Parasitologic Assessment of Two-Dose and Monthly Intermittent Preventive Treatment of Malaria during Pregnancy with Sulphadoxine-Pyrimethamine (IPTP-SP) in Lagos, Nigeria
Intermittent preventive treatment of malaria with sulphadoxine-pyrimethamine (IPTP-SP) is a key strategy in the control of malaria in pregnancy. However, reports of increasing level of resistance to SP using nonpregnant populations have made it imperative for the continuous monitoring of the efficacy of SP in pregnant women. This study assessed using microscopy, monthly dosing and the standard two-dose regimen among 259 pregnant women attending antenatal clinics in Lagos, Nigeria that consented 122 in the two-dose arm (Arm A) and 137 in the monthly dose arm (Arm B). Baseline parasitaemia in the two groups was 5 (4.1%) and 3 (2.2%) in Arms A and B, respectively. Few of the women developed parasitaemia after the initial SP dose in Arms A 4 (3.3%) and B 2 (1.5%). However, none of the women had malaria infection after the second dose in both Arms. Although IPTP-SP is suggestive of protecting the women from malaria infection, there was no significant difference observed between the two dosing schemes. 1. Introduction An estimated 25–30 million women become pregnant annually in malaria-endemic areas of Africa, most of them living in areas of stable malaria transmission [1]. The immunosuppression associated with pregnancy and the absence of specific immunity to the unique subset of parasites (VAR2CSA) that sequester in the placenta, especially in primigravidae, are the reasons for the increased susceptibility of pregnant women to malaria infection [2, 3]. However, the antidisease immunity acquired prior to pregnancy keeps the infection asymptomatic in presentation. However, the subclinical infection still poses a great danger to both the mother and the foetus. The presence of parasites in the placenta can lead to maternal anaemia (potentially responsible for maternal death when severe), low birth weight (LBW), congenital malaria, premature delivery, abortion, and stillbirth [4–6]. Current strategies to control malaria in pregnancy are the intermittent preventive treatment with sulphadoxine-pyrimethamine (IPTp-SP), use of insecticide-treated bed nets, and case management of malaria illness and anemia [1, 7]. IPTp-SP is the administration of two or more therapeutic doses of SP regardless of the presence of malarial infection, at an interval of at least four weeks, starting in the second trimester of pregnancy (after quickening). The first SP dose is administered in the second trimester after quickening and the second dose of SP in the third trimester to ensure that the placenta is cleared of malaria parasites at the time of rapid foetal growth [8]. Two doses of
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