title: Failure of a chloroquine chemoprophylaxis program to adequately prevent malaria during pregnancy in Koupéla District, Burkina Faso.
abstract: In West Africa, administration of chloroquine chemoprophylaxis during pregnancy is common, but little is known about its impact on Plasmodium falciparum infection during pregnancy. Therefore, cross-sectional studies in antenatal care clinics (ANCs) and delivery units (DUs) were conducted in Koupéla District, Burkina Faso. Chloroquine chemoprophylaxis was reported by 69% of 597 pregnant women at ANCs and by 93% of 853 women in DUs. P. falciparum peripheral parasitemia was identified in 29% of women at both ANCs and DUs. Placental parasitemia was identified in 22% of delivering women and was strongly associated with low birth weight (LBW) (risk ratio [RR], 1.7; 95% confidence interval [CI], 1.2-2.4) and prematurity (RR, 2.9; 95% CI, 1.6-5.4). In multivariate analysis, use of chemoprophylaxis was not associated with a reduction in the prevalence of placental parasitemia, LBW, or prematurity. Despite the high reported chloroquine chemoprophylaxis coverage, peripheral and placental malaria rates remain high and are associated with known adverse outcomes during pregnancy, including maternal anemia, prematurity, and LBW. Alternative prevention strategies, such as use of insecticide-treated mosquito nets and intermittent preventive treatment with more-effective antimalarials, are needed.
authors.affiliation: Centre National de Recherche et de Formation sur le Paludisme, Ministère de la Santé, Ouagadougou.
authors.forename: Sodiomon B
authors.initials: SB
authors.lastname: Sirima
authors.forename: Romial
authors.initials: R
authors.lastname: Sawadogo
authors.forename: Allisyn C
authors.initials: AC
authors.lastname: Moran
authors.forename: Amadou
authors.initials: A
authors.lastname: Konate
authors.forename: Amidou
authors.initials: A
authors.lastname: Diarra
authors.forename: Mathias
authors.initials: M
authors.lastname: Yameogo
authors.forename: Monica E
authors.initials: ME
authors.lastname: Parise
authors.forename: Robert D
authors.initials: RD
authors.lastname: Newman
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D000962:Antimalarials / Q000627:therapeutic use*; D002050:Burkina Faso; D018890:Chemoprevention; D002738:Chloroquine / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D009033:Culicidae / Q000187:drug effects; D004199:Disease Vectors; D005260:Female; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007306:Insecticides / Q000494:pharmacology; D016778:Malaria, Falciparum / Q000517:prevention & control*; D015767:Mefloquine / Q000627:therapeutic use; D018512:Parasitemia / Q000517:prevention & control*; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D000962:Antimalarials; D007306:Insecticides; D002738:Chloroquine; D015767:Mefloquine