Impact of a double dose of sulphadoxine–pyrimethamine to reduce prevalence of pregnancy malaria in southern Mozambique

Abstract

SummaryMalarial infection during pregnancy increases the risks of severe sequelae for the pregnant woman and the risk of delivering a low birthweight baby. The aim of this intervention study was to reduce significantly the prevalence of malaria parasitaemia in adolescent parturients in Matola and Boane in Mozambique. The study was focused upon the most malaria-vulnerable group, adolescent nulliparous and primiparous women. After completing the usual antenatal clinic and giving informed consent, 600 pregnant women were randomly chosen in a double blind manner to one of two regimens comparing the prevailing routine (placebo) for malaria prevention with a two dose regimen of sulphadoxinepyrimethamine (SP). The first dose was given at enrolment with a second dose at the beginning of the third trimester. At delivery maternal and placental malaria parasitaemia as well as birthweight and gestational duration were analysed. At booking the prevalence of malaria parasitaemia was 35.3% in the placebo group and 30.6% in the SP group. At the second dose, the prevalence of malaria parasitaemia in the placebo group and SP group was 19.7% and 8.7%, respectively. This implies a relative risk (RR) of 2.24 with 95% CI (1.34, 3.75). The corresponding figures at delivery were 13.6% and 6.3% with an RR of 2.22 (1.07, 4.60) and in placenta 13.3% and 2.4% with an RR of 4.87 (1.58, 15.0). Newborns with malaria within 7 days were significantly more frequent in the placebo group, 6.4% and 0.7% respectively, with an RR of 6.55 (1.20, 35.7). Almost all (approximately 98%) of the women studied had Plasmodium falciparum, the remainder had P. malariae and P. ovale. The mean birthweight in the SP group was 3077 g and in the placebo group 2926 g. The estimated mean difference between the two groups was 151 g with 95% CI (51, 252). The mean placental weight in the placebo group was 596 and 645 g in the SP group, implying a difference of 49 g with a 95% CI (11, 88). The mean gestational duration was 6.1 days longer in the SP group, 95% CI (1.5, 10.6). In the placebo group there were two cases of urticaria and one case of nausea; in the SP group there was one case of vomiting. No newborn showed any sign of serious SP side-effect. Two doses of SP were enough to significantly reduce the prevalence of peripheral and placental malaria parasitaemia among young nulliparous and primiparous pregnant women in Matola and Boane.

The Effect of Malaria Transmission Intensity on Neonatal Mortality in Endemic Areas

“…Trials were not included if they compared multiple drugs with no inactive control [53][54][55] or could not be matched to entomologic data. 56 The estimates refer to primigravidae, or primigravidae and secundigavidae together in the case of one trial. ࡗ ‫ס‬ chloroquine; ‫ס‬ dapsone-pyrimethamine; ᭡ ‫ס‬ sulfadoxinepyrimethamine; ᭹ ‫ס‬ pyrimethamine.…”

Appraisal of the Efficacy of Sp-Iptp at Aminu Kano Teaching Hospital-Impact on Maternal Anaemia, Malaria Parasitaemia and Clinical Malaria

“…The incidence of peripheral malaria parasitaemia at 34 weeks gestation of 6.3% among the participants in the SP group, is lower than 8.7% from southern Mozambique, 11.9% from Benin city and 10.4% from Ibadan in Nigeria, which may probably be because only primigravida were used in this study, while in these studies from southern Mozambique, Benin City and Ibadan, multigravid women were also involved [15,22,25,26]. This may be explained by the findings of Gies et al from Burkina Faso, that SP is more effective in preventing malaria parasitaemia among primigravida than among women of higher parity [27].…”

“…This showed that the effectiveness of SP-IPTp in preventing malaria in pregnancy is similar to that of proguanil, which shows that SP-IPTp is still effective in the prevention of malaria in pregnancy at Aminu Kano Teaching Hospital, despite reported cases of resistance in southern Asia and some part of Africa [15][16][17][18][19]. The similar mean packed cell volume between the two groups at recruitment showed that the base line PCV at recruitment did not contribute any bias in the final PCV at 34 weeks gestation.…”

“…In many countries in sub-Saharan Africa, SP-IPTp have proven efficacious in reducing the burden of pregnancy associated malaria, and two doses of SP were found to be enough to significantly reduce the prevalence of peripheral and placental malaria parasitaemia, but its effectiveness is being threatened by increasing levels of parasite resistance to SP across Africa and South East Asia [14][15][16][17][18][19]. This may seriously undermine the benefits of national SP-IPTp programs in these regions [16].…”

Induction of cell cycle arrest and apoptosis in JAR trophoblast by antimalarial drugs

“…Pyrimethamine is a dihydrofolate reductase inhibitor and slow-acting blood schizonticide for all malaria strains and is usually given in combination with sulphadoxine. Unlike other folic acid antagonist, pyrimethamine has no teratogenic effect and can be used for treatment and prophylaxis (2,3,25). Although these drugs are generally considered safe for treating malaria in pregnancies, drug interactions with human placenta still needs to be addressed.…”