Influence of malaria transmission intensity and the 581G mutation on the efficacy of intermittent preventive treatment in pregnancy: systematic review and meta-analysis.
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OBJECTIVES: To estimate where intermittent preventive treatment (IPTp) using sulphadoxine-pyrimethamine (SP) could be withdrawn as an intervention due to declining malaria transmission intensity, or due to increasing prevalence of the Plasmodium falciparum dihydropteroate synthetase resistance mutation at codon 581G. METHODS: We conducted a systematic review and meta-analysis of protection against the incidence of low birth weight (LBW) conferred by ≥2 doses of IPTp-SP. We matched these outcomes to a proxy measure of malaria incidence in women of the same studies, applied meta-regression models to these data and conducted sensitivity analysis of the 581G mutation. RESULTS: Variation in the protective effect of IPTp-SP against LBW could not be explained by malaria transmission intensity. Among primi- and secundigravidae, IPTp-SP protected against LBW where 581G was ≤10.1% [odds ratio (OR): 0.49; 95% confidence intervals (CI): 0.29, 0.81; P = <0.01] and 581G was >10.1% (OR = 0.73; 95% CI: 0.29, 1.81; P = 0.03). Random-effects models among multigravidae showed that IPTp-SP protects against LBW where 581G was ≤10.1% (OR = 0.56; 95% CI: 0.37, 0.86; P = 0.07), a finding of borderline statistical significance. No evidence of protection against LBW was observed where 581G was >10.1% (OR = 0.96; 95% CI: 0.70, 1.34; P = 0.47). CONCLUSION: There appears to be a prevalence of 581G above which IPTp-SP no longer protects against LBW. Pregnancy studies are urgently needed where 581G is >10.1% to define the specific prevalence threshold where new strategies should be deployed.
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The rate of P. falciparum infection among 2 to 10 year olds, as generated by the Malaria Atlas Project, has been used as a proxy for malaria among pregnant women.
“The rate of P. falciparum infection among 2 to 10 year olds, as generated by the Malaria Atlas Project (MAP), has been used as a proxy for malaria among pregnant women [23, 24].”
From Global estimates of pregnancies at risk of Plasmodium falciparum and Plasmodium vivax infection in 2020 and changes in risk patterns since 2000 (2022) · cites this paper as [24]
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- Authors
- Chico, R. M., Cano, J., Ariti, C., Collier, T. J., Chandramohan, D., Roper, C., & Greenwood, B.
- Affiliations
- London School of Hygiene & Tropical Medicine (GB)
- Nuffield Trust (GB)
- Corresponding author
- Chico, R. Matthew
- ORCID
- Venue
- Tropical Medicine & International Health
- Publisher
- Wiley
- Published
- 2015-09-30
- Volume
- 20
- Issue
- 12
- Pages
- 1621-1633
- ISSN
- 1360-2276 (ISSN-L)
- 1365-3156
- OpenAlex
- W1947887788
- Cited by
- 77
- References
- 47
- Citations by year
- 2026: 6 · 2025: 6 · 2024: 6 · 2023: 11 · 2022: 7 · 2021: 9 · 2020: 5 · 2019: 6 · 2018: 4 · 2017: 8 · 2016: 5 · 2015: 4
- FWCI
- 1.02
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Tropical Medicine & International Health (publishedVersion, cc-by)
- PubMed (publishedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- London School of Hygiene & Tropical Medicine (submittedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Malaria Research and Control
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
- Health Sciences › Medicine › Genetics › Hemoglobinopathies and Related Disorders
- Keywords
- intermittent preventive treatment in pregnancy, sulfadoxine-pyrimethamine, malaria transmission intensity, Plasmodium falciparum, antimalarial drug resistance, low birth weight, malaria in pregnancy
- MeSH terms
- Antimalarials, Dihydropteroate Synthase, Drug Combinations, Drug Resistance, Female, Humans, Infant, Low Birth Weight, Mutation, Plasmodium falciparum, Pregnancy, Pyrimethamine, Sulfadoxine, Pregnancy Complications, Parasitic, Malaria, Falciparum, Africa South of the Sahara, Gravidity
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