Impact of Sulfadoxine-Pyrimethamine resistance on effectiveness of intermittent preventive therapy for malaria in pregnancy at clearing infections and preventing low birth weight
Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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Impact of Sulfadoxine-Pyrimethamine resistance on effectiveness of intermittent preventive therapy for malaria in pregnancy at clearing infections and preventing low birth weight. / Desai, Meghna; Gutman, Julie; Taylor, Steve M.; Wiegand, Ryan E; Khairallah, Carole; Kayentao, Kassoum; Ouma, Peter; Coulibaly, Sheick O.; Kalilani, Linda; Mace, Kimberly E.; Arinaitwe, Emmanuel; Mathanga, Don P.; Doumbo, Ogobara; Otieno, Kephas; Edgar, Dabira; Chaluluka, Ebbie; Kamuliwo, Mulakwa; Ades, Veronica; Skarbinski, Jacek; Shi, Ya Ping; Magnussen, Pascal; Meshnick, Steve; Kuile, Feiko O. ter.
I: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, Bind 62, Nr. 3, 2016, s. 323-233.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Impact of Sulfadoxine-Pyrimethamine resistance on effectiveness of intermittent preventive therapy for malaria in pregnancy at clearing infections and preventing low birth weight
AU - Desai, Meghna
AU - Gutman, Julie
AU - Taylor, Steve M.
AU - Wiegand, Ryan E
AU - Khairallah, Carole
AU - Kayentao, Kassoum
AU - Ouma, Peter
AU - Coulibaly, Sheick O.
AU - Kalilani, Linda
AU - Mace, Kimberly E.
AU - Arinaitwe, Emmanuel
AU - Mathanga, Don P.
AU - Doumbo, Ogobara
AU - Otieno, Kephas
AU - Edgar, Dabira
AU - Chaluluka, Ebbie
AU - Kamuliwo, Mulakwa
AU - Ades, Veronica
AU - Skarbinski, Jacek
AU - Shi, Ya Ping
AU - Magnussen, Pascal
AU - Meshnick, Steve
AU - Kuile, Feiko O. ter
N1 - Published by Oxford University Press for the Infectious Diseases Society of America 2015. This work is written by (a) US Government employee(s) and is in the public domain in the US.
PY - 2016
Y1 - 2016
N2 - BACKGROUND: Owing to increasing sulfadoxine-pyrimethamine (SP) resistance in sub-Saharan Africa, monitoring the effectiveness of intermittent preventive therapy in pregnancy (IPTp) with SP is crucial.METHODS: Between 2009 and 2013, both the efficacy of IPTp-SP at clearing existing peripheral malaria infections and the effectiveness of IPTp-SP at reducing low birth weight (LBW) were assessed among human immunodeficiency virus-uninfected participants in 8 sites in 6 countries. Sites were classified as high, medium, or low resistance after measuring parasite mutations conferring SP resistance. An individual-level prospective pooled analysis was conducted.RESULTS: Among 1222 parasitemic pregnant women, overall polymerase chain reaction-uncorrected and -corrected failure rates by day 42 were 21.3% and 10.0%, respectively (39.7% and 21.1% in high-resistance areas; 4.9% and 1.1% in low-resistance areas). Median time to recurrence decreased with increasing prevalence of Pfdhps-K540E. Among 6099 women at delivery, IPTp-SP was associated with a 22% reduction in the risk of LBW (prevalence ratio [PR], 0.78; 95% confidence interval [CI], .69-.88; P < .001). This association was not modified by insecticide-treated net use or gravidity, and remained significant in areas with high SP resistance (PR, 0.81; 95% CI, .67-.97; P = .02).CONCLUSIONS: The efficacy of SP to clear peripheral parasites and prevent new infections during pregnancy is compromised in areas with >90% prevalence of Pfdhps-K540E. Nevertheless, in these high-resistance areas, IPTp-SP use remains associated with increases in birth weight and maternal hemoglobin. The effectiveness of IPTp in eastern and southern Africa is threatened by further increases in SP resistance and reinforces the need to evaluate alternative drugs and strategies for the control of malaria in pregnancy.
AB - BACKGROUND: Owing to increasing sulfadoxine-pyrimethamine (SP) resistance in sub-Saharan Africa, monitoring the effectiveness of intermittent preventive therapy in pregnancy (IPTp) with SP is crucial.METHODS: Between 2009 and 2013, both the efficacy of IPTp-SP at clearing existing peripheral malaria infections and the effectiveness of IPTp-SP at reducing low birth weight (LBW) were assessed among human immunodeficiency virus-uninfected participants in 8 sites in 6 countries. Sites were classified as high, medium, or low resistance after measuring parasite mutations conferring SP resistance. An individual-level prospective pooled analysis was conducted.RESULTS: Among 1222 parasitemic pregnant women, overall polymerase chain reaction-uncorrected and -corrected failure rates by day 42 were 21.3% and 10.0%, respectively (39.7% and 21.1% in high-resistance areas; 4.9% and 1.1% in low-resistance areas). Median time to recurrence decreased with increasing prevalence of Pfdhps-K540E. Among 6099 women at delivery, IPTp-SP was associated with a 22% reduction in the risk of LBW (prevalence ratio [PR], 0.78; 95% confidence interval [CI], .69-.88; P < .001). This association was not modified by insecticide-treated net use or gravidity, and remained significant in areas with high SP resistance (PR, 0.81; 95% CI, .67-.97; P = .02).CONCLUSIONS: The efficacy of SP to clear peripheral parasites and prevent new infections during pregnancy is compromised in areas with >90% prevalence of Pfdhps-K540E. Nevertheless, in these high-resistance areas, IPTp-SP use remains associated with increases in birth weight and maternal hemoglobin. The effectiveness of IPTp in eastern and southern Africa is threatened by further increases in SP resistance and reinforces the need to evaluate alternative drugs and strategies for the control of malaria in pregnancy.
U2 - 10.1093/cid/civ881
DO - 10.1093/cid/civ881
M3 - Journal article
C2 - 26486699
VL - 62
SP - 323
EP - 233
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
SN - 1058-4838
IS - 3
ER -
ID: 153374506