associated with reduced odds of experiencing PM (active and past infections combined). We found improved birth outcomes (+ 285 g birth weight, + 2 cm birth length, + 75 g placental weight) for women who had > 3 doses of SP compared to no doses, but did not detect a difference in birth weight or length for women who had 2 instead of > 3 SP doses. However, at 2 instead of > 3 doses placentas were 36 g lighter and the odds of low birth weight (< 2500 g) were 14% higher. Severe parasite densities were significantly associated with decreases in birth weight, birth length, and placental weight, as were chronic PM infections. The women who received no SP during pregnancy (7% of the study total) were younger and lacked primary school education. The women who received ≥ 3 doses of SP came from more affluent families.ConclusionsWomen who received no doses of SP during pregnancy experienced the most disadvantageous birth outcomes in both Bamako and on the Bandiagara Escarpment. Such women tended to be younger and to have had no primary school education. Targeting such women for antenatal care, which is the setting at which SP is most commonly administered in Mali, will have a more positive impact on public health than focusing on the increment from two to three doses of SP.

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Section: Discussionsupporting

confidence: 90%

Risk Factors for Placental Malaria, Sulfadoxine-pyrimethamine Doses, and Birth Outcomes in a Rural to Urban Prospective Cohort Study on the Bandiagara Escarpment and Bamako, Mali

Vincenz

Dolo²,

Saye³

et al. 2022

Preprint

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“…Those ndings could result from the fact that strategies are more focused on the distribution of preventive measures than the importance of their use [27]. We found the ANC usage as a strong predictor of complete MPM as con rmed in other settings [10,11]. Nevertheless, we can notice through the CART result that ANC is not the solely circumstance to have complete MPM.…”

Section: Discussionmentioning

confidence: 45%

“…However, challenges remain to ensure their optimal use, particularly in countries with high malaria endemicity [9,10]. For instance, in neighbouring country Senegal, a secondary analysis of the Demographic and Health Survey (DHS) 2013-2014 showed that 37.51% of pregnant women used this combination [11].…”

Section: Introductionmentioning

confidence: 99%

Variations in the use of malaria preventive measures among pregnant women in Guinea. A secondary analysis of the 2012 and 2018 demographic and health surveys.

Barry

Touré²,

SANGHO³

et al. 2022

Preprint

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Introduction Despite its effectiveness, the optimal use of the combination of insecticide treated nets (ITN) and intermittent preventive treatment during pregnancy with sulfadoxine-pyrimethamine (TPIg-SP) remains low in malaria endemic areas. Therefore, we studied its variations and predictors in Guinea.MethodsWe conducted a secondary analysis of the 2012 and 2018 Guinea Demographic and Health Surveys (DHS). It included women who had given birth in the 3 years before each DHS, slept on ITN and took at least one dose of SP. Moran indices were used to determine spatial autocorrelation. A logistic regression and classification and regression tree (CART) identified the predictors of malaria preventive measures (MPM).ResultsIn 2012, 60.88% of pregnant women used MPM incompletely compared with 79.11% in 2018. Associated factors with incomplete MPM in 2012 were as follows: having an indirect link with the head of household (AOR = 2.23, 95% CI 1.08–4.61) and performing at least 4 ANCs (AOR = 0.66, 95% CI 0.44–0.99). In 2018 : live in households of 2 to 5 people (AOR = 0.54, 95% CI 0.36–0.80), have a man as the head of the household (AOR = 0.56, 95% CI 0.35–0.89), perform the first ANC in the second quarter (AOR = 0.74, 95% CI 0.54–0.99), perform at least 4 ANCs (AOR = 0.47, 95% CI 0.36–0.62), have a job (AOR = 0. 67, 95% CI 0.50–0.88), give birth in a public health facility (AOR = 0.53, 95% CI 0.39–0.72) and the middle wealth quintile (AOR = 1.56, 95% CI 1.07–2.26). A global autocorrelation (I Moran=0.0009, p = 0.2349) and high-high clusters were found in Mamou in 2012. In 2018, autocorrelation was found (I Moran=0.0169, p ≤ 0.05), with spatial clusters in regions of Boké, Mamou, Labé, and N’Zérokoré.ConclusionComplete use of MPM during pregnancy remains still low throughout years in Guinea. Strategies toward familial and healthsystem levels should be implemented and monitored, to reduce inequality in the use of MPM. In this regard, Mamou region deserves more attention.

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“…Wild-type alleles; the lower map shows the ratio of SAK and AAK alleles among wild-type pfdhps alleles (Pearce et al, 2009). reported SP failure across East Africa, with Rwanda and Burundi exceeding the critical 25% value SP failure rates (Rapuoda et al, 2003); this could be due to a low uptake of SP by pregnant women due to weak health system and sub-optimal implementation policy, among other factors (Martin et al, 2020). The pfdhps A581G and pfdhfr I164L mutations, which confer SP resistance, have been found to be unevenly distributed across East Africa, suggesting a high level of SP resistance, as indicated by the prevalence of the K540E mutation, found across East Africa (Naidoo and Roper, 2011).…”

Section: The Spread Of Sulfadoxine-pyrimethamine Resistance In Sub-saharan Africamentioning

confidence: 99%

Chloroquine and Sulfadoxine–Pyrimethamine Resistance in Sub-Saharan Africa—A Review

et al. 2021

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Malaria is a great concern for global health and accounts for a large amount of morbidity and mortality, particularly in Africa, with sub-Saharan Africa carrying the greatest burden of the disease. Malaria control tools such as insecticide-treated bed nets, indoor residual spraying, and antimalarial drugs have been relatively successful in reducing the burden of malaria; however, sub-Saharan African countries encounter great challenges, the greatest being antimalarial drug resistance. Chloroquine (CQ) was the first-line drug in the 20th century until it was replaced by sulfadoxine–pyrimethamine (SP) as a consequence of resistance. The extensive use of these antimalarials intensified the spread of resistance throughout sub-Saharan Africa, thus resulting in a loss of efficacy for the treatment of malaria. SP was replaced by artemisinin-based combination therapy (ACT) after the emergence of resistance toward SP; however, the use of ACTs is now threatened by the emergence of resistant parasites. The decreased selective pressure on CQ and SP allowed for the reintroduction of sensitivity toward those antimalarials in regions of sub-Saharan Africa where they were not the primary drug for treatment. Therefore, the emergence and spread of antimalarial drug resistance should be tracked to prevent further spread of the resistant parasites, and the re-emergence of sensitivity should be monitored to detect the possible reappearance of sensitivity in sub-Saharan Africa.

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Correlates of uptake of optimal doses of sulfadoxine-pyrimethamine for prevention of malaria during pregnancy in East-Central Uganda

Cited by 13 publications

References 35 publications

Risk Factors for Placental Malaria, Sulfadoxine-pyrimethamine Doses, and Birth Outcomes in a Rural to Urban Prospective Cohort Study on the Bandiagara Escarpment and Bamako, Mali

Risk Factors for Placental Malaria, Sulfadoxine-pyrimethamine Doses, and Birth Outcomes in a Rural to Urban Prospective Cohort Study on the Bandiagara Escarpment and Bamako, Mali

Variations in the use of malaria preventive measures among pregnant women in Guinea. A secondary analysis of the 2012 and 2018 demographic and health surveys.

Chloroquine and Sulfadoxine–Pyrimethamine Resistance in Sub-Saharan Africa—A Review

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