title: Placental malaria and low birth weight in pregnant women living in a rural area of Burkina Faso following the use of three preventive treatment regimens.
abstract: BACKGROUND
  The weekly chemoprophylaxis of malaria during pregnancy with chloroquine (CQ) has become problematic with the increasing resistance of Plasmodium falciparum to this drug. There was a need to test the benefits of new strategies over the classical chemoprophylaxis. This study was conducted to provide data to the National Malarial Control Programme for an evidence-based policy change decision making process. It compares the efficacy of two IPT regimens, using chloroquine (CQ) or sulphadoxine/pyrimethamine (SP), with the classical chemoprophylaxis regimen using CQ in reducing the adverse outcomes of malaria infection, for the mother and the foetus.
  
  
  METHODS
  Pregnant women attending the first antenatal care visit were randomly assigned to one of the three treatment regimens. They were subsequently followed up till delivery. Maternal, placental and cord blood samples were obtained upon delivery to check for P. falciparum infection.
  
  
  RESULTS
  A total of 648 pregnant women were enrolled in the study. Delivery outcome were available for 423 of them. Peripheral maternal P. falciparum infection at delivery was found in 25.8% of the women. The proportion of women with maternal infection was significantly lower in the IPTp/SP group than in the CQ group (P << 0.000). The prevalence of placental malaria was 18.8% in the CWC/CQ group; 15.9% in the IPTp/CQ group and 10.6% in the IPTp/SP group. The incidence of LBW (weight < 2,500 g) was significantly higher among infants of mothers in the CWC/CQ group (23.9%) as compared with those of mothers in the IPTp/CQ (15.6%) and IPTp/SP (11.6%) groups (p = 0.02)
  
  
  CONCLUSIONS
  Intermittent preventive treatment with SP has shown clear superiority in reducing adverse outcomes at delivery, as compared with intermittent preventive treatment with CQ and classical chemoprophylaxis with CQ.
authors.affiliation: Centre National de Recherche et de Formation sur le Paludisme, Ministère de la Santé, Ouagadougou, Burkina Faso. t.alfred@fasonet.bf
authors.forename: Alfred B
authors.initials: AB
authors.lastname: Tiono
authors.forename: Alphonse
authors.initials: A
authors.lastname: Ouedraogo
authors.forename: Edith C
authors.initials: EC
authors.lastname: Bougouma
authors.forename: Amidou
authors.initials: A
authors.lastname: Diarra
authors.forename: Amadou T
authors.initials: AT
authors.lastname: Konaté
authors.forename: Issa
authors.initials: I
authors.lastname: Nébié
authors.forename: Sodiomon B
authors.initials: SB
authors.lastname: Sirima
mesh_terms: D000328:Adult; D000818:Animals; D000962:Antimalarials / Q000627:therapeutic use*; D002050:Burkina Faso; D018890:Chemoprevention / Q000379:methods*; D002738:Chloroquine / Q000627:therapeutic use; D004338:Drug Combinations; D005260:Female; D005312:Fetal Blood / Q000469:parasitology; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D016778:Malaria, Falciparum / Q000150:complications* / Q000517:prevention & control*; D010920:Placenta / Q000469:parasitology; D010922:Placenta Diseases / Q000469:parasitology* / Q000517:prevention & control*; D010963:Plasmodium falciparum / Q000302:isolation & purification; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000517:prevention & control*; D011739:Pyrimethamine / Q000627:therapeutic use; D012424:Rural Population; D013413:Sulfadoxine / Q000627:therapeutic use; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000962:Antimalarials; D004338:Drug Combinations; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D002738:Chloroquine; D011739:Pyrimethamine