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.
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.
Tiono
Alfred B
AB
Centre National de Recherche et de Formation sur le Paludisme, Ministère de la Santé, Ouagadougou, Burkina Faso. t.alfred@fasonet.bf
Ouedraogo
Alphonse
A
Bougouma
Edith C
EC
Diarra
Amidou
A
Konaté
Amadou T
AT
Nébié
Issa
I
Sirima
Sodiomon B
SB
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
D000962:Antimalarials; D004338:Drug Combinations; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D002738:Chloroquine; D011739:Pyrimethamine