Gestational Health and Predictors of Newborn Weight Amongst Pregnant Women in Rural Malawi

Tropical Med Int Health

Kulmala

Cheung

et al. 2013

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Abstractobjective To examine the potential to reduce foetal and neonatal growth faltering through intermittent preventive treatment in pregnancy (IPTp) of malaria and reproductive tract infections with monthly sulphadoxine-pyrimethamine (SP), alone or with two doses of azithromycin.methods We enrolled 1320 women with uncomplicated second trimester pregnancies into a randomised, partially placebo controlled, outcome assessor-blinded clinical trial in Malawi. The participants received either two doses of SP (control), SP monthly (monthly SP) or SP monthly and azithromycin (1 g) twice (AZI-SP). Newborn size was measured within two days of birth and infant growth at four weeks of age.results Babies in the AZI-SP group were on average (95% CI) 140 g (70-200) heavier at birth and 0.6 cm (0.2-0.9) longer at four weeks of age than control group babies. Corresponding differences between the monthly SP and control groups were 80 g (20-140) and 0.3 cm (À0.0 to 0.6).Compared with controls, babies in the AZI-SP group had a relative risk of 0.61 (0.40-0.93) for low birthweight, 0.60 (0.44-0.81) for stunting and 0.48 (0.29-0.79) for underweight at four weeks of age. Corresponding differences were similar but smaller between the monthly SP and control groups.conclusions An IPTp regimen with monthly SP given to all pregnant women is likely to increase mean birthweight and length at four weeks of age in malaria holoendemic areas. Adding azithromycin to the regimen appears to offer further benefits in reducing foetal and neonatal growth faltering.

Section: Methodsmentioning

confidence: 99%

The effect of antenatal monthly sulphadoxine–pyrimethamine, alone or with azithromycin, on foetal and neonatal growth faltering in Malawi: a randomised controlled trial

Tropical Med Int Health

Kulmala

Cheung

et al. 2013

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“…Malaria is holoendemic at this rural site and earlier evidence suggested that RTIs would be common among pregnant women. 28,29 Inclusion criteria were gestational age 14-26 weeks by ultrasound assessment, felt movements of the fetus, availability for follow-up, and informed consent. Exclusion criteria included severe illness, receipt of azithromycin during the current pregnancy or SP within preceding 28 days, allergy to study drugs, and any previous serious allergic reaction.…”

Section: Methodsmentioning

confidence: 99%

Effect of Repeated Treatment of Pregnant Women with Sulfadoxine-Pyrimethamine and Azithromycin on Preterm Delivery in Malawi: A Randomized Controlled Trial

The American Society of Tropical Medicine and Hygiene

Kulmala²,

Mbewe³

et al. 2010

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127

Abstract. Preterm delivery, which is associated with infections during pregnancy, is common in sub-Saharan Africa. We enrolled 1,320 pregnant women into a randomized, controlled trial in Malawi to study whether preterm delivery and low birth weight (LBW) incidence can be reduced by intermittent preventive treatment of maternal malaria and reproductive tract infections. The participants received either sulfadoxine-pyrimethamine (SP) twice (controls), monthly SP, or monthly SP and two doses of azithromycin (AZI-SP). The incidence of preterm delivery was 17.9% in controls, 15.4% in the monthly SP group ( P = 0.32), and 11.8% in AZI-SP group (risk ratio = 0.66, P = 0.01). Compared with controls, those in AZI-SP group had a risk ratio of 0.61 ( P = 0.02) for LBW. Incidence of serious adverse events was low in all groups. In conclusion, the incidence of preterm delivery and LBW can in some conditions be reduced by treating pregnant women with monthly SP and two azithromycin doses.

“…Malaria is holoendemic at this rural site [19]. Inclusion criteria for the study were gestational age 14–26 weeks by ultrasound assessment, felt movements of the fetus, availability for follow-up, and informed consent.…”

Section: Methodsmentioning

confidence: 99%

The Effect of Monthly Sulfadoxine-Pyrimethamine, Alone or with Azithromycin, on PCR-Diagnosed Malaria at Delivery: A Randomized Controlled Trial

Rantala²,

Meshnick³

et al. 2012

PLoS ONE

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BackgroundNew regimens for intermittent preventive treatment in pregnancy (IPTp) against malaria are needed as the effectiveness of the standard two-dose sulfadoxine-pyrimethamine (SP) regimen is under threat. Previous trials have shown that IPTp with monthly SP benefits HIV-positive primi- and secundigravidae, but there is no conclusive evidence of the possible benefits of this regimen to HIV-negative women, or to a population comprising of both HIV-positive and –negative women of different gravidities.MethodsThis study analyzed 484 samples collected at delivery as part of a randomized, partially placebo controlled clinical trial, conducted in rural Malawi between 2003 and 2007. The study included pregnant women regardless of their gravidity or HIV-infection status. The participants received SP twice (controls), monthly SP, or monthly SP and two doses of azithromycin (AZI-SP). The main outcome was the prevalence of peripheral Plasmodium falciparum malaria at delivery diagnosed with a real-time polymerase chain reaction (PCR) assay.FindingsOverall prevalence of PCR-diagnosed peripheral P. falciparum malaria at delivery was 10.5%. Compared with the controls, participants in the monthly SP group had a risk ratio (95% CI) of 0.33 (0.17 to 0.64, P<0.001) and those in the AZI-SP group 0.23 (0.11 to 0.48, P<0.001) for malaria at delivery. When only HIV-negative participants were analyzed, the corresponding figures were 0.26 (0.12 to 0.57, P<0.001) for women in the monthly SP group, and 0.24 (0.11 to 0.53, P<0.001) for those in the AZI-SP group.ConclusionsOur results suggest that increasing the frequency of SP administration during pregnancy improves the efficacy against malaria at delivery among HIV-negative women, as well as a population consisting of both HIV-positive and –negative pregnant women of all gravidities, in a setting of relatively low but holoendemic malaria transmission, frequent use of bed nets and high SP resistance.Trial RegistrationClinicalTrials.gov NCT00131235