Comparison of intermittent preventive treatment with chemoprophylaxis for the prevention of malaria during pregnancy in Mali.
BACKGROUND
Malaria during pregnancy contributes to maternal anemia and low birth weight. In East Africa, several studies have demonstrated that intermittent preventive treatment (IPT) with sulfadoxine-pyrimethamine (SP) is more efficacious than weekly chloroquine (CQ) chemoprophylaxis in preventing these adverse consequences. To our knowledge, there are no published trials evaluating IPT in West Africa.


METHODS
We undertook a randomized controlled trial of weekly CQ chemoprophylaxis, 2-dose IPT with CQ, and 2-dose IPT with SP; 1163 women were enrolled.


RESULTS
In multivariate analyses, when compared with weekly CQ, IPT/SP was associated with a reduction in third-trimester anemia (adjusted odds ratio [AOR], 0.49; P<.001), placental parasitemia (AOR, 0.69; P=.04), and low birth weight (<2500 g) (AOR, 0.69; P=.04). The prevalence of placental infection remained unexpectedly high, even in the IPT/SP group (24.5%), possibly because of the intensity of seasonal transmission. There were no significant differences in stillbirths, spontaneous abortions, or neonatal deaths among the 3 groups.


CONCLUSIONS
In Mali, IPT with SP appears more efficacious than weekly chloroquine chemoprophylaxis in preventing malaria during pregnancy. These data support World Health Organization recommendations to administer at least 2 doses of IPT during pregnancy. In intensely seasonal transmission settings in Mali, >2 doses may be required to prevent placental reinfection prior to delivery.
Kayentao
Kassoum
K
Malaria Research and Training Center, Department of Epidemiology and Parasitic Diseases, Faculty of Medicine and Dentistry, University of Bamako, Bamako, Mali.
Kodio
Mamoudou
M
Newman
Robert D
RD
Maiga
Hamma
H
Doumtabe
Didier
D
Ongoiba
Aissata
A
Coulibaly
Drissa
D
Keita
Abdoul Salam
AS
Maiga
Bouboucar
B
Mungai
Mary
M
Parise
Monica E
ME
Doumbo
Ogobara
O
D000022:Abortion, Spontaneous; D000293:Adolescent; D000328:Adult; D000740:Anemia; D001724:Birth Weight; D018890:Chemoprevention / Q000379:methods; D002738:Chloroquine / Q000008:administration & dosage* / Q000627:therapeutic use; D004334:Drug Administration Schedule; D004338:Drug Combinations; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008288:Malaria / Q000517:prevention & control*; D008302:Mali; D015999:Multivariate Analysis; D018512:Parasitemia; D010922:Placenta Diseases / Q000517:prevention & control; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000517:prevention & control*; D011256:Pregnancy Outcome; D011739:Pyrimethamine / Q000008:administration & dosage* / Q000627:therapeutic use; D013413:Sulfadoxine / Q000008:administration & dosage* / Q000627:therapeutic use
D004338:Drug Combinations; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D002738:Chloroquine; D011739:Pyrimethamine