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Eficacia individual del tratamiento preventivo intermitente con sulfadoxina‐pirimetamina en primi y secundigrávidas en Burkina Faso rural: impacto sobre parasitemia, anemia y peso al nacer
Author(s) -
Gies Sabine,
Coulibaly Sheick Oumar,
Ouattara Florence Tiemegna,
D’Alessandro Umberto
Publication year - 2009
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/j.1365-3156.2008.02215.x
Subject(s) - medicine , sulfadoxine , low birth weight , sulfadoxine/pyrimethamine , malaria , birth weight , odds ratio , obstetrics , pregnancy , pyrimethamine , immunology , chloroquine , biology , genetics
Summary Objective To assess the efficacy at individual level of intermittent preventive treatment with sulfadoxine–pyrimethamine (IPTp‐SP) in primi‐ and secundigravidae in rural Burkina Faso. Methods Data of 1441 women enrolled in a health centre randomized trial and delivering a live‐singleton between September 2004 and October 2006 were analysed at individual level. Prevalence of peripheral and placental parasitaemia, anaemia (PCV <33%), low‐birth weight (<2500 g; LBW), mean packed cell volume (PCV) and birth weight were compared in relation to the number of directly observed SP doses. Results Two or more doses of SP significantly reduced the risk of placental parasitaemia [adjusted odds ratio (AOR) = 0.04, 95%CI = 0.003–0.60, P = 0.023] and anaemia at delivery (AOR = 0.31, 95%CI = 0.18–0.52, P < 0.001). IPTp was associated with reduced risk of LBW in primigravidae (AOR = 0.11, 95%CI = 0.07–0.17, P < 0.001) but not secundigravidae (AOR = 0.70, 95%CI = 0.26–1.91, P = 0.452). For each increment in number of SP doses mean PCV increased by 1.0% (95%CI = 0.4–1.7, P = 0.005) at 32 weeks gestation, by 1.2% (95%CI = 0.2–2.2, P = 0.025) at delivery and mean birth weight by 220 g (95%CI = 134–306 P < 0.001) in primigravidae and by 102 g (95%CI = 55–148, P = 0.001) in secundigravidae. Conclusion The risk of malaria infection was significantly reduced by IPTp with SP in primi‐ and secundigravidae in rural Burkina Faso. The impact on clinical outcomes is lower and mainly limited to primigravidae for LBW. Incomplete uptake of IPTp‐SP and limited effect in low risk groups together may substantially dilute the measurable impact of effective interventions. This needs to be taken into account when evaluating interventions at community level.