title: Comparison of intermittent preventive treatment with chemoprophylaxis for the prevention of malaria during pregnancy in Mali.
abstract: 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.
authors.affiliation: Malaria Research and Training Center, Department of Epidemiology and Parasitic Diseases, Faculty of Medicine and Dentistry, University of Bamako, Bamako, Mali.
authors.forename: Kassoum
authors.initials: K
authors.lastname: Kayentao
authors.forename: Mamoudou
authors.initials: M
authors.lastname: Kodio
authors.forename: Robert D
authors.initials: RD
authors.lastname: Newman
authors.forename: Hamma
authors.initials: H
authors.lastname: Maiga
authors.forename: Didier
authors.initials: D
authors.lastname: Doumtabe
authors.forename: Aissata
authors.initials: A
authors.lastname: Ongoiba
authors.forename: Drissa
authors.initials: D
authors.lastname: Coulibaly
authors.forename: Abdoul Salam
authors.initials: AS
authors.lastname: Keita
authors.forename: Bouboucar
authors.initials: B
authors.lastname: Maiga
authors.forename: Mary
authors.initials: M
authors.lastname: Mungai
authors.forename: Monica E
authors.initials: ME
authors.lastname: Parise
authors.forename: Ogobara
authors.initials: O
authors.lastname: Doumbo
mesh_terms: 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
chemical_list: D004338:Drug Combinations; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D002738:Chloroquine; D011739:Pyrimethamine