title: Intermittent preventive therapy with sulfadoxine-pyrimethamine for malaria in pregnancy: a cross-sectional study from Tororo, Uganda.
abstract: BACKGROUND
  Intermittent preventive treatment during pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) is widely recommended in sub-Saharan Africa to reduce the risk of malaria and improve birth outcomes. However, there are reports that the efficacy of IPTp with SP is waning, especially in parts of Africa where antimalarial resistance to this drug has become widespread.
  
  
  RESULTS
  We conducted a cross-sectional study of 565 HIV-uninfected women giving birth at Tororo District Hospital in southeastern Uganda. The primary objective of the study was to measure associations between use of SP during pregnancy from antenatal records and the risk of adverse outcomes including placental malaria, low birth weight, maternal parasitemia and maternal anemia. The proportion of women who reported taking 0, 1, 2, and 3 doses of SP during pregnancy was 5.7%, 35.8%, 56.6% and 2.0% respectively. Overall, the prevalence of placental malaria was 17.5%, 28.1%, and 66.2% by placental smear, PCR, and histopathology, respectively. In multivariate analyses controlling for potential confounders, ≥ 2 doses of SP was associated with non-significant trends towards lower odds of placental malaria by placental smear (OR = 0.75, p = 0.25), placental malaria by PCR (OR = 0.93, p = 0.71), placental malaria by histopathology (OR = 0.75, p = 0.16), low birth weight (OR = 0.63, p = 0.11), maternal parasitemia (OR = 0.88, p = 0.60) and maternal anemia (OR = 0.88, p = 0.48). Using a composite outcome, ≥ 2 doses of SP was associated with a significantly lower odds of placental malaria, low birth weight, maternal parasitemia, or maternal anemia (OR = 0.52, p = 0.01).
  
  
  CONCLUSIONS
  In this area of Uganda with intense malaria transmission, the prevalence of placental malaria by histopathology was high even among women who reported taking at least 2 doses of SP during pregnancy. The reported use of ≥ 2 doses of SP was not associated with protection against individual birth and maternal outcome measures but did protect against a composite measure of any adverse outcome.
authors.affiliation: Infectious Disease Research Collaboration, Kampala, Uganda.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Arinaitwe
authors.forename: Veronica
authors.initials: V
authors.lastname: Ades
authors.forename: Andrew
authors.initials: A
authors.lastname: Walakira
authors.forename: Boaz
authors.initials: B
authors.lastname: Ninsiima
authors.forename: Olive
authors.initials: O
authors.lastname: Mugagga
authors.forename: Teja S
authors.initials: TS
authors.lastname: Patil
authors.forename: Alanna
authors.initials: A
authors.lastname: Schwartz
authors.forename: Moses R
authors.initials: MR
authors.lastname: Kamya
authors.forename: Sussann
authors.initials: S
authors.lastname: Nasr
authors.forename: Michelle
authors.initials: M
authors.lastname: Chang
authors.forename: Scott
authors.initials: S
authors.lastname: Filler
authors.forename: Grant
authors.initials: G
authors.lastname: Dorsey
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D004094:Dihydropteroate Synthase / Q000235:genetics; D004282:Documentation; D004338:Drug Combinations; D004351:Drug Resistance; D005260:Female; D006801:Humans; D008288:Malaria / Q000453:epidemiology* / Q000235:genetics / Q000517:prevention & control* / Q000635:transmission; D009154:Mutation; D036801:Parturition; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology* / Q000235:genetics / Q000517:prevention & control*; D011739:Pyrimethamine / Q000494:pharmacology*; D013413:Sulfadoxine / Q000494:pharmacology*; D013762:Tetrahydrofolate Dehydrogenase / Q000235:genetics; D014454:Uganda / Q000453:epidemiology; D055815:Young Adult
chemical_list: D004338:Drug Combinations; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D013762:Tetrahydrofolate Dehydrogenase; D004094:Dihydropteroate Synthase; D011739:Pyrimethamine
references.citation: PLoS One. 2010 Oct 19;5(10):e13438
references.pmid: 20976051
references.citation: Am J Trop Med Hyg. 2003 Jan;68(1):115-9
references.pmid: 12556159
references.citation: Parasitology. 2011 Oct;138(12):1469-79
references.pmid: 21835078
references.citation: Ann Trop Med Parasitol. 1998 Mar;92(2):141-50
references.pmid: 9625909
references.citation: Clin Infect Dis. 2012 Jul;55(1):42-50
references.pmid: 22441649
references.citation: Pharmacol Rev. 2005 Mar;57(1):117-45
references.pmid: 15734729
references.citation: JAMA. 2007 Jun 20;297(23):2603-16
references.pmid: 17579229
references.citation: J Infect Dis. 2006 Aug 1;194(3):286-93
references.pmid: 16826475
references.citation: JAMA. 2013 Feb 13;309(6):594-604
references.pmid: 23403684
references.citation: Malar J. 2012 Jul 04;11:134
references.pmid: 22540158
references.citation: Mol Biochem Parasitol. 1993 Apr;58(2):283-92
references.pmid: 8479452
references.citation: PLoS One. 2010 Aug 06;5(8):e12012
references.pmid: 20700457
references.citation: PLoS One. 2009;4(2):e4569
references.pmid: 19238219
references.citation: Health Policy Plan. 2006 Nov;21(6):459-68
references.pmid: 17030551
references.citation: Am J Trop Med Hyg. 1998 Nov;59(5):813-22
references.pmid: 9840604
references.citation: J Infect Dis. 2007 Dec 1;196(11):1585-94
references.pmid: 18008241
references.citation: Clin Infect Dis. 2011 Aug 1;53(3):215-23
references.pmid: 21765069
references.citation: Lancet. 2005 Apr 23-29;365(9469):1474-80
references.pmid: 15850631
references.citation: Clin Infect Dis. 2011 Aug 1;53(3):224-30
references.pmid: 21765070
references.citation: Lancet. 2009 Oct 31;374(9700):1521-32
references.pmid: 19765815
references.citation: Lancet Infect Dis. 2007 Feb;7(2):93-104
references.pmid: 17251080
references.citation: Proc Natl Acad Sci U S A. 2009 Jun 2;106(22):9027-32
references.pmid: 19451638
references.citation: PLoS One. 2012;7(7):e41123
references.pmid: 22829919
references.citation: PLoS One. 2008 Apr 09;3(4):e1934
references.pmid: 18398460
references.citation: BMJ. 2011 Mar 31;342:d1617
references.pmid: 21454456
references.citation: Trans R Soc Trop Med Hyg. 2011 Nov;105(11):607-16
references.pmid: 21962292
references.citation: Am J Trop Med Hyg. 1994 Nov;51(5):515-22
references.pmid: 7985742
references.citation: Lancet. 1999 Feb 20;353(9153):632-6
references.pmid: 10030329