title: Risk factors for placental malaria and associated adverse pregnancy outcomes in Rufiji, Tanzania: a hospital based cross sectional study.
abstract: BACKGROUND
  Prevention and treatment of malaria during pregnancy is crucial for reduction of malaria in pregnancy and its adverse outcomes. The spread of parasite resistance to Sulphadoxine-Pyrimethamine (SP) used for Intermittent Preventive Treatment for malaria in pregnancy (IPTp), particularly in East Africa has raised concerns about the usefulness and the reliability of the IPTp regimen. We aimed to assess the effectiveness of two doses of SP in treating and preventing occurrence of adverse pregnancy outcomes.
  
  
  METHODS
  The study was an analytical cross sectional study which enrolled 350 pregnant women from Kibiti Health Centre, South Eastern Tanzania. Structured questionnaires were used to obtain previous obstetrics and medical history of participants and verified by reviewing antenatal clinic cards. Maternal placental blood samples for microscopic examination of malaria parasites were collected after delivery. Data was analyzed for associations between SP dosage, risk for PM and pregnancy outcome. Sample size was estimated based on precision.
  
  
  RESULTS
  Prevalence of placental maternal (PM) was 8% among pregnant women (95%CI, 4.4-13.1%). Factors associated with increased risk of PM were primigravidity (P<0.001) and history of fever during pregnancy (P= 0.02). Use of at least 2 doses of SP for IPTp during pregnancy was insignificantly associated with reducing the risk PM (P=0.08), low birth weight (P=0.73) and maternal anemia (P=0.71) but associated significantly with reducing the risk of preterm birth (P<0.001).
  
  
  CONCLUSIONS
  Two doses of SP for IPTp regime are ineffective in preventing and treating PM and adverse pregnancy outcome. Hence a review to the current IPTp regimen should be considered with possibility of integrating it with other malaria control strategies.
authors.affiliation: Muhimbili Orthopaedic Institute.
authors.forename: Rabi
authors.initials: R
authors.lastname: Ndeserua
authors.affiliation: Kilimanjaro Christian Medical Center, Community Health Department.
authors.forename: Adinan
authors.initials: A
authors.lastname: Juma
authors.affiliation: Kilimanjaro Christian Medical University College, Community Health Department.
authors.forename: Dominic
authors.initials: D
authors.lastname: Mosha
authors.affiliation: Kilimanjaro Christian Medical University College, Biochemistry and Mol Biology.
authors.forename: Jaffu
authors.initials: J
authors.lastname: Chilongola
mesh_terms: D000328:Adult; D000962:Antimalarials / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D004305:Dose-Response Relationship, Drug; D004338:Drug Combinations; D005260:Female; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D008288:Malaria / Q000188:drug therapy* / Q000517:prevention & control; D010920:Placenta / Q000469:parasitology*; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000517:prevention & control*; D011256:Pregnancy Outcome / Q000453:epidemiology; D037841:Pregnant People; D015995:Prevalence; D011739:Pyrimethamine / Q000008:administration & dosage / Q000627:therapeutic use; D012307:Risk Factors; D012720:Severity of Illness Index; D013413:Sulfadoxine / Q000008:administration & dosage / Q000627:therapeutic use; D013636:Tanzania / Q000453:epidemiology; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000962:Antimalarials; D004338:Drug Combinations; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D011739:Pyrimethamine
keywords: Malaria in pregnancy; Placental malaria; Sulphadoxine-Pyrimethamine; intermittent preventive treatment