Inferiority of single-dose sulfadoxine-pyrimethamine intermittent preventive therapy for malaria during pregnancy among HIV-positive Zambian women.
BACKGROUND
The World Health Organization advocates 2-3 doses of sulfadoxine-pyrimethamine (SP) for intermittent preventive treatment of malaria (SP IPTp). The optimal number of doses and the consequences of single-dose therapy remain unclear.


METHODS
Data were from a randomized, controlled study of human immunodeficiency virus-positive Zambian women comparing monthly versus 2-dose SP IPTp. We compared maternal and neonatal birth outcomes as a function of how many doses the mothers received (1 to > or =4 doses).


RESULTS
Of 387 deliveries, 34 received 1 dose of SP. Single-dose SP was significantly associated with higher proportions of maternal anemia, peripheral and cord blood parasitemia, infant prematurity, and low birth weight. SP conferred dose-dependent benefits, particularly in the transition from 1 to 2 doses of SP. Women randomized to the standard 2-dose regimen were much more likely to receive only 1 dose than were women randomized to monthly IPT (relative risk, 16.4 [95% confidence interval, 4.0-68.3]).


CONCLUSIONS
Single-dose SP was a common result of trying to implement the standard 2-dose regimen and was inferior to all other dosing regimens. At a programmatic level, this implies that monthly SP IPTp may ultimately be more effective than the standard regimen by reducing the risk of inadvertently underdosing mothers.
Gill
C J
CJ
Department of International Health, Boston University School of Public Health, Boston, MA 02118, USA. cgill@bu.edu
Macleod
W B
WB
Mwanakasale
V
V
Chalwe
V
V
Mwananyanda
L
L
Champo
D
D
Mukwamataba
D
D
Chilengi
R
R
Thea
D M
DM
Hamer
D H
DH
D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology / Q000469:parasitology / Q000517:prevention & control*; D000328:Adult; D000740:Anemia / Q000139:chemically induced; D000962:Antimalarials / Q000008:administration & dosage* / Q000009:adverse effects*; D001724:Birth Weight; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D004338:Drug Combinations; D005260:Female; D005312:Fetal Blood / Q000469:parasitology; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D015994:Incidence; D008288:Malaria / Q000453:epidemiology / Q000517:prevention & control*; D016017:Odds Ratio; D018512:Parasitemia / Q000453:epidemiology; D010920:Placenta / Q000469:parasitology; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology / Q000469:parasitology / Q000517:prevention & control*; D011256:Pregnancy Outcome; D011739:Pyrimethamine / Q000008:administration & dosage* / Q000009:adverse effects*; D012307:Risk Factors; D013413:Sulfadoxine / Q000008:administration & dosage* / Q000009:adverse effects*; D016896:Treatment Outcome; D015024:Zambia / Q000453:epidemiology
D000962:Antimalarials; D004338:Drug Combinations; D006454:Hemoglobins; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D011739:Pyrimethamine