Intermittent Preventive Therapy with Sulfadoxine-Pyrimethamine for Malaria in Pregnancy: A Cross-Sectional Study from Tororo, Uganda

Details

• Alternative Title:
  PLoS One
• Personal Author:
  Arinaitwe, Emmanuel ; Ades, Veronica ; Walakira, Andrew ; Ninsiima, Boaz ; Mugagga, Olive ; Patil, Teja S. ; Schwartz, Alanna ; Kamya, Moses R. ; Nasr, Sussann ; Chang, Michelle ; Filler, Scott ; Dorsey, Grant
• Description:
  Background
  
  Intermittent preventive treatment during pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) is widely recommended in sub-Saharan Africa to reduce the risk of malaria and improve birth outcomes. However, there are reports that the efficacy of IPTp with SP is waning, especially in parts of Africa where antimalarial resistance to this drug has become widespread.
  
  Methodology/Principal Findings
  
  We conducted a cross-sectional study of 565 HIV-uninfected women giving birth at Tororo District Hospital in southeastern Uganda. The primary objective of the study was to measure associations between use of SP during pregnancy from antenatal records and the risk of adverse outcomes including placental malaria, low birth weight, maternal parasitemia and maternal anemia. The proportion of women who reported taking 0, 1, 2, and 3 doses of SP during pregnancy was 5.7%, 35.8%, 56.6% and 2.0% respectively. Overall, the prevalence of placental malaria was 17.5%, 28.1%, and 66.2% by placental smear, PCR, and histopathology, respectively. In multivariate analyses controlling for potential confounders, ≥2 doses of SP was associated with non-significant trends towards lower odds of placental malaria by placental smear (OR = 0.75, p = 0.25), placental malaria by PCR (OR = 0.93, p = 0.71), placental malaria by histopathology (OR = 0.75, p = 0.16), low birth weight (OR = 0.63, p = 0.11), maternal parasitemia (OR = 0.88, p = 0.60) and maternal anemia (OR = 0.88, p = 0.48). Using a composite outcome, ≥2doses of SP was associated with a significantly lower odds of placental malaria, low birth weight, maternal parasitemia, or maternal anemia (OR = 0.52, p = 0.01).
  
  Conclusions/Significance
  
  In this area of Uganda with intense malaria transmission, the prevalence of placental malaria by histopathology was high even among women who reported taking at least 2 doses of SP during pregnancy. The reported use of ≥2 doses of SP was not associated with protection against individual birth and maternal outcome measures but did protect against a composite measure of any adverse outcome.
  
  
• Subjects:
  Adult Cross-Sectional Studies Dihydropteroate Synthase Documentation Drug Combinations Drug Resistance Female Humans Malaria Mutation Parturition Pregnancy Pregnancy Complications Pyrimethamine Sulfadoxine Tetrahydrofolate Dehydrogenase Young Adult

  More +
• Source:
  PLoS One. 2013; 8(9).
• Pubmed ID:
  24023811
• Pubmed Central ID:
  PMC3762885
• Document Type:
  Journal Article
• Funding:
  1U51CK000117/CK/NCEZID CDC HHS/United States
• Place as Subject:
  Uganda
• Volume:
  8
• Issue:
  9
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:ca8af6fee5109c0e8d9e17487d91b0ec6aa809203bb1409bfca36c3ec0fcaf9c
• Download URL:
  https://stacks.cdc.gov/view/cdc/22573/cdc_22573_DS1.pdf
• File Type:
  [PDF - 418.95 KB ]