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Tagbor, Harry; Cairns, Matthew; Bojang, Kalifa; Coulibaly, Sheikh; Kayentao, Kassoum; Williams, John; Abubakar, Ismaela; Akor, Francis; Mohammed, Khalifa; Bationo, Richard; Dabira, Edgar; Soulama, Alamissa; Djimdé, Moussa; Guirou, Etienne; Awine, Timothy; Quaye, Stephen; Njie, Fanta; Ordi i Majà, Jaume; Doumbo, Ogobara; Hodgson, Abraham; Oduro, Abraham; Meshnick, Steven; Taylor, Steve; Magnussen, Pascal; Ter Kuile, Feiko O.; Woukeu, Arouna; Milligan, Paul; Chandramohan, Daniel; Greenwood, Brian (2015)
Publisher: Public Library of Science (PLoS)
Languages: English
Types: Article
Subjects: Drug testing, Research Article, Malària, Preventive medicine, wa_110, Medicine, Complicacions en l'embaràs, wc_765, Malaria, wa_310, wc_750, Q, R, Assaigs clínics de medicaments, Science, wq_200, Complications of pregnancy, Medicina preventiva

Classified by OpenAIRE into

mesheuropmc: parasitic diseases
BACKGROUND: The efficacy of intermittent preventive treatment for malaria with sulfadoxine-pyrimethamine (IPTp-SP) in pregnancy is threatened in parts of Africa by the emergence and spread of resistance to SP. Intermittent screening with a rapid diagnostic test (RDT) and treatment of positive women (ISTp) is an alternative approach. METHODS AND FINDINGS: An open, individually randomized, non-inferiority trial of IPTp-SP versus ISTp was conducted in 5,354 primi- or secundigravidae in four West African countries with a low prevalence of resistance to SP (The Gambia, Mali, Burkina Faso and Ghana). Women in the IPTp-SP group received SP on two or three occasions whilst women in the ISTp group were screened two or three times with a RDT and treated if positive for malaria with artemether-lumefantrine (AL). ISTp-AL was non-inferior to IPTp-SP in preventing low birth weight (LBW), anemia and placental malaria, the primary trial endpoints. The prevalence of LBW was 15.1% and 15.6% in the IPTp-SP and ISTp-AL groups respectively (OR = 1.03 [95% CI: 0.88, 1.22]). The mean hemoglobin concentration at the last clinic attendance before delivery was 10.97g/dL and 10.94g/dL in the IPTp-SP and ISTp-AL groups respectively (mean difference: -0.03 g/dL [95% CI: -0.13, +0.06]). Active malaria infection of the placenta was found in 24.5% and in 24.2% of women in the IPTp-SP and ISTp-AL groups respectively (OR = 0.95 [95% CI 0.81, 1.12]). More women in the ISTp-AL than in the IPTp-SP group presented with malaria parasitemia between routine antenatal clinics (310 vs 182 episodes, rate difference: 49.4 per 1,000 pregnancies [95% CI 30.5, 68.3], but the number of hospital admissions for malaria was similar in the two groups. CONCLUSIONS: Despite low levels of resistance to SP in the study areas, ISTp-AL performed as well as IPTp-SP. In the absence of an effective alternative medication to SP for IPTp, ISTp-AL is a potential alternative to IPTp in areas where SP resistance is high. It may also have a role in areas where malaria transmission is low and for the prevention of malaria in HIV positive women receiving cotrimoxazole prophylaxis in whom SP is contraindicated. TRIAL REGISTRATION: ClinicalTrials.gov NCT01084213 Pan African Clinical trials Registry PACT201202000272122.