Efficacy of Intermittent Preventive Treatment of Malaria with Sulphadoxine-pyrimethamine in Preventing Anaemia in Pregnancy among Nigerian Women
- 204 Downloads
Objective To evaluate the efficacy of intermittent preventive treatment of malaria using sulphadoxine-pyrimethamine (SP) in the prevention of anaemia in women of low parity in a low socio-economic, malaria endemic setting. Method The study design was an open randomized control trial comparing anaemia incidence among pregnant women on intermittent presumptive treatment of malaria with SP with those on chloroquine (CQ). A total of 352 primigravid and secondigravid women between 16 and 30 weeks gestation receiving antenatal care at the Primary Health Care Center, Enuwa in Ile-Ife, Osun State, Nigeria were serially recruited and randomly allocated into experimental and control groups of 176 each. The experimental group received SP (to a maximum of three doses depending on the gestational age at enrollment into the study) while the control group had treatment doses of CQ at recruitment and subsequently only if they had symptoms suggestive of malaria. The primary outcome measure was anaemia (haematocrit < 30) at 34 weeks of gestation. Result At recruitment and 34 weeks gestation, there was no statistically significant difference between the experimental and control group in terms of socio-demographic characteristics and past medical history. Thirty-three (22.6%) and 52 (37.1%) women in the study and control groups, respectively, had anaemia (protective efficacy 49.5%, p = 0.01). With multivariate analysis, controlling for the possible confounding effects of education, parity, haemoglobin level at booking and malaria parasitaemia in peripheral blood, the difference in the incidence of anaemia in the two groups remained significant (p = 0.01; odds ratio = 0.5; 95% confidence interval = 0.29–0.85). Conclusion The IPT regime with sulphadoxine-pyrimethamine is an effective, practicable strategy to decrease risk of anaemia in women of low parity residing in areas endemic for malaria.
KeywordsAnaemia in pregnancy Malaria in pregnancy Intermittent presumptive treatment of malaria Maternal health Nigeria
- 1.Paxton, L. A., Slutsker, L., Schultz, L. J., Luby, S. P., Meriwether, R., Matson, P., & Sulzer, A. J. (1996). Imported malaria in Montagnard refugees settling in North Carolina: Implications for prevention and control. American Journal of Tropical Medicine and Hygiene, 54, 54–57.PubMedGoogle Scholar
- 2.Malaria Foundation International. http://www.malaria.org. Accessed February 2003.
- 3.Federal Ministry of Health (Nigeria). (2004). Malaria control in Nigeria a strategy for behaviour change communication 2004–2005. Abuja: Federal Ministry of Health.Google Scholar
- 5.Malaria—A crisis with solutions. World Health Organisation. http://www.rbm.who.int/docs/AMD/factsheet.htm. Accessed 23 July 2005.
- 6.Brabin, B. (1991). The risks and severity of malaria in pregnant women. Applied Field Research in Malaria reports WHO; no 1.Google Scholar
- 8.Schultz, L. J., Steketee, R. W., Chitsulo, L., Macheso, A., Kazembe, P., & Wirima, J. J. (1996). Evaluation of maternal practices, efficacy, and cost-effectiveness of alternative antimalarial regimens for use in pregnancy: Chloroquine and sulphadoxine-pyrimethamine. American Journal of Tropical Medicine and Hygiene, 55, 87–94.PubMedGoogle Scholar
- 12.Mc Gregor, I. A., Wilson, M. E., & Billewicz W. Z. (1983). Malaria Infection of the placenta in the Gambia, West Africa: Its Incidence and relationship to still birth, birth weight and placental weight. Transactions of the Royal Society of Tropical Medicine and Hygiene, 77, 232–244.CrossRefGoogle Scholar
- 13.Wolfe, E. B., Parise, M. E., Haddix, A. C., Nahlen, B. L., Ayisi, J. G., Misore, A., & Steketee, R. W. (2001). Cost-effectiveness of sulphadoxine-pyrimethamine for the prevention of malaria-associated low birth weight. American Journal of Tropical Medicine and Hygiene, 64, 178–186.PubMedGoogle Scholar
- 15.Steketee, R. W., Wirima, J. J., Hightower, A. W., Slutsker, L., Heymann, D. L., & Breman, J. G. (1996). The effect of malaria and malaria prevention in pregnancy on offspring birth weight, prematurity and intrauterine growth retardation in rural Malawi. American Journal of Tropical Medicine and Hygiene, 55, 33–41.PubMedGoogle Scholar
- 19.WHO Expert Committee on malaria. (2000). Twentieth report. Geneva: World Health Organisation (WHO Technical report series, No 892).Google Scholar
- 22.Gahlinger, P. M., & Abramson, J. H. (1999). Computer programs for epidemiologists: PEPI Version 3.01. Wales: Brixton Books.Google Scholar
- 23.Cheesbrough, M. District laboratory practice in tropical countries, Part 1 1998 (pp. 239–249).Google Scholar
- 24.Kirkwood, B. R., & Sterne, J. A. C. (2003). Essential medical statistics (2nd ed., p. 454). Oxford: Blackwell Science.Google Scholar
- 25.Rogerson, S. J., Chaluluka, E., Kanjala, M., Mkundika, P., Mhango, C., & Molyneux, M. E. (2000). Intermittent sulphadoxine-pyrimethamine in pregnancy: Effectiveness against malaria morbidity in Blantyre, Malawi. Transactions of the Royal Society of Tropical Medicine and Hygiene, 94, 549–553.PubMedCrossRefGoogle Scholar