title: A randomized, placebo-controlled trial of intermittent preventive treatment with sulphadoxine-pyrimethamine in Gambian multigravidae.
abstract: We investigated the ability of intermittent preventive treatment in pregnancy (IPTp) with sulphadoxine/pyrimethamine to prevent anaemia and low birthweight in Gambian multigravidae. Between July 2002 and February 2004, 2688 multigravidae living in a rural area of The Gambia received SP (1346 women) or placebo (1342 women) up to four times during pregnancy and were followed until 6-weeks post-partum. Shortly after delivery, 10.7% of women in the intervention group and 8.8% in the control group were severely anaemic [Hb < 7 g/dl, risk difference = 0.02 (95% CI -0.01, 0.04), P = 0.17]. The overall mean birthweight of infants born to women who had received SP (3103 g) was very similar to that observed in infants born to women in the control group [3075 g; difference = 28 g (95% CI -11 g, 67 g), P = 0.16]. However, among women who did not use a bednet (either insecticide treated or untreated), infants born to women who had received SP weighed more than infants born to women in the control group [3147 g vs. 3044 g; difference 143 g (95% CI 53 g, 232 g), interaction test P < 0.001]. This study did not show that IPTp with SP benefited Gambian multigravidae overall but that it may benefit a sub-group of women who do not use a bednet. In areas such as The Gambia, provision of insecticide-treated bednets to multigravidae may provide an adequate means of protection against malaria in pregnancy without the need for additional IPTp.
authors.affiliation: Medical Research Council Laboratories, Fajara, The Gambia.
authors.forename: A
authors.initials: A
authors.lastname: Mbaye
authors.forename: K
authors.initials: K
authors.lastname: Richardson
authors.forename: B
authors.initials: B
authors.lastname: Balajo
authors.forename: S
authors.initials: S
authors.lastname: Dunyo
authors.forename: C
authors.initials: C
authors.lastname: Shulman
authors.forename: P
authors.initials: P
authors.lastname: Milligan
authors.forename: B
authors.initials: B
authors.lastname: Greenwood
authors.forename: G
authors.initials: G
authors.lastname: Walraven
mesh_terms: D000293:Adolescent; D000328:Adult; D000740:Anemia / Q000517:prevention & control; D000962:Antimalarials / Q000627:therapeutic use*; D001512:Bedding and Linens; D004338:Drug Combinations; D005260:Female; D005714:Gambia / Q000453:epidemiology; D020073:Gravidity; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D016778:Malaria, Falciparum / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D008875:Middle Aged; D018512:Parasitemia / Q000453:epidemiology / Q000517:prevention & control; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000517:prevention & control*; D015597:Pregnancy Complications, Parasitic / Q000517:prevention & control*; D011256:Pregnancy Outcome; D015995:Prevalence; D011739:Pyrimethamine / Q000627:therapeutic use*; D012423:Rural Health; D012621:Seasons; D013413:Sulfadoxine / Q000627:therapeutic use*
chemical_list: D000962:Antimalarials; D004338:Drug Combinations; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D011739:Pyrimethamine