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Cited by 174Malaria Research and ControlHemoglobinopathies and Related DisordersGlobal Maternal and Child Health

Impact of Sulfadoxine-Pyrimethamine Resistance on Effectiveness of Intermittent Preventive Therapy for Malaria in Pregnancy at Clearing Infections and Preventing Low Birth Weight

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Desai, Meghna, Gutman, Julie, Taylor, Steve M., Wiegand, Ryan E., Khairallah, Carole, Kayentao, Kassoum, Ouma, Peter, Coulibaly, Sheick O. +15 more·2016·Clinical Infectious Diseases
DOI 10.1093/cid/civ881PMC PMC4762476
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Abstract

BACKGROUND: Owing to increasing sulfadoxine-pyrimethamine (SP) resistance in sub-Saharan Africa, monitoring the effectiveness of intermittent preventive therapy in pregnancy (IPTp) with SP is crucial. METHODS: Between 2009 and 2013, both the efficacy of IPTp-SP at clearing existing peripheral malaria infections and the effectiveness of IPTp-SP at reducing low birth weight (LBW) were assessed among human immunodeficiency virus-uninfected participants in 8 sites in 6 countries. Sites were classified as high, medium, or low resistance after measuring parasite mutations conferring SP resistance. An individual-level prospective pooled analysis was conducted. RESULTS: Among 1222 parasitemic pregnant women, overall polymerase chain reaction-uncorrected and -corrected failure rates by day 42 were 21.3% and 10.0%, respectively (39.7% and 21.1% in high-resistance areas; 4.9% and 1.1% in low-resistance areas). Median time to recurrence decreased with increasing prevalence of Pfdhps-K540E. Among 6099 women at delivery, IPTp-SP was associated with a 22% reduction in the risk of LBW (prevalence ratio [PR], 0.78; 95% confidence interval [CI], .69-.88; P < .001). This association was not modified by insecticide-treated net use or gravidity, and remained significant in areas with high SP resistance (PR, 0.81; 95% CI, .67-.97; P = .02). CONCLUSIONS: The efficacy of SP to clear peripheral parasites and prevent new infections during pregnancy is compromised in areas with >90% prevalence of Pfdhps-K540E. Nevertheless, in these high-resistance areas, IPTp-SP use remains associated with increases in birth weight and maternal hemoglobin. The effectiveness of IPTp in eastern and southern Africa is threatened by further increases in SP resistance and reinforces the need to evaluate alternative drugs and strategies for the control of malaria in pregnancy.

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  • Despite the clinically proven advantages of IPTp-SP, utilisation of IPTp-SP has been low in many African countries.

    “Despite the clinically proven advantages of intermittent preventive treatment of malaria in pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP), utilisation has been low in many African countries.”

    From High uptake of Intermittent Preventive Treatment of malaria in pregnancy is associated with improved birth weight among pregnant women in Ghana (2019) · cites this paper as [12]

    The introductory passage (page unavailable) describes IPTp-SP’s benefits, including reduced risks of maternal anemia, low birth weight, and neonatal mortality. The Results, Delivery Module reports doses received by women at study sites in six countries, but does not establish that utilisation was low across many African countries. (LLM, conf=0.82)

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References 34 · Cited by 174

Research works printed but not linked: 29

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Authors
Desai, M., Gutman, J., Taylor, S. M., Wiegand, R. E., Khairallah, C., Kayentao, K., Ouma, P., Coulibaly, S. O., Kalilani, L., Mace, K. E., Arinaitwe, E., Mathanga, D. P., Doumbo, O., Otieno, K., Edgar, D., Chaluluka, E., Kamuliwo, M., Ades, V., Skarbinski, J., Shi, Y. P., Magnussen, P., Meshnick, S., & ter Kuile, F. O.
Affiliations
  • Centers for Disease Control and Prevention (US)
  • University of North Carolina at Chapel Hill (US)
  • Liverpool School of Tropical Medicine (GB)
  • Kenya Medical Research Institute (KE)
  • Université Joseph Ki-Zerbo (BF)
  • University of Malawi (MW)
  • Infectious Diseases Research Collaboration (UG)
  • Université des Sciences, des Techniques et des Technologies de Bamako (ML)
  • NYU Langone Health (US)
  • University of Copenhagen (DK)
Corresponding author
Desai, Meghna
ORCID
Venue
Clinical Infectious Diseases
Publisher
Oxford University Press (OUP)
Published
2015-10-20
Volume
62
Issue
3
Pages
323-333
ISSN
  • 1058-4838 (ISSN-L)
  • 1537-6591
DOI
10.1093/cid/civ881
PMC
PMC4762476
OpenAlex
W1808142626
Cited by
174
References
34
Citations by year
2026: 9 · 2025: 23 · 2024: 14 · 2023: 15 · 2022: 15 · 2021: 22 · 2020: 21 · 2019: 18 · 2018: 13 · 2017: 15 · 2016: 9
FWCI
13.23
Type
journal article
Language
en
Open access
Locations
  • Clinical Infectious Diseases (publishedVersion, public-domain)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
  • LSTM Online Archive (Liverpool School of Tropical Medicine) (submittedVersion, public-domain)
  • HighWire Press Open Archive (submittedVersion)
  • Research at the University of Copenhagen (University of Copenhagen) (submittedVersion, public-domain)
Funders
  • US President's Malaria Initiative
  • USAID
  • Malaria in Pregnancy Consortium,
  • Bill & Melinda Gates Foundation (46099, Liverpool School of Tropical Medicine)
  • European Developing Countries Clinical Trials Partnership (2007.31080.003)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Malaria Research and Control
  • Health Sciences › Medicine › Genetics › Hemoglobinopathies and Related Disorders
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
Keywords
sulfadoxine-pyrimethamine resistance, intermittent preventive treatment in pregnancy, malaria in pregnancy, low birth weight, parasite clearance, malaria recurrence, antimalarial drug resistance, maternal hemoglobin, sub-Saharan Africa
MeSH terms
Adult, Antimalarials, Dihydropteroate Synthase, Drug Combinations, Drug Resistance, Drug Therapy, Female, Humans, Infant, Low Birth Weight, Infant, Newborn, Malaria, Plasmodium falciparum, Pregnancy, Pregnancy Complications, Infectious, Prospective Studies, Pyrimethamine, Sulfadoxine, Treatment Outcome, Africa South of the Sahara, Amino Acid Substitution, Mutant Proteins, Young Adult

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