Sustained clinical benefit of malaria chemoprevention with sulfadoxine-pyrimethamine (SP) in pregnant women in a region with high SP resistance markers - 30/04/24
Summary |
Objective |
The effectiveness of intermittent preventive treatment of malaria in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) is threatened by increasing SP-resistance in Africa. We assessed the level of SP-resistance markers, and the clinical and parasitological effectiveness of IPTp-SP in southern Mozambique.
Methods |
P. falciparum infection, antimalarial antibodies and dhfr/dhps SP-resistance mutants were detected by quantitative polymerase chain reaction (qPCR), suspension array technology and targeted deep sequencing, respectively, among 4016 HIV-negative women in Maputo province (2016–2019). Univariate and multivariate regression models were used to assess the association between taking the recommended three or more IPTp-SP doses (IPTp3+) and parasitological and clinical outcomes.
Results |
84.3% (3385/4016) women received three or more IPTp-SP doses. The prevalence of quintuple mutants at first antenatal care (ANC) visit was 94.2%. IPTp3+ was associated with a higher clearance rate of qPCR-detected infections from first ANC visit to delivery (adjusted odds ratio [aOR]=5.9, 95% CI: 1.5–33.3; p = 0.012), lower seroprevalence at delivery of antibodies against the pregnancy-specific antigen VAR2CSADBL34 (aOR=0.72, 95% CI: 0.54–0.95; p = 0.022), and lower prevalence of low birth weight deliveries (aOR: 0.61, 95% CI: 0.41–0.90; p = 0.013).
Conclusion |
A sustained parasitological effect of IPTp-SP contributes to the clinical effectiveness of IPTp3+ in areas with high prevalence of SP-resistance markers.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Quintuple SP-resistance markers are almost fixated in southern Mozambique. |
• | In this context, IPTp-SP still retains parasitological and clinical effects. |
• | Both malaria-related and unrelated mechanisms can contribute to IPTp-SP effectiveness. |
• | Late ANC attendance and suboptimal number of IPTp-SP doses are still major barriers. |
Keywords : Malaria, Pregnancy, Chemoprevention, Intermittent preventive treatment, Sulfadoxine-pyrimethamine, Antimalarial resistance
Plan
Vol 88 - N° 5
Article 106144- mai 2024 Retour au numéro
Article précédent
- Utility of an in-house real-time PCR in whole blood samples as a minimally invasive method for early and accurate diagnosis of invasive mould infections.
- Mragnayani Pandey, Immaculata Xess, Janya Sachdev, Neha Sharad, Sonakshi Gupta, Gagandeep Singh, Renu Kumari Yadav, Bhaskar Rana, Stephen Raj, M.Nizam Ahmad, Neha Nityadarshini, Upendra Baitha, Manish Soneja, Bindu Prakash, Kapil Sikka, Purva Mathur, Viveka P. Jyotsna, Rakesh Kumar, Naveet Wig, Sudesh Gourav, Ashutosh Biswas, Alok Thakar
- Re-emergence of Diphtheria after COVID-19 pandemic in Pakistan: Time to consider booster vaccination strategies
- Muhammad Salman, Muhammad S. Rana, Muhammad Usman, Muhammad Tahir, Kashif Muqarrab, Muhammad B. Alam, Massab Umair, Muhammad Anas, Nadeem Ullah, Ayesha Farooq, Zurva Ashraf
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?