Effect of sulfadoxine-pyrimethamine doses for prevention of malaria during pregnancy in hypoendemic area in Tanzania
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Abstract
BACKGROUND: Malaria in pregnancy increases the risk of deleterious maternal and birth outcomes. The use of ≥ 3 doses of sulfadoxine-pyrimethamine (SP) for intermittent preventive treatment of malaria (IPTp-SP) is recommended for preventing the consequences of malaria during pregnancy. This study assessed the effect of IPTp-SP for prevention of malaria during pregnancy in low transmission settings. METHODS: A cross-sectional study that involved consecutively selected 1161 pregnant women was conducted at Mwananyamala regional referral hospital in Dar es Salaam. Assessment of the uptake of IPTp-SP was done by extracting information from antenatal clinic cards. Maternal venous blood, cord blood, placental blood and placental biopsy were collected for assessment of anaemia and malaria. High performance liquid chromatography with ultraviolet detection (HPLC-UV) was used to detect and quantify sulfadoxine (SDX). Dried blood spots (DBS) of placental blood were collected for determination of sub-microscopic malaria using polymerase chain reaction (PCR). RESULTS: In total, 397 (34.2%) pregnant women reported to have used sub-optimal doses (≤ 2) while 764 (65.8%) used optimal doses (≥ 3) of IPTp-SP at the time of delivery. The prevalence of placental malaria as determined by histology was 3.6%. Submicroscopic placental malaria was detected in 1.4% of the study participants. Women with peripheral malaria had six times risk of maternal anaemia than those who were malaria negative (aOR, 5.83; 95% CI 1.10-30.92; p = 0.04). The geometric mean plasma SDX concentration was 10.76 ± 2.51 μg/mL. Sub-optimal IPTp-SP dose was not associated with placental malaria, premature delivery and fetal anaemia. The use of ≤ 2 doses of IPTp-SP increased the risk of maternal anaemia by 1.36-fold compared to ≥ 3 doses (aOR, 1.36; 95% CI 1.04-1.79; p = 0.02). CONCLUSION: The use of < 2 doses of IPTp-SP increased the risk of maternal anaemia. However, sub-optimal doses (≤ 2 doses) were not associated with increased the risk of malaria parasitaemia, fetal anaemia and preterm delivery among pregnant women in low malaria transmission setting. The use of optimal doses (≥ 3 doses) of IPTp-SP and complementary interventions should continue even in areas with low malaria transmission.
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IPTp-SP is effective in preventing pregnancy-associated malaria in areas with moderate to high transmission but not so much in areas with substantial reduction of malaria transmission.
“Several studies have reported the effectiveness of IPTp with sulphadoxine-pyrmethamine (SP) (IPTp-SP) in the prevention of pregnancy associated malaria in areas with moderate to high transmission but not so much in areas with substantial reduction of malaria transmission [12].”
From Intermittent preventive treatment with Sulphadoxine-Pyrimethamine (IPTp-SP) is associated with protection against sub-microscopic P. falciparum infection in pregnant women during the low transmission dry season in southwestern Cameroon: A Semi - longitudinal study (2022) · cites this paper as [12]
The low IPTp-SP uptake recorded in this study can explain the 39.9% prevalence of P. falciparum infection.
“This can be explained by the low IPTp-SP uptake recorded in this study”
From Intermittent preventive treatment with Sulphadoxine-Pyrimethamine (IPTp-SP) is associated with protection against sub-microscopic P. falciparum infection in pregnant women during the low transmission dry season in southwestern Cameroon: A Semi - longitudinal study (2022) · cites this paper as [12]
Higher optimal IPTp-SP uptake was expected because the main healthcare facility was located close to households and parturient were expected to frequently attend ANC and be sensitized about SP by well-trained health care personnel.
“Higher optimal IPTp-SP uptake was expected as reported recently in a hypoendemic area in Tanzania [12] since the main healthcare facility was located close to the households and parturient expected to frequently attend ANC and be sensitized about SP by well-trained health care personnel [41].”
From Intermittent preventive treatment with Sulphadoxine-Pyrimethamine (IPTp-SP) is associated with protection against sub-microscopic P. falciparum infection in pregnant women during the low transmission dry season in southwestern Cameroon: A Semi - longitudinal study (2022) · cites this paper as [12]
The lack of statistical difference between optimal and sub-optimal doses suggests that the effect of the chemoprophylaxis may not be translated clinically.
“Although the lack of statistical difference between those who received optimal and sub-optimal doses for IPTp-SP suggests that the effect of the chemoprophylaxis may not be translated clinically [12]”
From Intermittent preventive treatment with Sulphadoxine-Pyrimethamine (IPTp-SP) is associated with protection against sub-microscopic P. falciparum infection in pregnant women during the low transmission dry season in southwestern Cameroon: A Semi - longitudinal study (2022) · cites this paper as [12]
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- [42]Iván B Anemia of infection. Iron metabolism 1983 Boston Springer 275 283
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Apinjoh, T. O., Ntui, V. N., Chi, H. F., Moyeh, M. N., Toussi, C. T., Mayaba, J. M., Tangi, L. N., Kwi, P. N., Anchang-Kimbi, J. K., Dionne-Odom, J., et al. (2022) · PLOS ONE · doi:10.1371/journal.pone.0275370 · Cited by 13 · see citing works
- Authors
- Mikomangwa, W. P., Minzi, O., Mutagonda, R., Baraka, V., Mlugu, E. M., Aklillu, E., & Kamuhabwa, A. A. R.
- Affiliations
- Muhimbili University of Health and Allied Sciences (TZ)
- National Institute for Medical Research (TZ)
- Karolinska University Hospital (SE)
- Corresponding author
- Mikomangwa, Wigilya P.
- ORCID
- Venue
- Malaria Journal
- Published
- 2020-04-19
- Volume
- 19
- Issue
- 1
- Pages
- 160-160
- ISSN
- 1475-2875 (ISSN-L)
- PMC
- PMC7168863
- OpenAlex
- W3016416111
- Cited by
- 36
- References
- 45
- Citations by year
- 2026: 3 · 2025: 10 · 2024: 9 · 2023: 6 · 2022: 6 · 2021: 2
- FWCI
- 2.62
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Malaria Journal (publishedVersion, cc-by)
- Research Square (acceptedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Styrelsen för Internationellt Utvecklingssamarbete
- Muhimbili University of Health and Allied Sciences
- University of Health and Allied Sciences
- 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
- sulfadoxine-pyrimethamine, intermittent preventive treatment in pregnancy, malaria in pregnancy, anemia in pregnancy, placental malaria, submicroscopic malaria infection, low transmission settings, Tanzania, Dar es Salaam, placental histology, fetal anemia, preterm birth, placental biopsy, dried blood spots
- MeSH terms
- Adult, Antimalarials, Cross-Sectional Studies, Drug Combinations, Female, Humans, Malaria, Pregnancy, Pyrimethamine, Sulfadoxine, Tanzania, Pregnancy Complications, Parasitic, Endemic Diseases, Young Adult
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