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Influence of malaria transmission intensity and the 581G mutation on the efficacy of intermittent preventive treatment in pregnancy: systematic review and meta‐analysis
Author(s) -
Chico R. Matthew,
Cano Jorge,
Ariti Cono,
Collier Timothy J.,
Chandramohan Daniel,
Roper Cally,
Greenwood Brian
Publication year - 2015
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/tmi.12595
Subject(s) - medicine , malaria , meta analysis , odds ratio , sulfadoxine , pregnancy , confidence interval , incidence (geometry) , low birth weight , obstetrics , pyrimethamine , primaquine , plasmodium falciparum , immunology , biology , chloroquine , genetics , physics , optics
Objectives To estimate where intermittent preventive treatment ( IPT p) using sulphadoxine–pyrimethamine ( SP ) could be withdrawn as an intervention due to declining malaria transmission intensity, or due to increasing prevalence of the Plasmodium falciparum dihydropteroate synthetase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 IPT p‐ 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 IPT p‐ SP against LBW could not be explained by malaria transmission intensity. Among primi‐ and secundigravidae, IPT p‐ 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 IPT p‐ 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 IPT p‐ 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.