Therapeutic Advances in Infectious Disease (Sep 2022)

Effectiveness of antenatal intermittent preventive treatment for malaria with sulphadoxine-pyrimethamine on peripartum outcomes

  • Isaac Okezie Godwin,
  • Ifeoma Mercy Ekejindu,
  • George Uchenna Eleje,
  • Dorothy Amauche Ezeagwuna,
  • Chigozie Geoffrey Okafor,
  • Arinze Anthony Onwuegbuna,
  • Osita Samuel Umeononihu,
  • Prisca Obiageli Godwin,
  • Onyecherelam Monday Ogelle,
  • Joseph Ifeanyichukwu Ikechebelu

DOI
https://doi.org/10.1177/20499361221122620
Journal volume & issue
Vol. 9

Abstract

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Background: Following the World Health Organization (WHO) recommendations for 4-weekly antenatal intermittent preventive treatment of malaria in pregnancy using sulphadoxine-pyrimethamine (IPTp-SP), there is a need to evaluate the drug performance in order to determine their effectiveness as tools in malaria control policy. Objectives: To determine prevalence of cord blood malaria, compliance gap and adverse pregnancy outcomes (anaemia, preterm delivery, spontaneous abortion, intra-uterine foetal death and low birth weight) among antenatal IPTp-SP users compared with non-users. Methods: A cross-sectional analytical study was conducted among consenting 390 participants who were administered a questionnaire, and paired blood samples were collected from the venous blood of participants and neonatal cord immediately after delivery. The participants were categorised as IPTp-SP users and non-users. Adverse pregnancy outcomes were assessed. Neonatal birth weights were also measured within 1 h after delivery. Malaria parasitaemia and anaemia were analysed using standard parasitological and haematological methods of examination. Data were analysed using SPSS version 25 for Windows and p -value of < 0.05 considered significant. Results: Of 390 women, 336 (86.2%) were IPTp-SP users, while 54 (13.8%) were non-users. The compliance gap was 13.8%. Malaria parasitemia in pregnant women (21.7% versus 53.7%; p < 0.001) and their babies (12.2% versus 25.4%; p = 0.002) were observed for IPTp-SP users and non-users, respectively. The prevalence of maternal anaemia was 27(8.0%) in IPTp-SP users and 5 (9.3%) in non-users ( p = 0.789). Mean parasite density was reduced in IPTp-SP users than in non-users ( p < 0.001). Correlation of birth weight according to their sex showed a weak correlation [correlation coefficient ( r ) = 0.027; p = 0.736]. Pregnant women with preterm delivery, spontaneous abortion, intra-uterine foetal death, and low birth weight were significantly lower ( p < 0.001, for all) in IPTp-SP users compared with non-users. Conclusion: Although the compliance gap was low, IPTp-SP users had significantly better pregnancy and foetal outcomes compared with non-users. Efforts should be intensified towards achieving total compliance in IPTp-SP usage by pregnant women.