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Intermittent Preventive Therapy with Sulfadoxine-Pyrimethamine for Malaria in Pregnancy: A Cross-Sectional Study from Tororo, Uganda

Author

Listed:
  • Emmanuel Arinaitwe
  • Veronica Ades
  • Andrew Walakira
  • Boaz Ninsiima
  • Olive Mugagga
  • Teja S Patil
  • Alanna Schwartz
  • Moses R Kamya
  • Sussann Nasr
  • Michelle Chang
  • Scott Filler
  • Grant Dorsey

Abstract

Background: Intermittent preventive treatment during pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) is widely recommended in sub-Saharan Africa to reduce the risk of malaria and improve birth outcomes. However, there are reports that the efficacy of IPTp with SP is waning, especially in parts of Africa where antimalarial resistance to this drug has become widespread. Methodology/Principal Findings: We conducted a cross-sectional study of 565 HIV-uninfected women giving birth at Tororo District Hospital in southeastern Uganda. The primary objective of the study was to measure associations between use of SP during pregnancy from antenatal records and the risk of adverse outcomes including placental malaria, low birth weight, maternal parasitemia and maternal anemia. The proportion of women who reported taking 0, 1, 2, and 3 doses of SP during pregnancy was 5.7%, 35.8%, 56.6% and 2.0% respectively. Overall, the prevalence of placental malaria was 17.5%, 28.1%, and 66.2% by placental smear, PCR, and histopathology, respectively. In multivariate analyses controlling for potential confounders, ≥2 doses of SP was associated with non-significant trends towards lower odds of placental malaria by placental smear (OR = 0.75, p = 0.25), placental malaria by PCR (OR = 0.93, p = 0.71), placental malaria by histopathology (OR = 0.75, p = 0.16), low birth weight (OR = 0.63, p = 0.11), maternal parasitemia (OR = 0.88, p = 0.60) and maternal anemia (OR = 0.88, p = 0.48). Using a composite outcome, ≥2doses of SP was associated with a significantly lower odds of placental malaria, low birth weight, maternal parasitemia, or maternal anemia (OR = 0.52, p = 0.01). Conclusions/Significance: In this area of Uganda with intense malaria transmission, the prevalence of placental malaria by histopathology was high even among women who reported taking at least 2 doses of SP during pregnancy. The reported use of ≥2 doses of SP was not associated with protection against individual birth and maternal outcome measures but did protect against a composite measure of any adverse outcome.

Suggested Citation

  • Emmanuel Arinaitwe & Veronica Ades & Andrew Walakira & Boaz Ninsiima & Olive Mugagga & Teja S Patil & Alanna Schwartz & Moses R Kamya & Sussann Nasr & Michelle Chang & Scott Filler & Grant Dorsey, 2013. "Intermittent Preventive Therapy with Sulfadoxine-Pyrimethamine for Malaria in Pregnancy: A Cross-Sectional Study from Tororo, Uganda," PLOS ONE, Public Library of Science, vol. 8(9), pages 1-6, September.
    • Handle: RePEc:plo:pone00:0073073
    DOI: 10.1371/journal.pone.0073073
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    1. Joaniter Nankabirwa & Bonnie Cundill & Sian Clarke & Narcis Kabatereine & Philip J Rosenthal & Grant Dorsey & Simon Brooker & Sarah G Staedke, 2010. "Efficacy, Safety, and Tolerability of Three Regimens for Prevention of Malaria: A Randomized, Placebo-Controlled Trial in Ugandan Schoolchildren," PLOS ONE, Public Library of Science, vol. 5(10), pages 1-9, October.
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