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Trop Med Int Health. 2014 Sep;19(9):1048-56. doi: 10.1111/tmi.12349. Epub 2014 Jun 26.

Effectiveness of intermittent preventive treatment with sulfadoxine-pyrimethamine during pregnancy on placental malaria, maternal anaemia and birthweight in areas with high and low malaria transmission intensity in Tanzania.

Author information

1
Ifakara Health Institute, Rufiji HDSS, Rufiji, Tanzania; Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland; Kilimanjaro Christian Medical University College, Tumaini University Makumira, Moshi, Tanzania.

Abstract

OBJECTIVE:

To assess the effectiveness of IPTp in two areas with different malaria transmission intensities.

METHODS:

Prospective observational study recruiting pregnant women in two health facilities in areas with high and low malaria transmission intensities. A structured questionnaire was used for interview. Maternal clinic cards and medical logs were assessed to determine drug intake. Placental parasitaemia was screened using both light microscopy and real-time quantitative PCR.

RESULTS:

Of 350 pregnant women were recruited and screened for placental parasitaemia, 175 from each area. Prevalence of placental parasitaemia was 16.6% (CI 11.4-22.9) in the high transmission area and 2.3% (CI 0.6-5.7) in the low transmission area. Being primigravida and residing in a high transmission area were significant risk factors for placental malaria (OR 2.4; CI 1.1-5.0; P = 0.025) and (OR 9.4; CI 3.2-27.7; P < 0.001), respectively. IPTp was associated with a lower risk of placental malaria (OR 0.3; CI 0.1-1.0; P = 0.044); the effect was more pronounced in the high transmission area (OR 0.2; CI 0.06-0.7; P = 0.015) than in the low transmission area (OR 0.4; CI 0.04-4.5; P = 0.478). IPTp use was not associated with reduced risk of maternal anaemia or low birthweight, regardless of transmission intensity. The number needed to treat (NNT) was four (CI 2-6) women in the high transmission area and 33 (20-50) in the low transmission area to prevent one case of placental malaria.

CONCLUSION:

IPTp may have an effect on lowering the risk of placental malaria in areas of high transmission, but this effect did not translate into a benefit on risks of maternal anaemia or low birthweight. The NNT needs to be considered, and weighted against that of other protective measures, eventually targeting areas which are above a certain threshold of malaria transmission to maximise the benefit.

KEYWORDS:

Anemia; IPTp-SP; TPI-SP; anaemia; anémie; bajo peso al nacer; faible poids de naissance; low birthweight; malaria placentaria; paludisme placentaire; placental malaria

PMID:
24965022
DOI:
10.1111/tmi.12349
[Indexed for MEDLINE]
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