Journal Article

Intermittent Treatment to Prevent Pregnancy Malaria Does Not Confer Benefit in an Area of Widespread Drug Resistance

Whitney E. Harrington, Theonest K. Mutabingwa, Edward Kabyemela, Michal Fried and Patrick E. Duffy

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 53, issue 3, pages 224-230
Published in print August 2011 | ISSN: 1058-4838
Published online August 2011 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1093/cid/cir376
Intermittent Treatment to Prevent Pregnancy Malaria Does Not Confer Benefit in an Area of Widespread Drug Resistance

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(See the article by Maiga et al, on pages 215–223, and editorial commentary by Leke and Taylor, on pages 231–233.)

Background. Millions of African women receive sulfadoxine-pyrimethamine (SP) as intermittent preventive treatment during pregnancy (IPTp) to avoid poor outcomes that result from malaria. However, parasites resistant to SP are widespread in parts of Africa, and IPTp may perversely exacerbate placental infections that contain SP-resistant parasites.

Methods. The study used a cross-sectional design. We determined IPTp use in a delivery cohort of 880 pregnant women in Muheza, Tanzania, by report and by plasma sulfa measurements, and we examined its effects on maternal and fetal delivery outcomes.

Results. In the overall cohort, IPTp was not associated with decreased odds of placental malaria or with increased mean maternal hemoglobin or mean birth weight. Unexpectedly, IPTp was associated with decreased cord hemoglobin level and increased risk of fetal anemia, which may be related to in utero SP exposure.

Conclusions. IPTp does not improve overall pregnancy outcomes in Muheza, Tanzania, where SP-resistant parasites predominate and may increase the odds of fetal anemia. As parasite resistance increases in a community, the overall effect of IPTp may transition from net benefit to neutral or net harm.

Journal Article.  4077 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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