Decline of placental malaria in southern Ghana after the implementation of intermittent preventive treatment in pregnancy.
BACKGROUND
Intermittent preventive treatment in pregnancy with sulphadoxine-pyrimethamine (IPTp-SP) has been adopted as policy by many countries in sub-Saharan Africa. However, data on the post-implementation effectiveness of this measure are scarce.


METHODS
Clinical and parasitological parameters were assessed among women delivering at a district hospital in rural southern Ghana in the year 2000 when pyrimethamine chemoprophylaxis was recommended (n = 839) and in 2006 (n = 226), approximately one year after the implementation of IPTp-SP. Examinations were performed in an identical manner in 2000 and 2006 including the detection of placental Plasmodium falciparum infection by microscopy, histidine-rich protein 2, and PCR.


RESULTS
In 2006, 77% of the women reported to have taken IPTp-SP at least once (26%, twice; 24%, thrice). In 2006 as compared to 2000, placental P. falciparum infection was reduced by 43-57% (P < 0.0001) and maternal anaemia by 33% (P = 0.0009), and median birth weight was 130 g higher (P = 0.02). In 2006, likewise, women who had taken > or = 1 dose of IPTp-SP revealed less infection and anaemia and their children tended to have higher birth weights as compared to women who had not used IPTp-SP. However, placental P. falciparum infection was still observed in 11% (microscopy) to 26% (PCR) of those women who had taken three doses of IPTp-SP.


CONCLUSIONS
In southern Ghana, placental malaria and maternal anaemia have declined substantially and birth weight has increased after the implementation of IPTp-SP. Likely, these effects can further be increased by improving IPTp-SP coverage and adherence. However, the remnant prevalence of infection in women having taken three doses of IPTp-SP suggests that additional antimalarial measures are needed to prevent malaria in pregnancy in this region.
Hommerich
Lena
L
Institute of Tropical Medicine and International Health, Charité - University Medicine, Berlin, Germany. l.hommerich@web.de
von Oertzen
Christa
C
Bedu-Addo
George
G
Holmberg
Ville
V
Acquah
Patrick A
PA
Eggelte
Teunis A
TA
Bienzle
Ulrich
U
Mockenhaupt
Frank P
FP
D000293:Adolescent; D000328:Adult; D000740:Anemia / Q000453:epidemiology; D000818:Animals; D000962:Antimalarials / Q000008:administration & dosage / Q000627:therapeutic use*; D001724:Birth Weight / Q000187:drug effects; D018890:Chemoprevention; D004334:Drug Administration Schedule; D004338:Drug Combinations; D005260:Female; D005869:Ghana / Q000453:epidemiology; D006801:Humans; D007231:Infant, Newborn; D016778:Malaria, Falciparum / Q000453:epidemiology* / Q000469:parasitology / Q000517:prevention & control; D008875:Middle Aged; D010920:Placenta / Q000469:parasitology; D010922:Placenta Diseases / Q000453:epidemiology* / Q000469:parasitology / Q000517:prevention & control; D010963:Plasmodium falciparum / Q000145:classification / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000453:epidemiology* / Q000469:parasitology / Q000517:prevention & control; D011739:Pyrimethamine / Q000008:administration & dosage / Q000627:therapeutic use*; D012424:Rural Population; D013413:Sulfadoxine / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome
D000962:Antimalarials; D004338:Drug Combinations; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D011739:Pyrimethamine