title: Intermittent preventive treatment of malaria with sulphadoxine-pyrimethamine during pregnancy in Burkina Faso: effect of adding a third dose to the standard two-dose regimen on low birth weight, anaemia and pregnancy outcomes.
abstract: BACKGROUND
  Intermittent preventive treatment with sulphadoxine-pyrimethamine (IPTp-SP) is being implemented in most malaria endemic countries as a standard two-doses regimen as it reduces the risk of low birth weight (LBW) and the prevalence of maternal anaemia. Nevertheless, where the risk of infection close to delivery is high because of intense transmission, a third IPTp-SP dose may further reduce the negative effects of malaria on pregnancy outcome.
  
  
  METHODS
  Pregnant women in the 2nd or 3rd trimester were randomized to receive either 2 (SP2) or 3 doses (SP3) of SP. Trained field workers paid home visits to the women for drug administration according to a predefined drug delivery schedule. Women were encouraged to attend their scheduled ANC visits and to deliver at the health facilities where the new-born was weighed. The prevalence of LBW (<2500 g), severe anaemia (Hb < 8 g/dL) and premature birth was analysed using intention-to-treat (ITT) and per-protocol (PP) analysis.
  
  
  RESULTS
  Data from 1274 singleton pregnancies were analysed (641 in the SP3 and 633 in the SP2 group). The uptake of the intervention appeared to be low. Though the prevalence of LBW in both intervention groups was similar (adjusted Incident Rate Ratio, AIRR = 0.92, 95%CI: 0.69-1.24) in the ITT analysis, the risk of severe anaemia was significantly lower in the SP3 group compared to the SP2 group (AIRR = 0.38, 95%CI: 0.16 - 0.90). The PP analysis showed a trend of reduced risk of LBW, severe anaemia and premature delivery in the SP3 group, albeit the difference between two and three IPTp-SP did not reach statistical significance.
  
  
  CONCLUSIONS
  The risk of LBW and severe anaemia tended to be lower in the SP3 group, though this was not statistically significant, probably due to the low uptake of the intervention which reduced the power of the study. Further studies are needed for establishing whether a third SP dose has a real benefit in preventing the negative effects of malaria in pregnancy in settings where transmission is markedly seasonal.
authors.affiliation: Laboratory of Parasitology and Entomology, Centre Muraz, Bobo-Dioulasso, Burkina Faso. innocentvalea@yahoo.fr.
authors.forename: Innocent
authors.initials: I
authors.lastname: Valea
authors.forename: Halidou
authors.initials: H
authors.lastname: Tinto
authors.forename: Maxime K
authors.initials: MK
authors.lastname: Drabo
authors.forename: Lieven
authors.initials: L
authors.lastname: Huybregts
authors.forename: Marie-Claire
authors.initials: MC
authors.lastname: Henry
authors.forename: Dominique
authors.initials: D
authors.lastname: Roberfroid
authors.forename: Robert T
authors.initials: RT
authors.lastname: Guiguemde
authors.forename: Patrick
authors.initials: P
authors.lastname: Kolsteren
authors.forename: Umberto
authors.initials: U
authors.lastname: D'Alessandro
mesh_terms: D000293:Adolescent; D000328:Adult; D000740:Anemia / Q000517:prevention & control*; D000962:Antimalarials / Q000627:therapeutic use*; D002050:Burkina Faso; D004338:Drug Combinations; D005260:Female; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D016778:Malaria, Falciparum / Q000469:parasitology / Q000517:prevention & control*; D018512:Parasitemia / Q000469:parasitology / Q000517:prevention & control; D010963:Plasmodium falciparum / Q000254:growth & development*; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000469:parasitology / Q000517:prevention & control*; D011262:Pregnancy Trimester, Second; D011263:Pregnancy Trimester, Third; D011739:Pyrimethamine / Q000627:therapeutic use*; D012044:Regression Analysis; D013413:Sulfadoxine / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D000962:Antimalarials; D004338:Drug Combinations; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D011739:Pyrimethamine