Effectiveness of Intermittent Screening and Treatment of Malaria in Pregnancy on Maternal and Birth Outcomes in Selected Districts in Rwanda: A Cluster Randomized Controlled Trial

Abstract

Background Malaria during pregnancy can cause serious consequences including maternal anemia and low birthweight (LBW). Routine antenatal care (ANC) in Rwanda includes malaria symptom screening at each ANC visit. This cluster randomized controlled trial investigated whether adding intermittent screening with a malaria rapid diagnostic test (RDT) at each routine ANC visit and treatment of positives during pregnancy (ISTp) is more effective than routine ANC for reducing malaria prevalence at delivery. Methods Between September 2016- June 2018, pregnant women initiating ANC at 14 health centers in Rwanda were enrolled into ISTp or control arms. All women received an insecticide-treated bed net at enrolment. Hemoglobin concentration, placental and peripheral parasitemia, newborn outcome, birthweight, and prematurity were assessed at delivery. Results 975 were enrolled in ISTp and 811 in the control. Routine ANC plus ISTp did not significantly reduce PCR-confirmed placental malaria compared to control (adjusted relative risk [aRR] 0.94, 95% confidence interval [CI] 0.59–1.50, p=0.799). ISTp had no impact on anemia (aRR 1.08, 95% CI 0.57-2.04, p=0.821). The mean birthweight of singleton newborns was not significantly different between arms (3054gm vs 3096gm, p=0.395), however women in the ISTp arm had a higher proportion of LBW (aRR = 1.59, 95% CI 1.02-2.49, p=0.042). Conclusions This is the only study to compare ISTp to symptomatic screening at ANC in a setting where intermittent preventive treatment is not routinely provided. ISTp did not reduce the prevalence of malaria or anemia at delivery and was associated with an increased risk of LBW. Clinical Trials Registration NCT03508349

Malaria in Pregnancy, Current Challenges, and Emerging Prevention Strategies in a Warming Climate

“…35,39,40 To minimize prenatal drug exposure to the fetus and to reduce pressure leading to drug resistance, intermittent screening, and treatment of malaria in pregnancy (ISTp) has been evaluated as an alternative strategy to IPTp for HIV-negative women. 41,42 ISTp involves screening pregnant women for malaria with a rapid diagnostic test (RDT) at each antenatal visit, with antimalarial treatment reserved only for those with identified infection. This approach might be beneficial for areas with high SP resistance, lower transmission areas, or if the sensitivity of rapid diagnostic tests improves.…”