Current efficacy of sulphadoxine-pyrimethamine for intermittent preventive treatment of malaria during pregnancy in Dar es salaam

Abstract

Background: Intermittent preventive treatment of malaria in pregnancy with Sulphadoxine-Pyrimethamine (IPTp-SP) reduces incidence of malaria, asymptomatic parasitaemia and anaemia, thus improving pregnancy outcome particularly by increasing birth weight. The strategy is widely used in malaria endemic countries. Currently, SP is probably the best available drug for IPTp and is reserved for the purpose in many countries. This reduces sustained drug pressure to P.falciparum, which may increase the level of SP resistance. However, there are anecdote reports that SP continues to be used in non-pregnant patients in Tanzania. Indeed, at least one meta-analysis has indicated that the benefit of SP for IPTp may be declining. Objective: To determine the current efficacy of SP for intermittent preventive treatment of malaria during pregnancy in Dar es Salaam. Methodology Two doses of SP were given to 310 pregnant women according to national guidelines. All participants were followed up and evaluated at least once at week 28 onwards and at delivery. Results A total of 310 pregnant women with a mean age (±SD) 26.4 (±0.3) years were enrolled. The proportion of low birth weight was not different from previous studies (6.5%versus 7.3 %; P = 0.721). The proportion of subjects with peripheral parasitemia at delivery was 2% (6/296). None had severe anemia or clinical malaria at delivery, and only six women (2%) had clinical malaria during follow up. Background Intermittent preventive treatment of malaria in pregnancy with Sulphadoxine-Pyrimethamine (IPTp-SP) reduces incidence of malaria, asymptomatic parasitaemia and anaemia, thus improving pregnancy outcome particularly by increasing birth weight. The strategy is widely used in malaria endemic countries. Currently, SP is probably the best available drug for IPTp and is reserved for the purpose in many countries. This reduces sustained drug pressure to P.falciparum, which may increase the level of SP resistance. However, there are anecdote reports that SP continues to be used in non-pregnant patients in Tanzania. Indeed, at least one meta-analysis has indicated that the benefit of SP for IPTp may be declining. Objective: To determine the current efficacy of SP for intermittent preventive treatment of malaria during pregnancy in Dar es Salaam. Methodology Two doses of SP were given to 310 pregnant women according to national guidelines. All participants were followed up and evaluated at least once at week 28 onwards and at delivery. Results A total of 310 pregnant women with a mean age (±SD) 26.4 (±0.3) years were enrolled. The proportion of low birth weight was not different from previous studies (6.5%versus 7.3 %; P = 0.721). The proportion of subjects with peripheral parasitemia at delivery was 2% (6/296). None had severe anemia or clinical malaria at delivery, and only six women (2%) had clinical malaria during follow up.

Conclusions Efficacy of SP for IPTp seems to be at a level similar to what it was about ten years ago. Our data are reassuring that the efficacy of IPTP-SP is still high and the Ministry of Health and Social Welfare may not need to change the policy for treatment of malaria in pregnancy at the moment. However, regular monitoring is essential for timely corrective measures when the need arises.