Intermittent Preventive Treatment for Malaria Control Administered at the Time of Routine Vaccinations in Mozambican Infants: A Randomized, Placebo‐Controlled Trial

Macete, Eusébio; Aíde, Pedro; Aponte, John J.; Sanz, Sergi; Mandomando, Inácio; Espasa, Mateu; Sigaùque, Betuel; Dobaño, Carlota; Mabunda, Samuel; Dgedge, Martinho; Alonso, Pedro L.; Menéndez, Clara

doi:10.1086/505431

Cited by 108 publications

(119 citation statements)

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“…Firstly, recent data on the in vivo efficacy of SP in children in this area have shown a therapeutic efficacy rate of 83%, with a parasitological sensitivity of 78.6% at day 14 [28]. Secondly, SP was highly efficacious for malaria prevention in the study women and in a concurrent study of IPT in infants in the same area, where the efficacy of SP for malaria prevention varied between 60 and 90% in the month after SP administration [29].…”

Section: Discussionmentioning

confidence: 90%

Mother‐to‐child transmission of HIV‐1: association with malaria prevention, anaemia and placental malaria^*

et al. 2008

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Malaria infection may impact on mother-to-child transmission (MTCT) of HIV-1. Prevention of malaria in pregnancy could thus potentially affect MTCT of HIV. We studied the impact of intermittent preventive treatment during pregnancy (IPTp) on HIV-1 MTCT in southern Mozambique. MethodsA total of 207 HIV-positive Mozambican pregnant women were enrolled in the study as part of a randomized placebo-controlled trial of two-dose sulfadoxine-pyrimethamine (SP) IPTp in women receiving single-dose nevirapine to prevent MTCT of HIV. HIV RNA viral load, maternal anaemia and peripheral and placental malaria were assessed at delivery. Infant HIV status was determined by DNA polymerase chain reaction (PCR) at 1 month of age. ResultsThere were 19 transmissions of HIV in 153 mother-infant pairs. IPTp with SP did not have a significant impact on MTCT (11.8% in the SP group vs. 13.2% in the placebo group; P 5 0.784) or on maternal HIV RNA viral load [16 312 (interquartile range {IQR} 4076-69 296) HIV-1 RNA copies/mL in the SP group vs. 18 274 (IQR 5471-74 104) copies/mL in the placebo group; P 5 0.715]. In multivariate analysis, maternal HIV RNA viral load [adjusted odds ratio (AOR) 19.9; 95% confidence interval (CI) 2.3-172; P 5 0.006] and anaemia (haematocrit o33%; AOR 7.5; 95% CI 1.7-32.4; P 5 0.007) were independent risk factors for MTCT. Placental malaria was associated with a decrease in MTCT (AOR 0.23; 95% CI 0.06-0.89; P 5 0.034). ConclusionsIPTp with SP was not associated with a significant impact on MTCT of HIV. Maternal anaemia was an independent risk factor for MTCT.Keywords: anaemia, intermittent preventive treatment, mother-to-child transmission, placental malaria, pregnancy Received: 18 February 2008, accepted 15 May 2008 Introduction HIV/AIDS and malaria infections are two of the most important global health problems of our time, and strongly overlap in sub-Saharan Africa [1]. The detrimental effects of this interaction may be especially relevant during pregnancy, with adverse outcomes for both the mother and the infant [2,3].Vertical transmission of HIV occurs at an approximate rate of 25-40% in untreated breast feeding populations [4,5]. Maternal RNA viral load [2,6,7] [6,7,11], it has been suggested that malaria, by increasing the replication of HIV, may increase the risk of MTCT [2,6]. However, studies assessing the impact of placental malaria (PM) on MTCT have produced conflicting results, suggesting either that PM could increase MTCT or that low-density PM parasitaemia could decrease MTCT [6,7,17,18]. Pregnant women are especially susceptible to malaria infection, which is associated with considerable maternal and infant morbidity and mortality. The World Health Organization recommends that pregnant women in stable transmission areas receive intermittent preventive treatment (IPTp) with sulfadoxine-pyrimethamine (SP) and sleep under insecticide-treated nets (ITNs). However, the efficacy of the concomitant use of these two interventions has not been evaluated. IPTp consists of the provision of two doses, at le...

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Section: Discussionmentioning

confidence: 90%

Mother‐to‐child transmission of HIV‐1: association with malaria prevention, anaemia and placental malaria^*

et al. 2008

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“…The resulting "IPTi Consortium" ( www.ipti-malaria.org ), has supported efficacy trials of IPTi in five countries, and together with other groups has generated information on safety, efficacy, potential interactions with the Expanded Program on Immunization (EPI) vaccines, resistance, acceptability, immunology, cost, and cost-effectiveness. [7][8][9][10][11][12][13][14][15][16] A recent independent review of IPTi concluded that "the evidence makes IPTi with sulphadoxine-pyrimethamine a promising public health strategy." 17 Efficacy is defined as the impact achieved by interventions when given in research settings.…”

Section: Introductionmentioning

confidence: 99%

Community Effectiveness of Intermittent Preventive Treatment for Infants (IPTi) in Rural Southern Tanzania

Schellenberg¹,

Shirima²,

Maokola³

et al. 2010

The American Society of Tropical Medicine and Hygiene

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Intermittent preventive treatment of malaria in infants (IPTi) with sulphadoxine-pyrimethamine shows evidence of efficacy in individually randomized, controlled trials. In a large-scale effectiveness study, IPTi was introduced in April 2005 by existing health staff through routine contacts in 12 randomly selected divisions out of 24 in 6 districts of rural southern Tanzania. Coverage and effects on malaria and anemia were estimated through a representative survey in 2006 with 600 children aged 2–11 months. Coverage of IPTi was 47–76% depending on the definition. Using an intention to treat analysis, parasitemia prevalence was 31% in intervention and 38% in comparison areas (P = 0.06). In a “per protocol” analysis of children who had recently received IPTi, parasite prevalence was 22%, 19 percentage points lower than comparison children (P = 0.01). IPTi can be implemented on a large scale by existing health service staff, with a measurable population effect on malaria, within 1 year of launch.

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“…Intermittent preventive treatment for malaria in infants (IPTi) is a promising new intervention consisting of the administration of a treatment dose of sulfadoxine/pyrimethamine (SP) at the time of routine vaccinations in the first year of life. 3 A pooled analysis 4 of six randomised controlled trials (RCT) of IPTi using SP (IPTi-SP) [5][6][7][8][9][10] suggested that the intervention can reduce the incidence of clinical malaria in the first year of life by 30%. If such an effect can be achieved by delivering an available and affordable antimalarial treatment at the time of routine contacts with the health system, IPTi-SP may become a useful component of antimalarial strategies in some settings.…”

Section: Introductionmentioning

confidence: 99%

Safety of sulfadoxine/pyrimethamine for intermittent preventive treatment of malaria in infants: evidence from large-scale operational research in southern Tanzania

Maokola

Chemba

Hamisi

et al. 2011

International Health

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Intermittent Preventive Treatment for Malaria Control Administered at the Time of Routine Vaccinations in Mozambican Infants: A Randomized, Placebo‐Controlled Trial

Cited by 108 publications

References 17 publications

Mother‐to‐child transmission of HIV‐1: association with malaria prevention, anaemia and placental malaria^*

Mother‐to‐child transmission of HIV‐1: association with malaria prevention, anaemia and placental malaria^*

Community Effectiveness of Intermittent Preventive Treatment for Infants (IPTi) in Rural Southern Tanzania

Safety of sulfadoxine/pyrimethamine for intermittent preventive treatment of malaria in infants: evidence from large-scale operational research in southern Tanzania

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Intermittent Preventive Treatment for Malaria Control Administered at the Time of Routine Vaccinations in Mozambican Infants: A Randomized, Placebo‐Controlled Trial

Cited by 108 publications

References 17 publications

Mother‐to‐child transmission of HIV‐1: association with malaria prevention, anaemia and placental malaria*

Mother‐to‐child transmission of HIV‐1: association with malaria prevention, anaemia and placental malaria*

Community Effectiveness of Intermittent Preventive Treatment for Infants (IPTi) in Rural Southern Tanzania

Safety of sulfadoxine/pyrimethamine for intermittent preventive treatment of malaria in infants: evidence from large-scale operational research in southern Tanzania

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Product

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Mother‐to‐child transmission of HIV‐1: association with malaria prevention, anaemia and placental malaria^*

Mother‐to‐child transmission of HIV‐1: association with malaria prevention, anaemia and placental malaria^*