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Ouédraogo S, Accrombessi M, Diallo I, Codo R, Ouattara A, Ouédraogo L, Massougbodji A, Cot M. Placental impression smears is a good indicator of placental malaria in sub-Saharan Africa. Pan Afr Med J 2019; 34:30. [PMID: 31762898 PMCID: PMC6859046 DOI: 10.11604/pamj.2019.34.30.20013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 08/18/2019] [Indexed: 12/16/2022] Open
Abstract
Introduction Placental malaria (PM) is an important predictor of infant morbidity and mortality in sub-Saharan Africa. Although placental histology is the gold standard test to diagnose PM, the placenta impression smears remains widely used in epidemiological studies. This study is set to evaluate the performance of placental impression smears to detect PM in pregnant women in southern Benin. Methods A cross-sectional analysis was performed on data collected in the framework a multicenter randomized clinical trial (Malaria in Pregnancy Preventive and Alternative Drugs). Samples from 491 pregnant women were examined in the district of Allada, Southern Benin. Plasmodium falciparum infections have been assessed in placental blood and placental biopsy. Results Placental malaria detected by placenta impression smears and histology were prevalent in 11.4% and 10.8%, respectively. Sensitivity and specificity of placental impression smears were 90.6% and 98.4%. Among 55 pregnant women tested positive by placenta impression smears, 48 were positive by the histology, while 7 were negative (positive predictive value: 87.3%). Four hundred and twenty four (424) of the 429 tested negative by the placenta impression smears, were also negative according to histology whereas the rest (5 of 429) of the women were positive (negative predictive value: 98.8%). Conclusion Placenta impression smear is an accurate and easy method for the diagnosis of placental malaria.
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Affiliation(s)
- Smaïla Ouédraogo
- Unité de Formation et de Recherche en Science de la Santé, Université Joseph Ki-Zerbo, Ouagdougou, Burkina Faso.,Centre Hospitalier Universitaire Yalgadogo, Ouédraogo, Burkina Faso
| | | | - Ismaël Diallo
- Unité de Formation et de Recherche en Science de la Santé, Université Joseph Ki-Zerbo, Ouagdougou, Burkina Faso.,Centre Hospitalier Universitaire Yalgadogo, Ouédraogo, Burkina Faso
| | - Roussine Codo
- Faculté de Médecine de Cotonou, Université d'Abomey-Calavi, Cotonou, Bénin
| | - Adama Ouattara
- Unité de Formation et de Recherche en Science de la Santé, Université Joseph Ki-Zerbo, Ouagdougou, Burkina Faso.,Centre Hospitalier Universitaire de Bogodogo, Ouagadougou, Burkina Faso
| | - Laurent Ouédraogo
- Unité de Formation et de Recherche en Science de la Santé, Université Joseph Ki-Zerbo, Ouagdougou, Burkina Faso.,Université de Ouahigouya, Ouahigouya, Burkina Faso
| | | | - Michel Cot
- MERIT- Mère et Enfant Face aux Infections Tropicales, Institut de Recherche pour le Développement, Paris, France, Université Paris Descartes, Sorbonne Paris Cité, France
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2
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Amimo F, Moon TD, Magit A, Sacarlal J, Lambert B, Nomura S. Trends in comparative efficacy and safety of malaria control interventions for maternal and child health outcomes in Africa: a study protocol for a Bayesian network meta-regression exploring the effect of HIV and malaria endemicity spectrum. BMJ Open 2019; 9:e024313. [PMID: 30798310 PMCID: PMC6398739 DOI: 10.1136/bmjopen-2018-024313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 11/05/2018] [Accepted: 12/18/2018] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION Unprecedented global efforts to prevent malaria morbidity and mortality in sub-Saharan Africa have saved hundreds of thousands of lives across the continent in the last two decades. This study aims to determine how the comparative efficacy and safety of available malaria control interventions intended to improve maternal and child health outcomes have changed over time considering the varied epidemiological contexts on the continent. METHODS We will review all randomised controlled trials that investigated malaria control interventions in pregnant women in sub-Saharan Africa and were published between January 1980 and December 2018. We will subsequently use network meta-regression to estimate temporal trends in the relative and absolute efficacy and safety of Intermittent Preventive Treatments, Intermittent Screening and Treatments, Insecticide-treated bed nets, and their combinations, and predict their ranking according to their relative and absolute efficacy and safety over time. Our outcomes will include 12 maternal and 7 child mortality and morbidity outcomes, known to be associated with either malaria infection or control. We will use intention-to-treat analysis to derive our estimates and meta-regression to estimate temporal trends and the effect modification by HIV infection, malaria endemicity and Plasmodium falciparum resistance to sulfadoxine-pyrimethamine, while adjusting for multiple potential confounders via propensity score calibration. PROSPERO REGISTRATION NUMBER CRD42018095138.
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Affiliation(s)
- Floriano Amimo
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Troy D Moon
- Division of Infectious Diseases, Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Anthony Magit
- Human Research Protection Program, University of California San Diego School of Medicine, San Diego, California, USA
| | - Jahit Sacarlal
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Ben Lambert
- MRC Centre for Outbreak Analysis and Modelling, Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Shuhei Nomura
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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3
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Manirakiza A, Serdouma E, Ngbalé RN, Moussa S, Gondjé S, Degana RM, Bata GGB, Moyen JM, Delmont J, Grésenguet G, Sepou A. A brief review on features of falciparum malaria during pregnancy. J Public Health Afr 2017; 8:668. [PMID: 29456824 PMCID: PMC5812306 DOI: 10.4081/jphia.2017.668] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 08/16/2017] [Accepted: 08/17/2017] [Indexed: 11/22/2022] Open
Abstract
Malaria in pregnancy is a serious public health problem in tropical areas. Frequently, the placenta is infected by accumulation of Plasmodium falciparum-infected erythrocytes in the intervillous space. Falciparum malaria acts during pregnancy by a range of mechanisms, and chronic or repeated infection and co-infections have insidious effects. The susceptibility of pregnant women to malaria is due to both immunological and humoral changes. Until a malaria vaccine becomes available, the deleterious effects of malaria in pregnancy can be avoided by protection against infection and prompt treatment with safe, effective antimalarial agents; however, concurrent infections such as with HIV and helminths during pregnancy are jeopardizing malaria control in sub-Saharan Africa.
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Affiliation(s)
| | | | | | - Sandrine Moussa
- Pasteur Institute of Bangui, Bangui, Central African Republic
| | - Samuel Gondjé
- Ministry of Public Health, Population and AIDS Control, Bangui, Central African Republic
| | - Rock Mbetid Degana
- Ministry of Public Health, Population and AIDS Control, Bangui, Central African Republic
| | | | - Jean Methode Moyen
- Ministry of Public Health, Population and AIDS Control, Bangui, Central African Republic
| | - Jean Delmont
- Center for Training and Research in Tropical Medicine and Health, Faculty of Medicine North, Marseille, France
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4
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Cates JE, Unger HW, Briand V, Fievet N, Valea I, Tinto H, D’Alessandro U, Landis SH, Adu-Afarwuah S, Dewey KG, ter Kuile FO, Desai M, Dellicour S, Ouma P, Gutman J, Oneko M, Slutsker L, Terlouw DJ, Kariuki S, Ayisi J, Madanitsa M, Mwapasa V, Ashorn P, Maleta K, Mueller I, Stanisic D, Schmiegelow C, Lusingu JPA, van Eijk AM, Bauserman M, Adair L, Cole SR, Westreich D, Meshnick S, Rogerson S. Malaria, malnutrition, and birthweight: A meta-analysis using individual participant data. PLoS Med 2017; 14:e1002373. [PMID: 28792500 PMCID: PMC5549702 DOI: 10.1371/journal.pmed.1002373] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 07/11/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Four studies previously indicated that the effect of malaria infection during pregnancy on the risk of low birthweight (LBW; <2,500 g) may depend upon maternal nutritional status. We investigated this dependence further using a large, diverse study population. METHODS AND FINDINGS We evaluated the interaction between maternal malaria infection and maternal anthropometric status on the risk of LBW using pooled data from 14,633 pregnancies from 13 studies (6 cohort studies and 7 randomized controlled trials) conducted in Africa and the Western Pacific from 1996-2015. Studies were identified by the Maternal Malaria and Malnutrition (M3) initiative using a convenience sampling approach and were eligible for pooling given adequate ethical approval and availability of essential variables. Study-specific adjusted effect estimates were calculated using inverse probability of treatment-weighted linear and log-binomial regression models and pooled using a random-effects model. The adjusted risk of delivering a baby with LBW was 8.8% among women with malaria infection at antenatal enrollment compared to 7.7% among uninfected women (adjusted risk ratio [aRR] 1.14 [95% confidence interval (CI): 0.91, 1.42]; N = 13,613), 10.5% among women with malaria infection at delivery compared to 7.9% among uninfected women (aRR 1.32 [95% CI: 1.08, 1.62]; N = 11,826), and 15.3% among women with low mid-upper arm circumference (MUAC <23 cm) at enrollment compared to 9.5% among women with MUAC ≥ 23 cm (aRR 1.60 [95% CI: 1.36, 1.87]; N = 9,008). The risk of delivering a baby with LBW was 17.8% among women with both malaria infection and low MUAC at enrollment compared to 8.4% among uninfected women with MUAC ≥ 23 cm (joint aRR 2.13 [95% CI: 1.21, 3.73]; N = 8,152). There was no evidence of synergism (i.e., excess risk due to interaction) between malaria infection and MUAC on the multiplicative (p = 0.5) or additive scale (p = 0.9). Results were similar using body mass index (BMI) as an anthropometric indicator of nutritional status. Meta-regression results indicated that there may be multiplicative interaction between malaria infection at enrollment and low MUAC within studies conducted in Africa; however, this finding was not consistent on the additive scale, when accounting for multiple comparisons, or when using other definitions of malaria and malnutrition. The major limitations of the study included availability of only 2 cross-sectional measurements of malaria and the limited availability of ultrasound-based pregnancy dating to assess impacts on preterm birth and fetal growth in all studies. CONCLUSIONS Pregnant women with malnutrition and malaria infection are at increased risk of LBW compared to women with only 1 risk factor or none, but malaria and malnutrition do not act synergistically.
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Affiliation(s)
- Jordan E. Cates
- Department of Epidemiology, UNC-Chapel Hill, Chapel Hill, North Carolina, United States of America
- * E-mail:
| | - Holger W. Unger
- Department of Obstetrics and Gynaecology, Edinburgh Royal Infirmary, Edinburgh, United Kingdom
- Department of Medicine at the Doherty Institute, The University of Melbourne, Parkville, Victoria, Australia
| | - Valerie Briand
- UMR216-MERIT, French National Research Institute for Sustainable Development (IRD), Paris Descartes University, Paris, France
| | - Nadine Fievet
- UMR216-MERIT, French National Research Institute for Sustainable Development (IRD), Paris Descartes University, Paris, France
| | - Innocent Valea
- Unite de Recherche Clinique de Nanoro, Institut de Recherche en Sciences de la Santé-DRO, Bobo-Dioulasso, Burkina Faso
- Departement de Recherche Clinique, Centre Muraz, Bobo-Dioulasso, Burkina Faso
| | - Halidou Tinto
- Unite de Recherche Clinique de Nanoro, Institut de Recherche en Sciences de la Santé-DRO, Bobo-Dioulasso, Burkina Faso
- Departement de Recherche Clinique, Centre Muraz, Bobo-Dioulasso, Burkina Faso
| | - Umberto D’Alessandro
- Medical Research Council Unit, The Gambia; London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sarah H. Landis
- Worldwide Epidemiology, GlaxoSmithKline, Uxbridge, United Kingdom
| | - Seth Adu-Afarwuah
- Department of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana
| | - Kathryn G. Dewey
- Department of Nutrition, University of California, Davis, California, United States of America
| | - Feiko O. ter Kuile
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Meghna Desai
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Stephanie Dellicour
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Peter Ouma
- Kenya Medical Research Institute (KEMRI)/ Centre for Global Health Research, Kisumu, Kenya
| | - Julie Gutman
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Martina Oneko
- Kenya Medical Research Institute (KEMRI)/ Centre for Global Health Research, Kisumu, Kenya
| | - Laurence Slutsker
- Malaria and Neglected Tropical Diseases, Center for Malaria Control and Elimination, PATH, Seattle, Washington, United States of America
| | - Dianne J. Terlouw
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Simon Kariuki
- Kenya Medical Research Institute (KEMRI)/ Centre for Global Health Research, Kisumu, Kenya
| | - John Ayisi
- Kenya Medical Research Institute (KEMRI)/ Centre for Global Health Research, Kisumu, Kenya
| | - Mwayiwawo Madanitsa
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Victor Mwapasa
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Per Ashorn
- Center for Child Health Research University of Tampere School of Medicine and Tampere University Hospital, Tampere, Finland
| | - Kenneth Maleta
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Ivo Mueller
- Walter and Eliza Hall Institute, Parkville, Victoria, Australia
| | - Danielle Stanisic
- Institute for Glycomics, Griffith University, Gold Coast, Queensland, Australia
| | - Christentze Schmiegelow
- Centre for Medical Parasitology, Depart. Of Immunology and Microbiology, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
| | - John P. A. Lusingu
- Centre for Medical Parasitology, Depart. Of Immunology and Microbiology, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
- National Institute for Medical Research, Tanga Centre, Tanga, Tanzania
| | - Anna Maria van Eijk
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Melissa Bauserman
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, School of Medicine, UNC-Chapel Hill, Chapel Hill, North Carolina, United States of America
- Department of Nutrition, UNC-Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Linda Adair
- Department of Nutrition, UNC-Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Stephen R. Cole
- Department of Epidemiology, UNC-Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Daniel Westreich
- Department of Epidemiology, UNC-Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Steven Meshnick
- Department of Epidemiology, UNC-Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Stephen Rogerson
- Department of Medicine at the Doherty Institute, The University of Melbourne, Parkville, Victoria, Australia
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Danhoundo G, Wiktorowicz ME, Yaya S. Governance of malaria prevention: How decision-makers' and pregnant women's sensemaking contribute to unintended consequences. Health Care Women Int 2016; 38:238-252. [PMID: 27617916 DOI: 10.1080/07399332.2016.1234483] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Although malaria in pregnancy predisposes women to increased perinatal mortality and morbidity, complex issues underlie its persistence. To develop a better understanding of the factors affecting women's access to Intermittent Preventive Treatment in Benin, we used the theoretical lens of "sensemaking" to clarify policymakers', health professionals', and women's perspectives concerning preventive policies and barriers to access. Several assumptions were found to underlie Benin's malaria preventive policy that contribute to the unintended effect of deterring pregnant women in poverty from accessing preventive treatment. Health system dysfunctions including drug shortages and deficiencies in health care professionalism exacerbate the unintended effect.
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Affiliation(s)
| | | | - Sanni Yaya
- b Faculty of Social Sciences, School of International Development and Global Studies , University of Ottawa , Ottawa , Ontario , Canada
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Briand V, Escolano S, Journot V, Massougbodji A, Cot M, Tubert-Bitter P. Mefloquine Versus Sulfadoxine-Pyrimethamine for Intermittent Preventive Treatment in Pregnancy: A Joint Analysis on Efficacy and Tolerability. Am J Trop Med Hyg 2015; 93:300-4. [PMID: 26055735 DOI: 10.4269/ajtmh.14-0783] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 04/22/2015] [Indexed: 11/07/2022] Open
Abstract
Since there is no ideal candidate to replace sulfadoxine-pyrimethamine (SP) for intermittent preventive treatment (IPTp), alternatives need to be evaluated on basis of their benefit-risk ratio. We reanalyzed the first Beninese trial on mefloquine (MQ) versus SP for IPTp using a multiple outcome approach, which allowed the joint assessment of efficacy and tolerability. Overall superiority of MQ to SP was defined as superiority on at least one efficacy outcome (low birth weight [LBW], placental malaria, or maternal anemia), non-inferiority on all of them as well as on tolerability defined as cutaneous or neuropsychiatric adverse events (AEs) or low compliance with the treatment. The analysis included 1,601 women. MQ was found to be overall superior to SP (P = 0.004). Performing several sensitivity analyses to handle both missing data and stillbirths provided similar results. Using MQ for IPTp as an example, we show that a multiple outcome analysis is a pragmatic way to assess the benefits/disadvantages of one drug compared with another. In the current context of a lack of antimalarials that could be used for IPTp, such a statistical approach could be widely used by institutional policy makers for future recommendations regarding the prevention of malaria in pregnancy (MiP).
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Affiliation(s)
- Valérie Briand
- Mère et Enfant Face aux Infections Tropicales (UMR216-MERIT), Institut de Recherche pour le Développement (IRD), Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Inserm, UMR1181, Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), Villejuif, France; UMR1181, B2PHI, Institut Pasteur, Paris, France; UMR1181, B2PHI, Université Versailles Saint Quentin, Villejuif, France; Centre INSERM U897-Epidemiologie-Biostatistique, Bordeaux, France; Laboratoire de Parasitologie, Faculté des Sciences de la Santé (FSS), Cotonou, Benin; Centre d'Étude et de Recherche sur le Paludisme Associé à la Grossesse et l'Enfance (CERPAGE), Cotonou, Benin
| | - Sylvie Escolano
- Mère et Enfant Face aux Infections Tropicales (UMR216-MERIT), Institut de Recherche pour le Développement (IRD), Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Inserm, UMR1181, Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), Villejuif, France; UMR1181, B2PHI, Institut Pasteur, Paris, France; UMR1181, B2PHI, Université Versailles Saint Quentin, Villejuif, France; Centre INSERM U897-Epidemiologie-Biostatistique, Bordeaux, France; Laboratoire de Parasitologie, Faculté des Sciences de la Santé (FSS), Cotonou, Benin; Centre d'Étude et de Recherche sur le Paludisme Associé à la Grossesse et l'Enfance (CERPAGE), Cotonou, Benin
| | - Valérie Journot
- Mère et Enfant Face aux Infections Tropicales (UMR216-MERIT), Institut de Recherche pour le Développement (IRD), Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Inserm, UMR1181, Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), Villejuif, France; UMR1181, B2PHI, Institut Pasteur, Paris, France; UMR1181, B2PHI, Université Versailles Saint Quentin, Villejuif, France; Centre INSERM U897-Epidemiologie-Biostatistique, Bordeaux, France; Laboratoire de Parasitologie, Faculté des Sciences de la Santé (FSS), Cotonou, Benin; Centre d'Étude et de Recherche sur le Paludisme Associé à la Grossesse et l'Enfance (CERPAGE), Cotonou, Benin
| | - Achille Massougbodji
- Mère et Enfant Face aux Infections Tropicales (UMR216-MERIT), Institut de Recherche pour le Développement (IRD), Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Inserm, UMR1181, Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), Villejuif, France; UMR1181, B2PHI, Institut Pasteur, Paris, France; UMR1181, B2PHI, Université Versailles Saint Quentin, Villejuif, France; Centre INSERM U897-Epidemiologie-Biostatistique, Bordeaux, France; Laboratoire de Parasitologie, Faculté des Sciences de la Santé (FSS), Cotonou, Benin; Centre d'Étude et de Recherche sur le Paludisme Associé à la Grossesse et l'Enfance (CERPAGE), Cotonou, Benin
| | - Michel Cot
- Mère et Enfant Face aux Infections Tropicales (UMR216-MERIT), Institut de Recherche pour le Développement (IRD), Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Inserm, UMR1181, Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), Villejuif, France; UMR1181, B2PHI, Institut Pasteur, Paris, France; UMR1181, B2PHI, Université Versailles Saint Quentin, Villejuif, France; Centre INSERM U897-Epidemiologie-Biostatistique, Bordeaux, France; Laboratoire de Parasitologie, Faculté des Sciences de la Santé (FSS), Cotonou, Benin; Centre d'Étude et de Recherche sur le Paludisme Associé à la Grossesse et l'Enfance (CERPAGE), Cotonou, Benin
| | - Pascale Tubert-Bitter
- Mère et Enfant Face aux Infections Tropicales (UMR216-MERIT), Institut de Recherche pour le Développement (IRD), Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Inserm, UMR1181, Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), Villejuif, France; UMR1181, B2PHI, Institut Pasteur, Paris, France; UMR1181, B2PHI, Université Versailles Saint Quentin, Villejuif, France; Centre INSERM U897-Epidemiologie-Biostatistique, Bordeaux, France; Laboratoire de Parasitologie, Faculté des Sciences de la Santé (FSS), Cotonou, Benin; Centre d'Étude et de Recherche sur le Paludisme Associé à la Grossesse et l'Enfance (CERPAGE), Cotonou, Benin
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Accrombessi M, Ouédraogo S, Agbota GC, Gonzalez R, Massougbodji A, Menéndez C, Cot M. Malaria in Pregnancy Is a Predictor of Infant Haemoglobin Concentrations during the First Year of Life in Benin, West Africa. PLoS One 2015; 10:e0129510. [PMID: 26052704 PMCID: PMC4460073 DOI: 10.1371/journal.pone.0129510] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 05/08/2015] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Anaemia is an increasingly recognized health problem in Africa, particularly in infants and pregnant women. Although malaria is known to be the main risk factor of anaemia in both groups, the consequences of maternal factors, particularly malaria in pregnancy (MiP), on infant haemoglobin (Hb) concentrations during the first months of life are still unclear. METHODS We followed-up a cohort of 1005 Beninese pregnant women from the beginning of pregnancy until delivery. A subsample composed of the first 400 offspring of these women were selected at birth and followed until the first year of life. Placental histology and blood smear at 1st clinical antenatal visit (ANC), 2nd ANC and delivery were used to assess malaria during pregnancy. Infant Hb concentrations were measured at birth, 6, 9 and 12 months of age. A mixed multi-level model was used to assess the association between MiP and infant Hb variations during the first 12 months of life. RESULTS Placental malaria (difference mean [dm] = - 2.8 g/L, 95% CI [-5.3, -0.3], P = 0.03) and maternal peripheral parasitaemia at delivery (dm = - 4.6 g/L, 95% CI [-7.9, -1.3], P = 0.007) were the main maternal factors significantly associated with infant Hb concentrations during the first year of life. Poor maternal nutritional status and malaria infection during infancy were also significantly associated with a decrease in infant Hb. CONCLUSION Antimalarial control and nutritional interventions before and during pregnancy should be reinforced to reduce specifically the incidence of infant anaemia, particularly in Sub-Saharan countries.
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Affiliation(s)
- Manfred Accrombessi
- Institut de Recherche pour le Développement (IRD), UMR216-Mère et enfant face aux infections tropicales, Paris, France
- PRES Paris Sorbonne Cité, Université Paris Descartes, Paris, France
- Faculté de Médecine de Cotonou, Université d’Abomey-Calavi, Cotonou, Benin
- * E-mail:
| | - Smaïla Ouédraogo
- Unité de Formation et de Recherche en Sciences de la Santé, Université de Ouagadougou, Ouagadougou, Burkina Faso
| | - Gino Cédric Agbota
- Institut de Recherche pour le Développement (IRD), UMR216-Mère et enfant face aux infections tropicales, Paris, France
- PRES Paris Sorbonne Cité, Université Paris Descartes, Paris, France
- Faculté de Médecine de Cotonou, Université d’Abomey-Calavi, Cotonou, Benin
| | - Raquel Gonzalez
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
- Manhiça Health Research Center (CISM), Manhiça, Mozambique
| | | | - Clara Menéndez
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
- Manhiça Health Research Center (CISM), Manhiça, Mozambique
| | - Michel Cot
- Institut de Recherche pour le Développement (IRD), UMR216-Mère et enfant face aux infections tropicales, Paris, France
- PRES Paris Sorbonne Cité, Université Paris Descartes, Paris, France
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8
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Drabo MK, Tiendrebéogo J, Saizonou J, Soglohoun CT, Paraïso NM, Sié A, Ouedraogo LT, Makoutodé M. Facteurs associés à la faible couverture du Traitement Préventif Intermittent chez les femmes enceintes de la zone sanitaire béninoise de Pobè-Adja-Ouèrè-Kétou. SANTÉ PUBLIQUE 2015. [DOI: 10.3917/spub.151.0099] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Toure OA, Kone PL, Coulibaly MAA, Ako BAA, Gbessi EA, Coulibaly B, N' Guessan LT, Koffi D, Beourou S, Soumahoro A, Bassinka I, Nogbou M, Swa T, Gba B, Esmel B, Bokossa EM. Coverage and efficacy of intermittent preventive treatment with sulphadoxine pyrimethamine against malaria in pregnancy in Côte d'Ivoire five years after its implementation. Parasit Vectors 2014; 7:495. [PMID: 25410760 PMCID: PMC4245798 DOI: 10.1186/s13071-014-0495-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Accepted: 10/21/2014] [Indexed: 11/10/2022] Open
Abstract
Background The World Health Organization (WHO) recommends for sub-Saharan Africa a package of prompt and effective case-management combined with the delivery of insecticide-treated nets (ITN) and intermittent preventive treatment during pregnancy (IPTp) with sulphadoxine-pyrimethamine (SP) through the national antenatal care (ANC) programs. Implemented in Côte d’Ivoire around 2005, few Data on IPTp coverage and efficacy in the country are available. Methods A multicentre, cross-sectional survey was conducted in Côte d’Ivoire from September 2009 to May 2010 at six urban and rural antenatal clinics. IPTp-sp coverage, Socio-economic and obstetrical data of mothers and neonate birth weights were documented. Peripheral blood as well as placental and cord blood were used to prepare thick and thin blood films. In addition, pieces of placental tissues were used to prepare impression smears and maternal haemoglobin concentration was measured. Regression logistics were used to study factors associated with placental malaria and LBW (<2.500 grams). Results A total of 1317 delivered women were enrolled with a median age of 26 years. A proportion of 43.28% of the women had received at least two doses of IPTsp during the current pregnancy although a high proportion (90.4%) of women received antenatal care and made enough visits (≥2). Variability in the results was observed depending on the type of area (rural/urban). Plasmodium falciparum was detected in the peripheral blood of 97 women (7.3%) and in the placenta of 119 women (9%). LBW infants were born to 18.8% (22/107) of women with placental malaria and 8.5% (103/1097) of women without placental malaria. LBW was associated with placental malaria. Conclusions This study found relative low coverage of IPTp in the study areas which supported findings that high ANC attendance does not guarantee high IPTp coverage. Urgent efforts are required to improve service delivery of this important intervention.
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Affiliation(s)
- Offianan A Toure
- Malariology Department, Institut Pasteur of Côte d'Ivoire, P.O. Box 490, Abidjan, 01, Côte d'Ivoire.
| | - Penali L Kone
- Malariology Department, Institut Pasteur of Côte d'Ivoire, P.O. Box 490, Abidjan, 01, Côte d'Ivoire.
| | - M'Lanhoro A A Coulibaly
- Malariology Department, Institut Pasteur of Côte d'Ivoire, P.O. Box 490, Abidjan, 01, Côte d'Ivoire.
| | - Berenger A A Ako
- Malariology Department, Institut Pasteur of Côte d'Ivoire, P.O. Box 490, Abidjan, 01, Côte d'Ivoire.
| | - Eric A Gbessi
- Malariology Department, Institut Pasteur of Côte d'Ivoire, P.O. Box 490, Abidjan, 01, Côte d'Ivoire.
| | - Baba Coulibaly
- Malariology Department, Institut Pasteur of Côte d'Ivoire, P.O. Box 490, Abidjan, 01, Côte d'Ivoire.
| | - Landry T N' Guessan
- Malariology Department, Institut Pasteur of Côte d'Ivoire, P.O. Box 490, Abidjan, 01, Côte d'Ivoire.
| | - David Koffi
- Malariology Department, Institut Pasteur of Côte d'Ivoire, P.O. Box 490, Abidjan, 01, Côte d'Ivoire.
| | - Sylvain Beourou
- Malariology Department, Institut Pasteur of Côte d'Ivoire, P.O. Box 490, Abidjan, 01, Côte d'Ivoire.
| | - Adama Soumahoro
- Malariology Department, Institut Pasteur of Côte d'Ivoire, P.O. Box 490, Abidjan, 01, Côte d'Ivoire.
| | - Issiaka Bassinka
- Malariology Department, Institut Pasteur of Côte d'Ivoire, P.O. Box 490, Abidjan, 01, Côte d'Ivoire.
| | - Messoun Nogbou
- PMI of Yopougon Abidjan, P.O. Box 1351, Abidjan, 23, Côte d'Ivoire.
| | - Tidjane Swa
- PMI of Yopougon Abidjan, P.O. Box 1351, Abidjan, 23, Côte d'Ivoire.
| | - Bernadin Gba
- Maternity Service, Bonoua Hospital, P.O. Box 25, Bonoua, Côte d'Ivoire.
| | - Beugre Esmel
- CHU Cocody, Boulevard de l'Université, P.O. Box v13, Abidjan, Côte d'Ivoire.
| | - Ernestine M Bokossa
- CHU Cocody, Boulevard de l'Université, P.O. Box v13, Abidjan, Côte d'Ivoire.
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González R, Mombo-Ngoma G, Ouédraogo S, Kakolwa MA, Abdulla S, Accrombessi M, Aponte JJ, Akerey-Diop D, Basra A, Briand V, Capan M, Cot M, Kabanywanyi AM, Kleine C, Kremsner PG, Macete E, Mackanga JR, Massougbodgi A, Mayor A, Nhacolo A, Pahlavan G, Ramharter M, Rupérez M, Sevene E, Vala A, Zoleko-Manego R, Menéndez C. Intermittent preventive treatment of malaria in pregnancy with mefloquine in HIV-negative women: a multicentre randomized controlled trial. PLoS Med 2014; 11:e1001733. [PMID: 25247709 PMCID: PMC4172436 DOI: 10.1371/journal.pmed.1001733] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 07/17/2014] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) is recommended by WHO to prevent malaria in African pregnant women. The spread of SP parasite resistance has raised concerns regarding long-term use for IPT. Mefloquine (MQ) is the most promising of available alternatives to SP based on safety profile, long half-life, and high efficacy in Africa. We evaluated the safety and efficacy of MQ for IPTp compared to those of SP in HIV-negative women. METHODS AND FINDINGS A total of 4,749 pregnant women were enrolled in an open-label randomized clinical trial conducted in Benin, Gabon, Mozambique, and Tanzania comparing two-dose MQ or SP for IPTp and MQ tolerability of two different regimens. The study arms were: (1) SP, (2) single dose MQ (15 mg/kg), and (3) split-dose MQ in the context of long lasting insecticide treated nets. There was no difference on low birth weight prevalence (primary study outcome) between groups (360/2,778 [13.0%]) for MQ group and 177/1,398 (12.7%) for SP group; risk ratio [RR], 1.02 (95% CI 0.86-1.22; p=0.80 in the ITT analysis). Women receiving MQ had reduced risks of parasitemia (63/1,372 [4.6%] in the SP group and 88/2,737 [3.2%] in the MQ group; RR, 0.70 [95% CI 0.51-0.96]; p=0.03) and anemia at delivery (609/1,380 [44.1%] in the SP group and 1,110/2743 [40.5%] in the MQ group; RR, 0.92 [95% CI 0.85-0.99]; p=0.03), and reduced incidence of clinical malaria (96/551.8 malaria episodes person/year [PYAR] in the SP group and 130/1,103.2 episodes PYAR in the MQ group; RR, 0.67 [95% CI 0.52-0.88]; p=0.004) and all-cause outpatient attendances during pregnancy (850/557.8 outpatients visits PYAR in the SP group and 1,480/1,110.1 visits PYAR in the MQ group; RR, 0.86 [0.78-0.95]; p=0.003). There were no differences in the prevalence of placental infection and adverse pregnancy outcomes between groups. Tolerability was poorer in the two MQ groups compared to SP. The most frequently reported related adverse events were dizziness (ranging from 33.9% to 35.5% after dose 1; and 16.0% to 20.8% after dose 2) and vomiting (30.2% to 31.7%, after dose 1 and 15.3% to 17.4% after dose 2) with similar proportions in the full and split MQ arms. The open-label design is a limitation of the study that affects mainly the safety assessment. CONCLUSIONS Women taking MQ IPTp (15 mg/kg) in the context of long lasting insecticide treated nets had similar prevalence rates of low birth weight as those taking SP IPTp. MQ recipients had less clinical malaria than SP recipients, and the pregnancy outcomes and safety profile were similar. MQ had poorer tolerability even when splitting the dose over two days. These results do not support a change in the current IPTp policy. TRIAL REGISTRATION ClinicalTrials.gov NCT 00811421; Pan African Clinical Trials Registry PACTR 2010020001429343 Please see later in the article for the Editors' Summary.
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Affiliation(s)
- Raquel González
- Barcelona Centre for International Health Research (CRESIB, Hospital Clínic-Universitat de Barcelona), ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain
- Manhiça Health Research Center (CISM), Manhiça, Mozambique
| | - Ghyslain Mombo-Ngoma
- Centre de Recherches Médicales de Lambaréné (CERMEL), Albert Schweitzer Hospital, Lambaréné, Gabon
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - Smaïla Ouédraogo
- Faculté des Sciences de la Santé (FSS), Université d'Aboméy Calavi, Cotonou, Benin
- Institut de Recherche pour le Développement (IRD), Paris, France
| | | | | | - Manfred Accrombessi
- Faculté des Sciences de la Santé (FSS), Université d'Aboméy Calavi, Cotonou, Benin
- Institut de Recherche pour le Développement (IRD), Paris, France
| | - John J. Aponte
- Barcelona Centre for International Health Research (CRESIB, Hospital Clínic-Universitat de Barcelona), ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain
- Manhiça Health Research Center (CISM), Manhiça, Mozambique
| | - Daisy Akerey-Diop
- Centre de Recherches Médicales de Lambaréné (CERMEL), Albert Schweitzer Hospital, Lambaréné, Gabon
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - Arti Basra
- Centre de Recherches Médicales de Lambaréné (CERMEL), Albert Schweitzer Hospital, Lambaréné, Gabon
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - Valérie Briand
- Institut de Recherche pour le Développement (IRD), Paris, France
- Université René Descartes, Paris, France
| | - Meskure Capan
- Centre de Recherches Médicales de Lambaréné (CERMEL), Albert Schweitzer Hospital, Lambaréné, Gabon
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - Michel Cot
- Institut de Recherche pour le Développement (IRD), Paris, France
- Université René Descartes, Paris, France
| | | | - Christian Kleine
- Centre de Recherches Médicales de Lambaréné (CERMEL), Albert Schweitzer Hospital, Lambaréné, Gabon
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - Peter G. Kremsner
- Centre de Recherches Médicales de Lambaréné (CERMEL), Albert Schweitzer Hospital, Lambaréné, Gabon
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - Eusebio Macete
- Manhiça Health Research Center (CISM), Manhiça, Mozambique
| | - Jean-Rodolphe Mackanga
- Centre de Recherches Médicales de Lambaréné (CERMEL), Albert Schweitzer Hospital, Lambaréné, Gabon
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - Achille Massougbodgi
- Faculté des Sciences de la Santé (FSS), Université d'Aboméy Calavi, Cotonou, Benin
| | - Alfredo Mayor
- Barcelona Centre for International Health Research (CRESIB, Hospital Clínic-Universitat de Barcelona), ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain
- Manhiça Health Research Center (CISM), Manhiça, Mozambique
| | | | - Golbahar Pahlavan
- Barcelona Centre for International Health Research (CRESIB, Hospital Clínic-Universitat de Barcelona), ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain
| | - Michael Ramharter
- Centre de Recherches Médicales de Lambaréné (CERMEL), Albert Schweitzer Hospital, Lambaréné, Gabon
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
| | - María Rupérez
- Barcelona Centre for International Health Research (CRESIB, Hospital Clínic-Universitat de Barcelona), ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain
- Manhiça Health Research Center (CISM), Manhiça, Mozambique
| | | | - Anifa Vala
- Manhiça Health Research Center (CISM), Manhiça, Mozambique
| | - Rella Zoleko-Manego
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
- Ngounie Medical Research Centre, Fougamou, Gabon
| | - Clara Menéndez
- Barcelona Centre for International Health Research (CRESIB, Hospital Clínic-Universitat de Barcelona), ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain
- Manhiça Health Research Center (CISM), Manhiça, Mozambique
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11
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Valea I, Tinto H, Traore-Coulibaly M, Toe LC, Lindegardh N, Tarning J, Van Geertruyden JP, D'Alessandro U, Davies GR, Ward SA. Pharmacokinetics of co-formulated mefloquine and artesunate in pregnant and non-pregnant women with uncomplicated Plasmodium falciparum infection in Burkina Faso. J Antimicrob Chemother 2014; 69:2499-507. [PMID: 24891429 DOI: 10.1093/jac/dku154] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Mefloquine/artesunate has recently been developed as a fixed-dose combination, providing a promising rescue/alternative treatment for malaria during pregnancy. However, limited data are available on the effect of pregnancy on its pharmacokinetic properties. This study was conducted to assess the pharmacokinetic properties of mefloquine/carboxymefloquine and artesunate/dihydroartemisinin in pregnant and non-pregnant women with uncomplicated malaria. METHODS Twenty-four women in their second and third trimesters of pregnancy and 24 paired non-pregnant women were enrolled. All patients were treated for uncomplicated Plasmodium falciparum malaria with a standard fixed-dose combination of oral mefloquine and artesunate one daily over 3 days. Frequent blood samples were collected before treatment and at scheduled times post-dose for the drug measurements and pharmacokinetic analyses. The study was registered at www.clinicaltrials.gov (identifier: NCT00701961). RESULTS The total median exposure to mefloquine and dihydroartemisinin was not significantly different between the pregnant and non-pregnant women (P>0.05). There was a trend of higher exposure to mefloquine in the pregnant women, but this difference did not reach statistical significance (656700 versus 542400 h × ng/mL; P=0.059). However, the total exposure to carboxymefloquine was 49% lower during pregnancy (735600 versus 1499000 h × ng/mL; P<0.001) and the total drug exposure to artesunate was 42% higher during pregnancy (89.0 versus 62.9 h × ng/mL; P=0.039) compared with non-pregnant controls. CONCLUSIONS The plasma levels of mefloquine and dihydroartemisinin appeared to be similar in both pregnant and non-pregnant women, but there were significant differences in carboxymefloquine and artesunate exposure. The data presented here do not warrant a dose adjustment in pregnant patients, but an extensive analysis of the data could provide a better understanding of these findings.
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Affiliation(s)
- Innocent Valea
- Unité de Recherche Paludisme et Maladies Tropicales Négligées, Centre Muraz, Bobo-Dioulasso, Burkina Faso Institut de Recherche en Sciences de la Santé, Unité de Recherche Clinique de Nanoro, Nanoro, Burkina Faso
| | - Halidou Tinto
- Unité de Recherche Paludisme et Maladies Tropicales Négligées, Centre Muraz, Bobo-Dioulasso, Burkina Faso Institut de Recherche en Sciences de la Santé, Direction Régionale de l'Ouest, Bobo-Dioulasso, Burkina Faso
| | - Maminata Traore-Coulibaly
- Institut de Recherche en Sciences de la Santé, Unité de Recherche Clinique de Nanoro, Nanoro, Burkina Faso Institut de Recherche en Sciences de la Santé, Direction Régionale de l'Ouest, Bobo-Dioulasso, Burkina Faso
| | - Laeticia C Toe
- Unité de Recherche Paludisme et Maladies Tropicales Négligées, Centre Muraz, Bobo-Dioulasso, Burkina Faso
| | - Niklas Lindegardh
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Joel Tarning
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | - Umberto D'Alessandro
- Unit of Epidemiology and Control of Parasitic Diseases, Department of Parasitology, Prince Leopold Institute of Tropical Medicine, Antwerp, Belgium Disease Control and Elimination, Medical Research Council Unit, Fajara, The Gambia
| | - Geraint R Davies
- Institutes of Global Health & Translational Medicine, University of Liverpool, Liverpool, UK
| | - Stephen A Ward
- Molecular and Biochemical Parasitolgy, Liverpool School of Tropical Medicine, Liverpool, UK
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12
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Abstract
Pregnant women have a higher risk of malaria compared to non-pregnant women. This review provides an update on knowledge acquired since 2000 on P. falciparum and P.vivax infections in pregnancy. Maternal risk factors for malaria in pregnancy (MiP) include low maternal age, low parity, and low gestational age. The main effects of MIP include maternal anaemia, low birth weight (LBW), preterm delivery and increased infant and maternal mortality. P. falciparum infected erythrocytes sequester in the placenta by expressing surface antigens, mainly variant surface antigen (VAR2CSA), that bind to specific receptors, mainly chondroitin sulphate A. In stable transmission settings, the higher malaria risk in primigravidae can be explained by the non-recognition of these surface antigens by the immune system. Recently, placental sequestration has been described also for P.vivax infections. The mechanism of preterm delivery and intrauterine growth retardation is not completely understood, but fever (preterm delivery), anaemia, and high cytokines levels have been implicated. Clinical suspicion of MiP should be confirmed by parasitological diagnosis. The sensitivity of microscopy, with placenta histology as the gold standard, is 60% and 45% for peripheral and placental falciparum infections in African women, respectively. Compared to microscopy, RDTs have a lower sensitivity though when the quality of microscopy is low RDTs may be more reliable. Insecticide treated nets (ITN) and intermittent preventive treatment in pregnancy (IPTp) are recommended for the prevention of MiP in stable transmission settings. ITNs have been shown to reduce malaria infection and adverse pregnancy outcomes by 28–47%. Although resistance is a concern, SP has been shown to be equivalent to MQ and AQ for IPTp. For the treatment of uncomplicated malaria during the first trimester, quinine plus clindamycin for 7 days is the first line treatment and artesunate plus clindamycin for 7 days is indicated if this treatment fails; in the 2nd and 3rd trimester first line treatment is an artemisinin-based combination therapy (ACT) known to be effective in the region or artesunate and clindamycin for 7 days or quinine and clindamycin. For severe malaria, in the second and third trimester parenteral artesunate is preferred over quinine. In the first trimester, both artesunate and quinine (parenteral) may be considered as options. Nevertheless, treatment should not be delayed and should be started immediately with the most readily available drug.
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Amoran OE, Ariba AA, Iyaniwura CA. Determinants of intermittent preventive treatment of malaria during pregnancy (IPTp) utilization in a rural town in Western Nigeria. Reprod Health 2012; 9:12. [PMID: 22889320 PMCID: PMC3453493 DOI: 10.1186/1742-4755-9-12] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2012] [Accepted: 06/14/2012] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Malaria infection in pregnancy is a major risk factor for maternal and child death, and substantially increases the risk of miscarriage, stillbirth and low birthweight. The aim of this study therefore is to assess the prevalence and determinants of Intermittent preventive treatment of Malaria [IPTp] utilization by pregnant women in a rural town in Western Nigeria. METHODS This study is an analytical cross-sectional study. All pregnant women that were due for delivery and were attending the three primary health care center in Sagamu town, Nigeria within a 2 months period were recruited into the study. A semi- structured questionnaire was used to collect relevant information. RESULTS A total of 255 pregnant women were recruited into the study. The mean age of respondents was 28.07 ± 5.12 years. The mean parity and booking age was 2.7 ± 1.67 and 4.42 ± 1.7 months respectively. The prevalence of Malaria attack in the last 3 months was 122(47.8%). Only 107/255 (40.4%) practice IPTp for malaria prevention during the current pregnancy, with only 14.6% of them taking the second dose during pregnancy as recommended. Chloroquine [27.1%] was the most frequently used medication for the treatment of Malaria in Pregnancy. Early booking age [OR = 1.11, C.I = 0.61-2.01], adverse last pregnancy outcome [OR = 1.23, C.I = 0.36-4.22], and parity [OR = 1.87, C.I = 0.25-16.09] were not statistically significantly associated with IPTp utilization. The only predictor of IPTp use was the knowledge of prophylaxis for malaria prevention [OR = 2.47, C.I = 1.06-3.52] using multivariate analysis. CONCLUSION The study concludes that most women who attend ANC in rural areas in Nigeria do not receive IPTp as expected. A major determinant of utilization of IPTp among the study population was the knowledge of prophylaxis for malaria prevention. This study highlights the importance of health education of the pregnant women in increasing IPTp uptake despite the regular drug stock out at the facility level in rural areas in low resource countries.
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Affiliation(s)
- Olorunfemi E Amoran
- Department of Community Medicine and Primary Care, College of Health Sciences Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria.
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14
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Manirakiza A, Serdouma E, Heredeïbona LS, Djalle D, Madji N, Moyen M, Soula G, Le Faou A, Delmont J. Rational case management of malaria with a rapid diagnostic test, Paracheck Pf®, in antenatal health care in Bangui, Central African Republic. BMC Public Health 2012; 12:482. [PMID: 22734602 PMCID: PMC3681256 DOI: 10.1186/1471-2458-12-482] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2012] [Accepted: 06/26/2012] [Indexed: 11/24/2022] Open
Abstract
Background Both treatment and prevention strategies are recommended by the World Health
Organization for the control of malaria during pregnancy in tropical areas.
The aim of this study was to assess use of a rapid diagnostic test for
prompt management of malaria in pregnancy in Bangui, Central African
Republic. Methods A cohort of 76 pregnant women was screened systematically for malaria with
ParacheckPf® at each antenatal visit. The usefulness of
the method was analysed by comparing the number of malaria episodes
requiring treatment in the cohort with the number of prescriptions received
by another group of pregnant women followed-up in routine antenatal
care. Results In the cohort group, the proportion of positive ParacheckPf®
episodes during antenatal clinics visits was 13.8%, while episodes of
antimalarial prescriptions in the group which was followed-up routinely by
antenatal personnel was estimated at 26.3%. Hence, the relative risk of the
cohort for being prescribed an antimalarial drug was 0.53. Therefore, the
attributable fraction of presumptive treatment avoided by systematic
screening with ParacheckPf® was 47%. Conclusions Use of a rapid diagnostic test is useful, affordable and easy for adequate
treatment of malaria in pregnant women. More powerful studies of the
usefulness of introducing the test into antenatal care are needed in all
heath centres in the country and in other tropical areas.
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15
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Huynh BT, Fievet N, Briand V, Borgella S, Massougbodji A, Deloron P, Cot M. Consequences of gestational malaria on birth weight: finding the best timeframe for intermittent preventive treatment administration. PLoS One 2012; 7:e35342. [PMID: 22514730 PMCID: PMC3325930 DOI: 10.1371/journal.pone.0035342] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Accepted: 03/15/2012] [Indexed: 11/18/2022] Open
Abstract
To investigate the consequences of intermittent preventive treatment (IPTp) timing on birth weight, we pooled data from two studies conducted in Benin between 2005 and 2010: a prospective cohort of 1037 pregnant women and a randomised trial comparing sulfadoxine-pyrimethamine (SP) to mefloquine in 1601 women. A total of 1439 women (752 in the cohort and 687 in the SP arm of the randomised trial) who delivered live singletons were analysed. We showed that an early intake of the first SP dose (4 months of gestation) was associated with a lower risk of LBW compared to a late intake (6–7 months of gestation) (aOR = 0.5 p = 0.01). We also found a borderline increased risk of placental infection when the first SP dose was administered early in pregnancy (aOR = 1.7 p = 0.1). This study is the first to investigate the timing of SP administration during pregnancy. We clearly demonstrated that women who had an early intake of the first SP dose were less at risk of LBW compared to those who had a late intake. Pregnant women should be encouraged to attend antenatal visits early to get their first SP dose and a third dose of SP could be recommended to cover the whole duration of pregnancy and to avoid late infections of the placenta.
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Affiliation(s)
- Bich-Tram Huynh
- UMR216, Institut de Recherche pour le Développement, Paris, France.
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16
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Bertin G, Briand V, Bonaventure D, Carrieu A, Massougbodji A, Cot M, Deloron P. Molecular markers of resistance to sulphadoxine-pyrimethamine during intermittent preventive treatment of pregnant women in Benin. Malar J 2011; 10:196. [PMID: 21767415 PMCID: PMC3199903 DOI: 10.1186/1475-2875-10-196] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Accepted: 07/19/2011] [Indexed: 11/24/2022] Open
Abstract
Background The prevention of malaria faces with the repeated emergence of Plasmodium falciparum resistance to drugs, often involving point mutations of the target gene. In the pregnant woman, currently the WHO recommendation is the administration of an intermittent preventive treatment (IPTp) with sulphadoxine-pyrimethamine. Sulphadoxine-pyrimethamine (SP) resistance has increased for several years in Africa, stressing the need for alternative molecules. In this context, the first randomized clinical trial comparing the efficacy of SP and mefloquine for IPTp has been conducted recently in Benin. Using samples from this trial, the current study evaluated and quantified the prevalence of mutations on the pfdhfr and pfdhps genes as well as the copy number of the pfmdr1 gene in parasites from P. falciparum-infected pregnant women before first and second IPTp administration, and at delivery. Methods PCR-restriction fragment length polymorphism of polymorphic codons of the pfdhfr gene (51, 59, 108, and 164) was performed. The identification of mutations in three codons of the pfdhps gene (436, 437 and 540) was achieved by PCR and sequencing. Copy number quantification for pfmdr1 gene was performed using real-time PCR. Results Results show a high prevalence rate of mutant parasites in women taking IPTp with sulphadoxine-pyrimethamine or mefloquine. The prevalence of triple and quadruple mutants was high before first drug regimen administration (79/93, 85%), and remained similar until delivery. Infection with mutant parasites was not correlated with low birth weight nor placental infection. In all samples, the copy number of pfmdr1 gene was equal to one. Conclusions The clinical trial comparing SP and mefloquine efficacy during IPTp showed SP remained efficacious in preventing low birth weight. The present study shows a high prevalence of triple and quadruple mutations implicated in SP resistance. Although the pfdhfr/pfdhps triple and quadruple mutations were frequent, there was no evidence of correlation between these genotypes and the lack of efficacy of SP in the context of IPTp. Nevertheless, it is now obvious that SP will soon be compromised in whole Africa. Molecular markers have been recommended to monitor SP efficacy for IPTp, but given the current prevalence of mutant parasites their usefulness is questionable.
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Affiliation(s)
- Gwladys Bertin
- Institut de Recherche pour le Développement (IRD), Mère et enfant face aux infections tropicales (UMR216), Paris Cedex, France
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d'Almeida TCDA, Agboton-Zoumenou MA, Garcia A, Massougbodji A, Briand V, Imorou Y, Cottrell G. Field evaluation of the intermittent preventive treatment of malaria during pregnancy (IPTp) in Benin: evolution of the coverage rate since its implementation. Parasit Vectors 2011; 4:108. [PMID: 21679439 PMCID: PMC3135562 DOI: 10.1186/1756-3305-4-108] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Accepted: 06/16/2011] [Indexed: 05/26/2023] Open
Abstract
Background Malaria is an important public health problem in Africa. Pregnant women are a vulnerable population and this disease can underlie an increased risk of low-birth weight newborns (< 2500 g); these women therefore need management during pregnancy. This was previously provided by chloroquine treatment, which, because of compliance problems and drug resistance, was replaced by intermittent preventive treatment with sulfadoxine-pyrimethamine (ITPp-SP) with two single doses taken after 16 weeks of amenorrhea, at least 4 weeks apart. This protocol was recommended by the World Health Organization (WHO) in 1998 and was initiated in Benin in 2006 after its political adoption in 2004. A retrospective longitudinal study was conducted in eight maternity hospitals in two geographical areas in Benin (in the south and north). The study investigated 2420 women who gave birth from 2005 to 2009. The antenatal cards of those women were randomly selected over 5 years with the aim of analyzing the IPT coverage in the study's maternity hospitals. Results The rate of IPT-SP coverage evolved from 3.7% in 2005 to 87.8% in 2009 for women who had received at least one dose and from 2.7% to 68.4% from 2005 to 2009 for those who had received complete ITP (two doses). Variability in the results was observed depending on the geographical area (north/south) and the type of area (rural/urban). Conclusions In total, application of IPT-SP 2-doses has rapidly evolved since 2005, but the objective of 80% IPT coverage has not yet been achieved throughout the country. Moreover, problems of drug shortage recurring in the field (reported by health staff) remain to be resolved.
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Vanga-Bosson HA, Coffie PA, Kanhon S, Sloan C, Kouakou F, Eholie SP, Kone M, Dabis F, Menan H, Ekouevi DK. Coverage of intermittent prevention treatment with sulphadoxine-pyrimethamine among pregnant women and congenital malaria in Côte d'Ivoire. Malar J 2011; 10:105. [PMID: 21529344 PMCID: PMC3108318 DOI: 10.1186/1475-2875-10-105] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Accepted: 04/29/2011] [Indexed: 11/26/2022] Open
Abstract
Background The World Health Organization (WHO) recommends using insecticide-treated mosquito nets (ITNs) and intermittent preventive treatment with sulphadoxine-pyrimethamine (IPT-SP) to prevent malaria in sub-Saharan Africa. Data on IPT-SP coverage and factors associated with placental malaria parasitaemia and low birth weight (LBW) are scarce in Côte d'Ivoire. Methods A multicentre, cross-sectional survey was conducted in Côte d'Ivoire from March to September 2008 at six urban and semi-urban antenatal clinics. Standardized forms were used to collect the demographic information and medical histories of women and their offspring. IPT-SP coverage (≥2 doses) as well as placental and congenital malaria prevalence parasitaemia were estimated. Regression logistics were used to study factors associated with placental malaria and LBW (birth weight of alive babies < 2,500 grams). Results Overall, 2,044 women with a median age of 24 years were included in this study. Among them 1017 (49.8%) received ≥2 doses of IPT-SP and 694 (34.0%) received one dose. A total of 99 mothers (4.8%) had placental malaria, and of them, four cases of congenital malaria were diagnosed. Factors that protected from maternal placental malaria parasitaemia were the use of one dose (adjusted odds ratio (aOR), 0.32; 95%CI: 0.19-0.55) or ≥2 doses IPT-SP (aOR: 0.18; 95%CI: 0.10-0.32); the use of ITNs (aOR: 0.47; 95%CI: 0.27-0.82). LBW was associated with primigravidity and placental malaria parasitaemia. Conclusion IPT-SP decreases the rate of placental malaria parasitaemia and has a strong dose effect. Despite relatively successful IPT-SP coverage in Côte d'Ivoire, substantial commitments from national authorities are urgently required for such public health campaigns. Strategies, such as providing IPT-SP free of charge and directly observing treatment, should be implemented to increase the use of IPT-SP as well as other prophylactic methods.
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Deloron P, Bertin G, Briand V, Massougbodji A, Cot M. Sulfadoxine/pyrimethamine intermittent preventive treatment for malaria during pregnancy. Emerg Infect Dis 2011; 16:1666-70. [PMID: 21029522 PMCID: PMC3294539 DOI: 10.3201/eid1611.101064] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Adequate methods for monitoring this treatment are needed.
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Le Port A, Cottrell G, Dechavanne C, Briand V, Bouraima A, Guerra J, Choudat I, Massougbodji A, Fayomi B, Migot-Nabias F, Garcia A, Cot M. Prevention of malaria during pregnancy: assessing the effect of the distribution of IPTp through the national policy in Benin. Am J Trop Med Hyg 2011; 84:270-5. [PMID: 21292898 PMCID: PMC3029181 DOI: 10.4269/ajtmh.2011.10-0319] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Accepted: 09/10/2010] [Indexed: 11/07/2022] Open
Abstract
The efficiency of malaria prevention during pregnancy was compared between three studies in Benin for malaria infection of the placenta (MIP) and low birth weight (LBW). The first was carried out when chloroquine prophylaxis was still recommended, the second was an intermittent preventive treatment in pregnancy (IPTp) clinical trial comparing sulfadoxine pyrimetamine (SP) versus mefloquine, and the third was an observational study after SP-IPTp national implementation. We showed an association between the use of IPTp and the reduction of LBW (10% with national IPTp and 8.7% in IPTp trial versus 15.7% in pre-trial study). The effect on MIP was better in the trial (2.9% versus 11.2% and 16.7% for national IPTp and pre-trial studies, respectively). In spite of a good overall compliance with the national IPTp (with 84% of women taking at least one dose of SP), there are still failures in adherence to the directly observed therapy (DOT) scheme and needs for better training of health staff.
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Affiliation(s)
- Agnès Le Port
- Institut de Recherche pour le Développement (IRD), UMR216, Mère et Enfant Face aux Infections Tropicales, Paris, France.
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McGready R, White NJ, Nosten F. Parasitological efficacy of antimalarials in the treatment and prevention of falciparum malaria in pregnancy 1998 to 2009: a systematic review. BJOG 2010; 118:123-35. [DOI: 10.1111/j.1471-0528.2010.02810.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Badaut C, Bertin G, Rustico T, Fievet N, Massougbodji A, Gaye A, Deloron P. Towards the rational design of a candidate vaccine against pregnancy associated malaria: conserved sequences of the DBL6epsilon domain of VAR2CSA. PLoS One 2010; 5:e11276. [PMID: 20585655 PMCID: PMC2890577 DOI: 10.1371/journal.pone.0011276] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2009] [Accepted: 05/30/2010] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Placental malaria is a disease linked to the sequestration of Plasmodium falciparum infected red blood cells (IRBC) in the placenta, leading to reduced materno-fetal exchanges and to local inflammation. One of the virulence factors of P. falciparum involved in cytoadherence to chondroitin sulfate A, its placental receptor, is the adhesive protein VAR2CSA. Its localisation on the surface of IRBC makes it accessible to the immune system. VAR2CSA contains six DBL domains. The DBL6epsilon domain is the most variable. High variability constitutes a means for the parasite to evade the host immune response. The DBL6epsilon domain could constitute a very attractive basis for a vaccine candidate but its reported variability necessitates, for antigenic characterisations, identifying and classifying commonalities across isolates. METHODOLOGY/PRINCIPAL FINDINGS Local alignment analysis of the DBL6epsilon domain had revealed that it is not as variable as previously described. Variability is concentrated in seven regions present on the surface of the DBL6epsilon domain. The main goal of our work is to classify and group variable sequences that will simplify further research to determine dominant epitopes. Firstly, variable sequences were grouped following their average percent pairwise identity (APPI). Groups comprising many variable sequences sharing low variability were found. Secondly, ELISA experiments following the IgG recognition of a recombinant DBL6epsilon domain, and of peptides mimicking its seven variable blocks, allowed to determine an APPI cut-off and to isolate groups represented by a single consensus sequence. CONCLUSIONS/SIGNIFICANCE A new sequence approach is used to compare variable regions in sequences that have extensive segmental gene relationship. Using this approach, the VAR2CSA DBL6 domain is composed of 7 variable blocks with limited polymorphism. Each variable block is composed of a limited number of consensus types. Based on peptide based ELISA, variable blocks with 85% or greater sequence identity are expected to be recognized equally well by antibody and can be considered the same consensus type. Therefore, the analysis of the antibody response against the classified small number of sequences should be helpful to determine epitopes.
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Affiliation(s)
- Cyril Badaut
- Mother and Child Faced with Tropical Infections Research Unit, Institut de Recherche pour le Développement, UMR216, Paris, France
- Université Paris Descartes, Paris, France
- * E-mail: (CB); (PD)
| | - Gwladys Bertin
- Mother and Child Faced with Tropical Infections Research Unit, Institut de Recherche pour le Développement, UMR216, Paris, France
- Université Paris Descartes, Paris, France
| | - Tatiana Rustico
- Mother and Child Faced with Tropical Infections Research Unit, Institut de Recherche pour le Développement, UMR216, Paris, France
| | - Nadine Fievet
- Mother and Child Faced with Tropical Infections Research Unit, Institut de Recherche pour le Développement, UMR216, Paris, France
| | - Achille Massougbodji
- Département de Zoologie et Génétique, Faculté des Sciences et Techniques, Université d'Abomey-Calavi, Cotonou, Benin
| | - Alioune Gaye
- Centre de Santé Roi Baudoin de Guédiawaye, Dakar, Senegal
| | - Philippe Deloron
- Mother and Child Faced with Tropical Infections Research Unit, Institut de Recherche pour le Développement, UMR216, Paris, France
- Université Paris Descartes, Paris, France
- * E-mail: (CB); (PD)
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Bouyou-Akotet MK, Mawili-Mboumba DP, Tchantchou TDD, Kombila M. High prevalence of sulfadoxine/pyrimethamine-resistant alleles of Plasmodium falciparum isolates in pregnant women at the time of introduction of intermittent preventive treatment with sulfadoxine/pyrimethamine in Gabon. J Antimicrob Chemother 2010; 65:438-41. [PMID: 20053688 DOI: 10.1093/jac/dkp467] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The frequency of dhfr and dhps point mutations was assessed in Plasmodium falciparum isolates from pregnant women in Libreville. METHODS PCR-restriction fragment length polymorphism of polymorphic codons of the dhfr gene (51, 59 and 108) and the dhps gene (436, 437 and 540) was performed in matched peripheral and placental blood samples. RESULTS The proportion of multiple mutations was high (98%), and was not different between women with and without a history of intermittent preventive treatment with sulfadoxine/pyrimethamine (IPTp/SP). The prevalence of triple dhfr mutation was 80%, and that of quadruple and quintuple mutations was 53% and 22%, respectively. The Glu540 mutation was present in two isolates. The concordance of resistant alleles in matched peripheral and placental isolates was >90% for both genes. CONCLUSIONS These findings underline the need for a regular assessment of the relationship between the presence of resistant isolates and in vitro/in vivo IPTp/SP efficacy, and evaluation of an alternative drug.
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Affiliation(s)
- Marielle Karine Bouyou-Akotet
- Department of Parasitology, Mycology and Tropical Medicine, Faculty of Medicine, Université des Sciences de la Santé, Libreville, Gabon.
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Fievet N, Varani S, Ibitokou S, Briand V, Louis S, Perrin RX, Massougbogji A, Hosmalin A, Troye-Blomberg M, Deloron P. Plasmodium falciparum exposure in utero, maternal age and parity influence the innate activation of foetal antigen presenting cells. Malar J 2009; 8:251. [PMID: 19889240 PMCID: PMC2780449 DOI: 10.1186/1475-2875-8-251] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2009] [Accepted: 11/05/2009] [Indexed: 12/14/2022] Open
Abstract
Background Malaria in pregnancy is associated with immunological abnormalities in the newborns, such as hampered T-helper 1 responses and increased T-regulatory responses, while the effect of maternal Plasmodium falciparum infection on foetal innate immunity is still controversial. Materials and methods The immunophenotype and cytokine release by dendritic cells (DC) and monocytes were evaluated in cord blood from 59 Beninese women with or without malaria infection by using flow cytometry. Results Accumulation of malaria pigment in placenta was associated with a partial maturation of cord blood myeloid and plasmacytoid DC, as reflected by an up-regulated expression of the major histocompatibility complex class II molecules, but not CD86 molecules. Cells of newborns of mothers with malaria pigment in their placenta also exhibited significantly increased cytokine responses upon TLR9 stimulation. In addition, maternal age and parity influenced the absolute numbers and activation status of cord blood antigen-presenting cells. Lastly, maternal age, but not parity, influenced TLR3, 4 and 9 responses in cord blood cells. Discussion Our findings support the view that placental parasitization, as indicated by the presence of malaria pigment in placental leukocytes, is significantly associated with partial maturation of different DC subsets and also to slightly increased responses to TLR9 ligand in cord blood. Additionally, other factors, such as maternal age and parity should be taken into consideration when analysing foetal/neonatal innate immune responses. Conclusion These data advocate a possible mechanism by which PAM may modulate foetal/neonatal innate immunity.
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Affiliation(s)
- Nadine Fievet
- UR010, Mother and Child Health in the Tropics, Institut de Recherche pour le Développement (IRD), Cotonou, Benin
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