title: Coverage of intermittent prevention treatment with sulphadoxine-pyrimethamine among pregnant women and congenital malaria in Côte d'Ivoire.
abstract: BACKGROUND
  The World Health Organization (WHO) recommends using insecticide-treated mosquito nets (ITNs) and intermittent preventive treatment with sulphadoxine-pyrimethamine (IPT-SP) to prevent malaria in sub-Saharan Africa. Data on IPT-SP coverage and factors associated with placental malaria parasitaemia and low birth weight (LBW) are scarce in Côte d'Ivoire.
  
  
  METHODS
  A multicentre, cross-sectional survey was conducted in Côte d'Ivoire from March to September 2008 at six urban and semi-urban antenatal clinics. Standardized forms were used to collect the demographic information and medical histories of women and their offspring. IPT-SP coverage (≥2 doses) as well as placental and congenital malaria prevalence parasitaemia were estimated. Regression logistics were used to study factors associated with placental malaria and LBW (birth weight of alive babies < 2,500 grams).
  
  
  RESULTS
  Overall, 2,044 women with a median age of 24 years were included in this study. Among them 1017 (49.8%) received ≥2 doses of IPT-SP and 694 (34.0%) received one dose. A total of 99 mothers (4.8%) had placental malaria, and of them, four cases of congenital malaria were diagnosed. Factors that protected from maternal placental malaria parasitaemia were the use of one dose (adjusted odds ratio (aOR), 0.32; 95%CI: 0.19-0.55) or ≥2 doses IPT-SP (aOR: 0.18; 95%CI: 0.10-0.32); the use of ITNs (aOR: 0.47; 95%CI: 0.27-0.82). LBW was associated with primigravidity and placental malaria parasitaemia.
  
  
  CONCLUSIONS
  IPT-SP decreases the rate of placental malaria parasitaemia and has a strong dose effect. Despite relatively successful IPT-SP coverage in Côte d'Ivoire, substantial commitments from national authorities are urgently required for such public health campaigns. Strategies, such as providing IPT-SP free of charge and directly observing treatment, should be implemented to increase the use of IPT-SP as well as other prophylactic methods.
authors.affiliation: Programme PAC-CI, Abidjan, Côte d'Ivoire. didier.ekouevi@gmail.com
authors.forename: Henriette A
authors.initials: HA
authors.lastname: Vanga-Bosson
authors.forename: Patrick A
authors.initials: PA
authors.lastname: Coffie
authors.forename: Serge
authors.initials: S
authors.lastname: Kanhon
authors.forename: Caroline
authors.initials: C
authors.lastname: Sloan
authors.forename: Firmin
authors.initials: F
authors.lastname: Kouakou
authors.forename: Serge P
authors.initials: SP
authors.lastname: Eholie
authors.forename: Moussa
authors.initials: M
authors.lastname: Kone
authors.forename: François
authors.initials: F
authors.lastname: Dabis
authors.forename: Hervé
authors.initials: H
authors.lastname: Menan
authors.forename: Didier K
authors.initials: DK
authors.lastname: Ekouevi
mesh_terms: D000293:Adolescent; D000328:Adult; D018890:Chemoprevention / Q000379:methods*; D007560:Cote d'Ivoire / Q000453:epidemiology; D003430:Cross-Sectional Studies; D004338:Drug Combinations; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D006302:Health Services Research; D006801:Humans; D007231:Infant, Newborn; D008288:Malaria / Q000151:congenital / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control*; D018512:Parasitemia / Q000453:epidemiology / Q000517:prevention & control; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy* / Q000517:prevention & control*; D037841:Pregnant People; D011739:Pyrimethamine / Q000008:administration & dosage*; D013413:Sulfadoxine / Q000008:administration & dosage*; D055815:Young Adult
chemical_list: D004338:Drug Combinations; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D011739:Pyrimethamine