title: Clinical malaria among pregnant women on combined insecticide treated nets (ITNs) and intermittent preventive treatment (IPTp) with sulphadoxine-pyrimethamine in Yaounde, Cameroon.
abstract: BACKGROUND
  Malaria remains a burden for pregnant women and the under 5. Intermittent preventive treatment of pregnant women (IPTp) for malaria with sulfadoxine - pyrimethamine (SP) has since replaced prophylaxis and legislation has been reinforced in the area of insecticide treated mosquito nets (ITNs) in Cameroon. Clinical malaria despite all these measures remains a problem. We compared the socio-obstetrical characteristics of women who developed clinical malaria and those who did not though in the same regimen.
  
  
  METHODS
  A 5 - year nested cohort study (2007 - 2011 inclusive) at the tertiary level hospitals in Yaounde. Pregnant women who willingly accepted to participate in the study were enrolled at booking and three doses of SP were administered between 18 - 20 weeks of gestation, between 26-28 weeks and between 32 - 34 weeks. Those who developed clinical malaria were considered as cases and were compared for socio - obstetrical characteristics with those who did not. Venous blood was drawn from the women in both arms for parasite density estimation and identification and all the clinical cases were treated conventionally.
  
  
  RESULTS
  Each arm had 166 cases and many women who developed clinical malaria were between 15 and 19 years (OR 5.5, 95% CI 3.9 - 5.3, p < 0.001). They were of low gravidity (OR 6.5, 95% CI 3.8 - 11.3, p < 0.001) as well as low parity (OR 4.6, 95% CI 2.7 - 7.9, p < 0.001). The cases were single women (OR 4.58, 95% CI 2.54 - 8.26, p < 0.001) and had attained only primary level of education (OR 4.6, 95% CI 2.8 - 7.9, p < 0.001). Gestational ages were between 20 to 30 weeks during clinical malaria (OR 6.8, 95% CI 4.1 - 11.7, p < 0.001). The time between the first and second dose of SP was longer than ten weeks in the cases (OR 5.5, 95% CI 3.2 - 9.3, p < 0.001) and parasite density was higher also among the cases (OR 6.9, 95% CI 5.9 - 12.1, p < 0.001).
  
  
  CONCLUSIONS
  Long spacing between the first and second dose of SP seemed to be responsible for clinical malaria in the cases.
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Cameroon and the Maternity Unit, Central Hospital, Yaounde, Cameroon. rembu2000@yahoo.com.
authors.forename: Robinson Enow
authors.initials: RE
authors.lastname: Mbu
authors.forename: William Ako
authors.initials: WA
authors.lastname: Takang
authors.forename: Hortence Jeanne
authors.initials: HJ
authors.lastname: Fouedjio
authors.forename: Florent Ymele
authors.initials: FY
authors.lastname: Fouelifack
authors.forename: Florence Ndikum
authors.initials: FN
authors.lastname: Tumasang
authors.forename: Rebecca
authors.initials: R
authors.lastname: Tonye
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000962:Antimalarials / Q000008:administration & dosage* / Q000627:therapeutic use; D002163:Cameroon; D016022:Case-Control Studies; D018890:Chemoprevention / Q000379:methods; D015331:Cohort Studies; D004334:Drug Administration Schedule; D004338:Drug Combinations; D005260:Female; D005865:Gestational Age; D020073:Gravidity; D006801:Humans; D057148:Insecticide-Treated Bednets; D008288:Malaria / Q000517:prevention & control*; D010298:Parity; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000517:prevention & control*; D011295:Prenatal Care / Q000379:methods*; D011739:Pyrimethamine / Q000008:administration & dosage* / Q000627:therapeutic use; D013413:Sulfadoxine / Q000008:administration & dosage* / Q000627:therapeutic use; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000962:Antimalarials; D004338:Drug Combinations; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D011739:Pyrimethamine