Effectiveness of intermittent preventive treatment in pregnancy with sulphadoxine-pyrimethamine (IPTp-SP) in Ghana
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Date
2021
Journal Title
Journal ISSN
Volume Title
Publisher
BMJ GLOBAL HEALTH
Abstract
Introduction Ghana adopted the revised WHO
recommendation on intermittent preventive treatment in
pregnancy using sulfadoxine-pyrimethamine
(IPTp-SP)
in
2012. This study has assessed the effectiveness and safety
of this policy in Ghana.
Methods A total of 1926 pregnant women enrolled
at antenatal care (ANC) clinics were assessed for birth
outcomes at delivery, and placental histology results for
malaria infection were obtained from 1642 participants.
Association of reduced placental or peripheral malaria,
anaemia and low birth weight (LBW) in women who
received ≥4 IPTp-SP
doses compared with 3 or ≤2 doses
was determined by logistic regression analysis.
Results Among the 1926 participants, 5.3% (103),
19.2% (369), 33.2% (640) and 42.3% (817) of women had
received ≤1, 2, 3 or ≥4 doses, respectively. There was no
difference in risk of active placental malaria (PM) infection
in women who received 3 doses compared with ≥4 doses
(adjusted OR (aOR) 1.00, 95% CI 0.47 to 2.14). The risk
of overall PM infection was 1.63 (95% CI 1.07 to 2.48) in
2 dose group and 1.06 (95% CI 0.72 to 1.57) in 3 dose
group compared with ≥4 dose group. The risk of LBW
was 1.55 (95% CI 0.97 to 2.47) and 1.06 (95% CI 0.68
to 1.65) for 2 and 3 dose groups, respectively, compared
with the ≥4 dose group. Jaundice in babies was present in
0.16%, and 0% for women who received ≥4 doses of SP.
Conclusion There was no difference in the risk of PM,
LBW or maternal anaemia among women receiving 3
doses compared with ≥4 doses. Receiving ≥3 IPTp-SP
doses during pregnancy was associated with a lower risk
of overall PM infection compared with 2 doses. As there
are no safety concerns, monthly administration of IPTp-SP
offers a more practical opportunity for pregnant women to
receive ≥3 doses during pregnancy.
Description
Research Article
Keywords
Ghana, pregnancy, sulphadoxine-pyrimethamine, WHO, preventive treatment