Malar J

BackgroundIntermittent preventive treatment of malaria in pregnancy (IPTp) with sulphadoxine-pyrimethamine (SP) decreases placental parasitaemia, thus improving birth outcomes. Zambian policy recommends monthly SP-IPTp doses given presumptively during pregnancy at each antenatal examination, spaced one month apart after 16\ua0weeks of gestation. The effectiveness of SP-IPTp was evaluated in Zambia where a recent study showed moderate prevalence of Plasmodium falciparum parasites with genetic mutations that confer SP resistance.MethodsHIV-negative women were enrolled at the time of delivery at two facilities in Mansa, Zambia, an area of high malaria transmission. Women were interviewed and SP exposure was determined by antenatal card documentation or self-reports. Using Poisson regression modelling, the effectiveness of SP-IPTp was evaluated for outcomes of parasitaemia (microscopic examination of maternal peripheral, cord, and placental blood films), maternal anaemia (Hb\u2009<\u200911\ua0g/dl), placental infection (histopathology), and infant outcomes (low birth weight (LBW), preterm delivery, and small for gestational age) in women who took 0\u20134 doses of SP-IPTp.ResultsParticipants included 435 women, with a median age of 23\ua0years (range 16\u201344). Thirty-four women took zero doses of SP-IPTp, while 115, 142 and 144 women took one, two, or\u2009 65\u2009three doses, respectively. Multivariate Poisson regression models considering age, mosquito net usage, indoor residual spraying, urban home, gravidity, facility, wet season delivery, and marital status showed that among paucigravid women\u2009 65\u2009two doses of SP-ITPp compared to one or less doses was associated with a protective effect on LBW (prevalence ratio (PR) 0.33, 95% confidence interval (CI) 0.12\u20130.91) and any infection (PR 0.76, CI 0.58\u20130.99). Multivariate models considering SP-IPTp as a continuous variable showed a protective dose\u2013response association with LBW (paucigravid women: PR 0.54, CI 0.33\u20130.90, multigravid women: PR 0.63, CI 0.41\u20130.97).ConclusionsIn Mansa, Zambia, an area of moderate SP resistance, 65 two doses of SP-IPTp were associated with a protective effect from malaria in pregnancy, especially among paucigravid women. Each dose of SP-IPTp contributed to a 46 and 37% decrease in the frequency of LBW among paucigravid and multigravid women, respectively. SP-IPTp remains a viable strategy in this context.2015665