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 numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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