Skip to main content

Advertisement

SpringerLink
Log in

Efficacy of Intermittent Preventive Treatment of Malaria with Sulphadoxine-pyrimethamine in Preventing Anaemia in Pregnancy among Nigerian Women

  • Published:
Maternal and Child Health Journal Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  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.

    PubMed  CAS  Google 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.

  4. McGregor, I. A. (1984). Epidemiology, malaria and pregnancy. American Journal of Tropical Medicine and Hygiene, 33, 517–525.

    PubMed  CAS  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.

  7. Shulman, C. E., Dorman, E. K., Cutts, F., Kawuondo, K., Bulmer, J. N., Peshu, N., & Marsh, K. (1999). Intermittent sulphadoxine-pyrimethamine to prevent severe anemia secondary to malaria in pregnancy: A randomized placebo-controlled trial. Lancet, 353, 632–636.

    Article  PubMed  CAS  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.

    PubMed  CAS  Google Scholar 

  9. Deen, J. L., Von Seidlein, L., Pinder, M., Walraven, G. E., & Greenwood, B. M. (2001). The safety of the combination artesunate and pyrimethamine-sulphadoxine given during pregnancy. Transactions of the Royal Society of Tropical Medicine and Hygiene, 95, 424–428.

    Article  PubMed  CAS  Google Scholar 

  10. Steketee, R. W., & Breman, J. G. (1988). Malaria infection in pregnant women in Zaire: The effects and potential for intervention. Annals of Tropical Medicine and Parasitology, 82, 113–120.

    PubMed  CAS  Google Scholar 

  11. Van Dongen, P. W. J., & van’t Hof, M. A. (1983). Sickle cell trait, Malaria and anemia in pregnant Zambian women. Transactions of the Royal Society of Tropical Medicine and Hygiene, 77, 402–404.

    Article  PubMed  Google 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.

    Article  CAS  Google 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.

    PubMed  CAS  Google Scholar 

  14. Mutabingwa, T. K., Malle, L. N., de Geus, A., & Oosting, J. (1993). Malaria chemosuppression in pregnancy. II. Its effects on maternal haemoglobin levels, placental malaria and birth weight. Tropical and Geographical Medicine, 45, 49–55.

    PubMed  CAS  Google 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.

    PubMed  CAS  Google Scholar 

  16. Cot, M., Roisin, A., Barro, D., Yada, A., Verhave, J. P., Carnevale, P., & Breart, G. (1992). Effect of chloroquine chemoprophylaxis during pregnancy on birth weight: Results of a randomized trial. American Journal of Tropical Medicine and Hygiene, 46, 21–27.

    PubMed  CAS  Google Scholar 

  17. Geelhoed, D. W., Visser, L. E., Addae, V., Asare, K., Schagen van Leeuwen, J. H., & van Roosmalen, J. (2001). Malaria prophylaxis and the reduction of anemia at child birth. International journal of gynaecology and obstetrics, 74, 133–138.

    Article  PubMed  CAS  Google Scholar 

  18. Salihu, H. M., Naik, E. G., Tchuinguem, G., Bosny, J. P., & Dagne, G. (2002). Weekly Chloroquine prophylaxis and the effect on maternal hemoglobin status at delivery. Tropical medicine & international health, 7, 29–34.

    Article  CAS  Google Scholar 

  19. WHO Expert Committee on malaria. (2000). Twentieth report. Geneva: World Health Organisation (WHO Technical report series, No 892).

  20. Hernandez-Diaz, S., Werter, M. M., Walker, A. M., & Mitchell, A. A. (2000). Folic acid antagonists during pregnancy and the risk of birth defects. New England Journal of Medicine, 343, 1608–1614.

    Article  PubMed  CAS  Google Scholar 

  21. Czeizel, A. E., Rockenbayer, M., Sorensen, H. T., & Olsen, J. (2001). The teratogenic risk of trimethoprim-sulphonamides: A population based case control study. Reproductive Toxicology, 15, 637–646.

    Article  PubMed  CAS  Google Scholar 

  22. Gahlinger, P. M., & Abramson, J. H. (1999). Computer programs for epidemiologists: PEPI Version 3.01. Wales: Brixton Books.

  23. Cheesbrough, M. District laboratory practice in tropical countries, Part 1 1998 (pp. 239–249).

  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.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Community Health, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria

    O. O. Asa, A. A. Onayade, A. O. Fatusi, K. T. Ijadunola & T. C. Abiona

  2. Department of Community Health, Faculty of Clinical Sciences, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria

    A. A. Onayade, A. O. Fatusi, K. T. Ijadunola & T. C. Abiona

Authors
  1. O. O. Asa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. A. Onayade
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. O. Fatusi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. K. T. Ijadunola
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. T. C. Abiona
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. O. Fatusi.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Asa, O.O., Onayade, A.A., Fatusi, A.O. et al. Efficacy of Intermittent Preventive Treatment of Malaria with Sulphadoxine-pyrimethamine in Preventing Anaemia in Pregnancy among Nigerian Women. Matern Child Health J 12, 692–698 (2008). https://doi.org/10.1007/s10995-008-0319-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10995-008-0319-3

Keywords

Search

Navigation