Intermittent Preventive Therapy with Sulfadoxine-Pyrimethamine for Malaria in Pregnancy: A Cross-Sectional Study from Tororo, Uganda

Abstract

BackgroundIntermittent preventive treatment during pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) is widely recommended in sub-Saharan Africa to reduce the risk of malaria and improve birth outcomes. However, there are reports that the efficacy of IPTp with SP is waning, especially in parts of Africa where antimalarial resistance to this drug has become widespread.Methodology/Principal FindingsWe conducted a cross-sectional study of 565 HIV-uninfected women giving birth at Tororo District Hospital in southeastern Uganda. The primary objective of the study was to measure associations between use of SP during pregnancy from antenatal records and the risk of adverse outcomes including placental malaria, low birth weight, maternal parasitemia and maternal anemia. The proportion of women who reported taking 0, 1, 2, and 3 doses of SP during pregnancy was 5.7%, 35.8%, 56.6% and 2.0% respectively. Overall, the prevalence of placental malaria was 17.5%, 28.1%, and 66.2% by placental smear, PCR, and histopathology, respectively. In multivariate analyses controlling for potential confounders, ≥2 doses of SP was associated with non-significant trends towards lower odds of placental malaria by placental smear (OR = 0.75, p = 0.25), placental malaria by PCR (OR = 0.93, p = 0.71), placental malaria by histopathology (OR = 0.75, p = 0.16), low birth weight (OR = 0.63, p = 0.11), maternal parasitemia (OR = 0.88, p = 0.60) and maternal anemia (OR = 0.88, p = 0.48). Using a composite outcome, ≥2doses of SP was associated with a significantly lower odds of placental malaria, low birth weight, maternal parasitemia, or maternal anemia (OR = 0.52, p = 0.01).Conclusions/SignificanceIn this area of Uganda with intense malaria transmission, the prevalence of placental malaria by histopathology was high even among women who reported taking at least 2 doses of SP during pregnancy. The reported use of ≥2 doses of SP was not associated with protection against individual birth and maternal outcome measures but did protect against a composite measure of any adverse outcome.

Low birth weight among adolescents at Cape Coast Metropolitan Hospital of Ghana

“…This corroborates with other works that reported that 2 or more doses of SP were not significantly associated with LBW. 24 Breech presentation has not been established in earlier literature as a risk factor for low birth weight among adolescents just as what this study suggests. The observed association between breech presentation and low birth weight in all the mothers in the study (p=0.046) needs to be interpreted with some caution as the presence of an association does not mean causation.…”

The Effect of Storage and Extraction Methods on Amplification of Plasmodium falciparum DNA from Dried Blood Spots

“…On the other hand, spin-column extraction using protocols from Qiagen, which involves lysis with proteinase K instead of saponin, may have an advantage in obtaining DNA from older samples, which are difficult to lyse, especially when parasite densities are high such that inefficiencies of the column are relatively unimportant. Anecdotally, we have also found that spin-column extraction appears to work better than the saponin/Chelex method for DBS samples obtained from placentas, 15 perhaps for the same reason. A positive finding in our study is that saponin/Chelex extracted DNA was remarkably stable during long-term storage at −20 C, and that the detectability of parasite DNA was not affected by repeated freeze thaws.…”

Impact of Sulfadoxine-Pyrimethamine Resistance on Effectiveness of Intermittent Preventive Therapy for Malaria in Pregnancy at Clearing Infections and Preventing Low Birth Weight

“…The studies were conducted between 2009 and 2013 at 8 sites in 6 countries: 2 countries in West Africa (Mali [2 sites] and Burkina Faso [16]) and 4 in eastern and southern Africa (Zambia [19, 20], Malawi [2 sites] [15, 17, 21], Uganda [14], and Kenya [18]).…”

“…We conducted multicountry studies [14–19] in sub-Saharan Africa to investigate 2 effects of IPTp-SP: (1) its efficacy at clearing existing peripheral infections in asymptomatic pregnant women receiving their first dose of IPTp-SP; and (2) the effectiveness of IPTp-SP at increasing mean birth weight, reducing LBW, or improving other birth outcomes. Here we present individual-level pooled analyses of peripheral parasite clearance and birth outcomes to better quantify the impact of SP resistance on IPTp-SP effectiveness.…”