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Ogba P, Badru O, Ibhawoh B, Archer N, Baumann A. Perceptions of sulphadoxine-pyrimethamine use among pregnant women in sub-Saharan Africa: a scoping review. MALARIAWORLD JOURNAL 2023; 14:1. [PMID: 37090061 PMCID: PMC10117231 DOI: 10.5281/zenodo.7828460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
Background Malaria is a major global public health issue that disproportionately affects pregnant women in sub-Saharan Africa. The World Health Organization recommends intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP) for its control. Despite its proven efficacy, drug uptake remains low. Sulphadoxine-pyrimethamine (SP) safety concerns have been cited as one of several reasons for this low uptake. Methods We conducted a scoping review using the Arksey and O'Malley framework and the health belief model to investigate perceptions of SP use among pregnant women in sub-Saharan Africa. We looked for peer-reviewed publications in five international databases. Results The review included 19 articles out of a total of 246. It showed that pregnant women in sub-Saharan Africa have a good understanding of malaria and its consequences, but this does not necessarily translate into increased IPTp-SP uptake. It is worrisome to know that some pregnant women (from 2 studies) did not believe that SP use is beneficial, and several participants (from 4 studies) were unsure or did not see the drug as an effective intervention. Many pregnant women believe SP harms them, their partners, or their unborn children. Conclusions Healthcare professionals should continue prescribing and encouraging pregnant women to use SP for malaria prevention until a better substitute becomes available.
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Affiliation(s)
- Patricia Ogba
- Faculty of Health Sciences, Global Health Office, McMaster University, Main St. W, Hamilton, Ontario, Canada
| | - Oluwaseun Badru
- Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Bonny Ibhawoh
- Department of History, McMaster University, Main St. W, Hamilton, Ontario, Canada
| | - Norm Archer
- Degroote School of Business, McMaster University, Main St. W, Hamilton, Ontario, Canada
| | - Andrea Baumann
- Faculty of Health Sciences, Global Health Office, McMaster University, Main St. W, Hamilton, Ontario, Canada
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Systematic Review of Mixed Studies on Malaria in Pregnancy: Individual, Cultural and Socioeconomic Determinants of Its Treatment and Prevention. Trop Med Infect Dis 2022; 7:tropicalmed7120423. [PMID: 36548677 PMCID: PMC9784813 DOI: 10.3390/tropicalmed7120423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/23/2022] [Accepted: 11/28/2022] [Indexed: 12/13/2022] Open
Abstract
Malaria in pregnancy (MiP) is a global public health problem; its research is predominantly quantitative. The objective was to analyze the individual, cultural and socioeconomic determinants of the treatment and prevention of MiP with a systematic review of mixed studies (search had no date restriction). Reproducibility and evaluation of the methodological quality were guaranteed. 21 studies were included (20 from Africa). The quantitative component included 7816 pregnant women and 483 health workers. The qualitative component included 800 subjects (pregnant women, health workers, family members and community leaders). The main topics were the use and acceptability of WHO strategies to prevent MiP, individual determinants related with knowledge, perceptions, attitudes and behaviors on MiP, and cultural and socioeconomic barriers for its treatment and prevention. The main determinants of MiP were long distance to the clinic, lack of economic resources, low-coverage antenatal care, few health workers in the communities, drug shortages, cultural rules that prevent women's participation in health issues, and misconceptions about MiP. MiP has determinants related to economic conditions, the structure and functioning of the health system, symbolic and cultural aspects, as well as knowledge, beliefs, perceptions and behavior of pregnant women, which prevent optimal access and use of preventive strategies. This study evidences the importance of intersectional, intersectoral, and interdisciplinary work to prevent MiP.
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Prevention of Malaria in Pregnancy: What Do the Pregnant Women of Nigeria Know and Do about It? Infect Dis Obstet Gynecol 2022; 2022:7061548. [PMID: 36438171 PMCID: PMC9699741 DOI: 10.1155/2022/7061548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 10/10/2022] [Accepted: 10/31/2022] [Indexed: 11/19/2022] Open
Abstract
Objective We assessed knowledge, attitude, and practice regarding two malaria prevention measures (long-lasting impregnated mosquito nets, LLINs, and intermittent preventative therapy with sulphadoxine-pyrimethamine (IPTp-SP)) among pregnant women in Nigeria. Methods Pregnant women selected from among the four communities of Nnewi were interviewed by using a semistructured, interviewer-administered questionnaire on the respondents' demography, knowledge of the cause, consequences, and malaria prevention methods. Also, a total of 48 focused group discussions, 24 key informant interviews, and 24 in-depth interviews were held among women leaders, village heads, pregnant women, community health workers, husbands of pregnant wives, and drug and insecticide-treated net sellers. Results A total of 384 women (88.0% third trimester, 90.0% literate, and 41.1% primigravidae) participated. About 80.0% suffered from malaria during their current pregnancy. The majority was aware of the cause of malaria, local name of malaria, mode of transmission, risk of malaria among pregnant women, etc. However, their knowledge and attitude were inadequate regarding the symptomatology and complications of malaria in pregnancy, benefits of sleeping under the net or taking chemoprophylactic doses, or the concurrent use of both. About 80.0% had LLINs, yet only 41.5% slept under it the previous night. Only 31.0% had IPTp-SP doses under direct observation. Only 35.9% had a good understanding of IPTp-SP during pregnancy. Conclusion Our work presents important practice gaps associated with the prevention of malaria during pregnancy. The pregnant women seemed to be aware of the basic concepts related to malaria but that does not translate into adequate attitude and practice necessary for malaria reduction.
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Intermittent Preventive Treatment of Malaria in Pregnancy with Sulphadoxine-Pyrimethamine and its Associated Factors in the Atwima Kwanwoma District, Ghana. Ann Glob Health 2022; 88:27. [PMID: 35582408 PMCID: PMC9053532 DOI: 10.5334/aogh.3560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Intermittent preventive treatment of malaria in pregnancy with Sulphadoxine-Pyrimethamine (IPTp-SP) tablets is one of the recommended interventions to reduce the burden of malaria on both the pregnant woman and the unborn child. The aim of this study was to assess the prevalence of IPTp-SP uptake and its associated factors in the Atwima Kwanwoma District of Ashanti Region, Ghana. Methods: The study was cross sectional. A structured questionnaire was administered to 394 respondents, comprising pregnant women in their last two months of pregnancy and nursing mothers who delivered within three months prior to the study. Medical records of the respondents were also reviewed. Descriptive statistics such as simple proportions, and averages were computed. Chi-square test and multiple logistic regression analysis were performed to determine factors associated with IPTp-SP uptake. Results: The average age of the respondents was 28.2 (±5.9) years. Almost all of the respondents (98%) had received SP at the time of the study. Fifty percent received their first dose of SP between 16 and 19 weeks of gestation. The multiple logistic regression analysis showed a statistically significant association between IPTp-SP uptake and educational level, time of first ANC visit, number of ANC visits and receiving education on SP prior to the administration of the drug. Conclusion: Education on SP use should be intensified at all levels of the health system. Early initiation of ANC is also recommended for optimal uptake of IPTp-SP. More research is needed to understand factors affecting the uptake of SP during pregnancy in the country.
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Aberese-Ako M, Magnussen P, Ampofo GD, Gyapong M, Ansah E, Tagbor H. An ethnographic study of how health system, socio-cultural and individual factors influence uptake of intermittent preventive treatment of malaria in pregnancy with sulfadoxine-pyrimethamine in a Ghanaian context. PLoS One 2021; 16:e0257666. [PMID: 34618812 PMCID: PMC8496863 DOI: 10.1371/journal.pone.0257666] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 09/08/2021] [Indexed: 11/29/2022] Open
Abstract
Background Intermittent preventive treatment of malaria among pregnant women with sulfadoxine-pyrimethamine (IPTp-SP), is one of the three recommended interventions for the prevention of malaria in pregnancy (MiP) in sub-Sahara Africa. The World Health Organisation recommended in 2012 that SP be given at each scheduled ANC visit except during the first trimester and can be given a dose every month until the time of delivery, to ensure that a high proportion of women receive at least three doses of SP during pregnancy. Despite implementation of this policy, Ghana did not attain the target of 100% access to IPTp-SP by 2015. Additionally, negative outcomes of malaria infection in pregnancy are still recurring. This ethnographic study explored how health system, individual and socio-cultural factors influence IPTp-SP uptake in two Ghanaian regions. Methods The study design was ethnographic, employing non-participant observation, case studies and in depth interviews in 8 health facilities and 8 communities, from April 2018 to March 2019, in two Ghanaian regions. Recommended ethical procedures were observed. Results Health system factors such as organization of antenatal care (ANC) services and strategies employed by health workers to administer SP contributed to initial uptake. Women’s trust in the health care system contributed to continued uptake. Inadequate information provided to women accessing ANC, stock-outs and fees charged for ANC services reduced access to IPTp-SP. Socio-cultural factor such as encouragement from social networks influenced utilization of ANC services and IPTp-SP uptake. Individual factors such as refusing to take SP, skipping ANC appointments and initiating ANC attendance late affected uptake. Conclusion Health system, socio-cultural and individual factors influence uptake of optimum doses of IPTp-SP. Consequently, interventions that aim at addressing IPTp-SP uptake should focus on regular and sufficient supply of SP to health facilities, effective implementation of free ANC, provision of appropriate and adequate information to women and community outreach programmes to encourage early and regular ANC visits.
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Affiliation(s)
- Matilda Aberese-Ako
- Institute of Health Research, University of Health and Allied Sciences, Ho, Volta Region, Ghana
- * E-mail: ,
| | - Pascal Magnussen
- Faculty of Health and Medical Sciences, Centre for Medical Parasitology, University of Copenhagen, Copenhagen, Denmark
| | - Gifty D. Ampofo
- School of Medicine, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Margaret Gyapong
- Institute of Health Research, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Evelyn Ansah
- Institute of Health Research, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Harry Tagbor
- School of Medicine, University of Health and Allied Sciences, Ho, Volta Region, Ghana
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Mwin PK, Kuffuor A, Nuhu K, Okine R, Kubio C, Wurapa F, Osei FA, Afari E. Predictors of placental malaria in Upper West Regional Hospital-Ghana. BMC Pregnancy Childbirth 2021; 21:403. [PMID: 34039288 PMCID: PMC8157656 DOI: 10.1186/s12884-021-03861-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 05/06/2021] [Indexed: 12/02/2022] Open
Abstract
Background Placental malaria (PM) poses life-threatening complications to pregnant women as they are at increased risk of maternal and perinatal morbidity and mortality associated with malaria. This study examined the factors associated with placental malaria in the Upper West Regional Hospital (UWR). Methods A cross-sectional hospital-based study was carried out among pregnant women delivering at Upper West Regional Hospital. A cross-sectional screening survey was conducted from January 2019 to April 2019. Three hundred eligible mothers were consecutively recruited. A record review of their maternal and child history was assessed using a checklist. Placental blood samples were taken for microscopy to determine placental malaria parasitemia. Logistic regression analysis was done to determine the factors associated with placental malaria at 95 % confidence level. Results The proportion of mothers with placental malaria was 7 % (21/300), (95 % CI, 4.3–10.5 %). Plasmodium falciparum was the only species identified in those with PM. Majority of the women 66.7 % (14/21) with placental malaria had parasite density in the range 501 to 5,000 parasites/µL. Obstetric and health service factors that were significantly associated with placental malaria were gravidity and antenatal care (ANC) attendance. Primigravida (aOR = 3.48, 95 %CI = 1.01–12.01) and having less than 4 ANC attendance (aOR = 9.78, 95 %CI = 2.89–33.11) were found to be significantly associated with placental malaria. Conclusions The proportion of women with PM was relatively low. Primigravid mothers reporting less than 4 ANC visits had the highest risk of placental malaria. Expectant mothers should be encouraged to attend at least 4 ANC visits prior to delivery.
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Affiliation(s)
- Pascal Kingsley Mwin
- Field Epidemiology and Laboratory Training Program, School of Public Health, University of Ghana, Legon, USA
| | - Afreh Kuffuor
- Ghana Health Service, Upper West Regional Health Directorate, Karaga, Ghana
| | - Kaamel Nuhu
- State University of New York - Cortland, Cortland, USA
| | - Rafiq Okine
- World Health Organization (WHO), Country Office for Ghana, Accra, Ghana
| | - Chrysantus Kubio
- Ghana Health Service, Karaga District Health Directorate, Karaga, Ghana
| | - Frederick Wurapa
- Field Epidemiology and Laboratory Training Program, School of Public Health, University of Ghana, Legon, USA
| | - Francis Adjei Osei
- Public Health Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana. .,KNUST School of Public Health, Kumasi, Ghana.
| | - Edwin Afari
- Field Epidemiology and Laboratory Training Program, School of Public Health, University of Ghana, Legon, USA
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Looman L, Pell C. End-user perspectives on preventive antimalarials: A review of qualitative research. Glob Public Health 2021; 17:753-767. [PMID: 33617406 DOI: 10.1080/17441692.2021.1888388] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Antimalarials have been administered widely to prevent clinical malaria and researchers have explored how end-users' perspectives influence uptake and adherence. Drawing on a systematic search, this review aims to synthesise qualitative research on end-user perceptions of antimalarials for disease prevention. Searches were undertaken in PubMed and ISI Web of Knowledge. After applying exclusion criteria, identified sources underwent thematic analysis. Identified sources were published between 2000 and 2020 and drew on studies undertaken across Africa, Asia, Europe, Oceania and America. The sources revealed end-user concerns about the potential benefits and harms of preventive treatment that are entwined with broader understandings of the disease, the intervention, its implementation, accompanying information, and how it is embedded in wider healthcare and social relationships. The implications for antimalarials as preventive therapy encompass the need to build trust, including interpersonal trust, engage diverse stakeholders and to address broader health and wellbeing concerns during implementation.
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Affiliation(s)
- Lisanne Looman
- Department of Global Health Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Christopher Pell
- Department of Global Health Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Institute for Global Health and Development (AIGHD), Amsterdam, The Netherlands.,Centre for Social Science and Global Health, University of Amsterdam, Amsterdam, The Netherlands
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8
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Dosoo DK, Chandramohan D, Atibilla D, Oppong FB, Ankrah L, Kayan K, Agyemang V, Adu-Gyasi D, Twumasi M, Amenga-Etego S, Bruce J, Asante KP, Greenwood B, Owusu-Agyei S. Epidemiology of malaria among pregnant women during their first antenatal clinic visit in the middle belt of Ghana: a cross sectional study. Malar J 2020; 19:381. [PMID: 33097044 PMCID: PMC7585211 DOI: 10.1186/s12936-020-03457-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 10/19/2020] [Indexed: 01/15/2023] Open
Abstract
Background Malaria during pregnancy may result in unfavourable outcomes in both mothers and their foetuses. This study sought to document the current burden and factors associated with malaria and anaemia among pregnant women attending their first antenatal clinic visit in an area of Ghana with perennial malaria transmission. Methods A total of 1655 pregnant women aged 18 years and above with a gestational age of 13–22 weeks, who attended an antenatal care (ANC) clinic for the first time, were consented and enrolled into the study. A structured questionnaire was used to collect socio-demographic and obstetric data and information on use of malaria preventive measures. Venous blood (2 mL) was collected before sulfadoxine-pyrimethamine administration. Malaria parasitaemia and haemoglobin concentration were determined using microscopy and an automated haematology analyser, respectively. Data analysis was carried out using Stata 14. Results Mean age (SD) and gestational age (SD) of women at enrolment were 27.4 (6.2) years and 16.7 (4.3) weeks, respectively. Overall malaria parasite prevalence was 20.4% (95% CI 18.5–22.4%). Geometric mean parasite density was 442 parasites/µL (95% CI 380–515). Among women with parasitaemia, the proportion of very low (1–199 parasites/µL), low (200–999 parasites/µL), medium (1000–9999 parasites/µL) and high (≥ 10,000 parasites/µL) parasite density were 31.1, 47.0, 18.9, and 3.0%, respectively. Age ≥ 25 years (OR 0.57, 95% CI 0.41–0.79), multigravid (OR 0.50, 95% CI 0.33–0.74), educated to high school level or above (OR 0.53, 95% CI 0.33–0.83) and in household with higher socio-economic status (OR 0.34, 95% CI 0.21–0.54) were associated with a lower risk of malaria parasitaemia. The prevalence of anaemia (< 11.0 g/dL) was 56.0%, and the mean haemoglobin concentration in women with or without parasitaemia was 9.9 g/dL or 10.9 g/dL, respectively. Conclusion One out of five pregnant women attending their first ANC clinic visit in an area of perennial malaria transmission in the middle belt of Ghana had Plasmodium falciparum infection. Majority of the infections were below 1000 parasites/µL and with associated anaemia. There is a need to strengthen existing malaria prevention strategies to prevent unfavourable maternal and fetal birth outcomes in this population.
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Affiliation(s)
- David Kwame Dosoo
- Kintampo Health Research Centre, Ghana Health Service, PO Box 200, Kintampo, Ghana. .,Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
| | - Daniel Chandramohan
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Dorcas Atibilla
- Kintampo Health Research Centre, Ghana Health Service, PO Box 200, Kintampo, Ghana
| | - Felix Boakye Oppong
- Kintampo Health Research Centre, Ghana Health Service, PO Box 200, Kintampo, Ghana
| | - Love Ankrah
- Kintampo Health Research Centre, Ghana Health Service, PO Box 200, Kintampo, Ghana
| | - Kingsley Kayan
- Kintampo Health Research Centre, Ghana Health Service, PO Box 200, Kintampo, Ghana
| | - Veronica Agyemang
- Kintampo Health Research Centre, Ghana Health Service, PO Box 200, Kintampo, Ghana
| | - Dennis Adu-Gyasi
- Kintampo Health Research Centre, Ghana Health Service, PO Box 200, Kintampo, Ghana
| | - Mieks Twumasi
- Kintampo Health Research Centre, Ghana Health Service, PO Box 200, Kintampo, Ghana
| | - Seeba Amenga-Etego
- Kintampo Health Research Centre, Ghana Health Service, PO Box 200, Kintampo, Ghana
| | - Jane Bruce
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Kwaku Poku Asante
- Kintampo Health Research Centre, Ghana Health Service, PO Box 200, Kintampo, Ghana
| | - Brian Greenwood
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Seth Owusu-Agyei
- Kintampo Health Research Centre, Ghana Health Service, PO Box 200, Kintampo, Ghana.,Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.,Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
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Effect of Drug Pressure on Promoting the Emergence of Antimalarial-Resistant Parasites among Pregnant Women in Ghana. Antimicrob Agents Chemother 2020; 64:AAC.02029-19. [PMID: 32179528 DOI: 10.1128/aac.02029-19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 03/08/2020] [Indexed: 11/20/2022] Open
Abstract
The continuous spread of antimalarial drug resistance is a threat to current chemotherapy efficacy. Therefore, characterizing the genetic diversity of drug resistance markers is needed to follow treatment effectiveness and further update control strategies. Here, we genotyped Plasmodium falciparum resistance gene markers associated with sulfadoxine-pyrimethamine (SP) and artemisinin-based combination therapy (ACT) in isolates from pregnant women in Ghana. The prevalence of the septuple IRN I- A/FG K GS/T pfdhfr/pfdhps haplotypes, including the pfdhps A581G and A613S/T mutations, was high at delivery among post-SP treatment isolates (18.2%) compared to those of first antenatal care (before initiation of intermittent preventive treatment of malaria in pregnancy with sulfadoxine-pyrimethamine [IPTp-SP]; 6.1%; P = 0.03). Regarding the pfk13 marker gene, two nonsynonymous mutations (N458D and A481C) were detected at positions previously related to artemisinin resistance in isolates from Southeast Asia. These mutations were predicted in silico to alter the stability of the pfk13 propeller-encoding domain. Overall, these findings highlight the need for intensified monitoring and surveillance of additional mutations associated with increased SP resistance as well as emergence of resistance against artemisinin derivatives.
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Quakyi I, Tornyigah B, Houze P, Kusi KA, Coleman N, Escriou G, Laar A, Cot M, Fobil J, Asare GQ, Deloron P, Anang AK, Cottrell G, Ofori MF, Ndam NT. High uptake of Intermittent Preventive Treatment of malaria in pregnancy is associated with improved birth weight among pregnant women in Ghana. Sci Rep 2019; 9:19034. [PMID: 31836735 PMCID: PMC6911095 DOI: 10.1038/s41598-019-55046-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 11/20/2019] [Indexed: 11/09/2022] Open
Abstract
Despite the clinically proven advantages of intermittent preventive treatment of malaria in pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP), utilisation has been low in many African countries. To increase uptake and achieve the desired effect, the World Health Organization revised the policy to a monthly administration. Assessing the coverage and impact of the revised policy on pregnancy and neonatal outcomes is, therefore, a necessity. A 2-parallel cross-sectional hospital-based study was carried out among pregnant women attending first antenatal care (ANC) and delivery. Maternal and cord blood samples were assayed for malaria parasites by quantitative PCR targeting both the 18S rDNA and the acidic terminal segment of Plasmodium falciparum var genes, and plasma SP levels were measured by liquid chromatography coupled to tandem mass spectrometry. Parasite prevalence was similar between the two study sites but decreased significantly between the first ANC (9% or 43%) and delivery (4% or 11%) based on the qPCR target. At delivery, 64.5% of women received ≥3 IPTp-SP dose, 15.5% received 2 doses and 6% had 1 dose. Taking ≥3 IPTp-SP doses was associated with an average birth weight increase of more than 0.165 kg. IPTp-SP uptake was associated with plasma SP level at delivery (OR = 32.3, p ≤ 0.005, 95% CI (13.3;78.4) for those that reported ≥3 IPTp-SP doses) while the same trend of improved birth weight was observed with high plasma SP levels. The new IPTp policy is well implemented and well utilised by women in the sites considered in this study and translates to the improved birth weight observed. This study confirms the interest and the clinical benefit expected from this policy change.
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Affiliation(s)
- Isabella Quakyi
- Université de Paris, MERIT, IRD, F-75006, Paris, France.,Department of Biological Environmental and Occupational Health Sciences, School of Public Health, College of Health Sciences, University of Ghana, Legon, Ghana
| | - Bernard Tornyigah
- Université de Paris, MERIT, IRD, F-75006, Paris, France.,Department of Immunology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, Legon, Ghana
| | - Pascal Houze
- Service de biochimie générale, Hôpital universitaire Necker-Enfants Malades, AP-HP, 149 rue de Sèvres, 75015, Paris, France.,Unité de Technologies Biologiques et Chimiques pour la Santé (UTCBS), Paris 5-CNRS UMR8258 Inserm U1022, Faculté de Pharmacie, Université Paris Descartes, Paris, France.,Department of Parasitology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Ghana
| | - Kwadwo A Kusi
- Department of Immunology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, Legon, Ghana
| | - Nathaniel Coleman
- Department of Biological Environmental and Occupational Health Sciences, School of Public Health, College of Health Sciences, University of Ghana, Legon, Ghana
| | | | - Amos Laar
- Department of Biological Environmental and Occupational Health Sciences, School of Public Health, College of Health Sciences, University of Ghana, Legon, Ghana
| | - Michel Cot
- Université de Paris, MERIT, IRD, F-75006, Paris, France
| | - Julius Fobil
- Department of Biological Environmental and Occupational Health Sciences, School of Public Health, College of Health Sciences, University of Ghana, Legon, Ghana
| | - Gloria Quansah Asare
- Department of Biological Environmental and Occupational Health Sciences, School of Public Health, College of Health Sciences, University of Ghana, Legon, Ghana
| | | | - Abraham K Anang
- Department of Parasitology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Ghana
| | | | - Michael F Ofori
- Department of Immunology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, Legon, Ghana
| | - Nicaise Tuikue Ndam
- Université de Paris, MERIT, IRD, F-75006, Paris, France. .,Department of Immunology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, Legon, Ghana.
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11
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Bhalla D, Cleenewerck L, Okorafor Kalu S, Abubakar Gulma K. Malaria Prevention Measures among Pregnant Women: A Population-Based Survey in Nnewi, Nigeria. ScientificWorldJournal 2019; 2019:6402947. [PMID: 31827414 PMCID: PMC6881563 DOI: 10.1155/2019/6402947] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 08/24/2019] [Accepted: 08/30/2019] [Indexed: 11/21/2022] Open
Abstract
We examined factors related to the uptake of two malaria prevention measures, insecticide-treated bed-nets and prophylactic sulphadoxine-pyrimethamine (SP), among pregnant women in Nnewi, Nigeria. The survey had a quantitative and qualitative part. For each part, the subjects meeting our inclusion criteria were systematically identified in a population-based manner. For the qualitative part, focused group discussions, in-depth interviews with a wide variety of stakeholders (e.g., health workers, males whose wives are pregnant, and drug and net sellers), and key informants including doctors and nurses were held. All data covered various aspects related to the topics. A total of 384 subjects participated. The mean age was 28.9 years (95% CI 23.4-34.5). The primigravidae (odds 1.8-2.3) and illiterates (odds 4.1-13.5) were less likely to sleep under the net. Primigravidae were 2.0x less likely to uptake adequate SP. The uptake was also associated with having adequate knowledge on SP (2.4x), completing usual (≥4 visits) antenatal visits (3.9x), and being in the best (≥9 visits) antenatal visit scenario (10.5x). Other barriers identified were thermal discomfort, lack of availability, cost, and unsupervised uptake of SP. Based on a representative sample, systematic procedures, and within current evaluation limits, we conclude that primigravidae and those with no formal education and inadequate antenatal visits should be the foremost group for encouraging uptake of malaria prevention measures. The policymakers should resolve issues of thermal discomfort, availability, cost, unsupervised uptake, and inadequate awareness and confidence on SP prophylaxis. The solutions are available and should be actively sought.
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Affiliation(s)
- Devender Bhalla
- School of Global Health and Bioethics, EUCLID (Pôle Universitaire Euclide/Euclid University), Bangui, Central African Republic
| | - Laurent Cleenewerck
- School of Global Health and Bioethics, EUCLID (Pôle Universitaire Euclide/Euclid University), Bangui, Central African Republic
| | - Stephen Okorafor Kalu
- School of Global Health and Bioethics, EUCLID (Pôle Universitaire Euclide/Euclid University), Bangui, Central African Republic
| | - Kabiru Abubakar Gulma
- School of Global Health and Bioethics, EUCLID (Pôle Universitaire Euclide/Euclid University), Bangui, Central African Republic
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Oppong FB, Gyaase S, Zandoh C, Nettey OEA, Amenga-Etego S, Anane EA, Adda R, Dosoo DK, Owusu-Agyei S, Asante KP. Intermittent preventive treatment of pregnant women in Kintampo area of Ghana with sulphadoxine-pyrimethamine (SP): trends spanning 2011 and 2015. BMJ Open 2019; 9:e027946. [PMID: 31230017 PMCID: PMC6596987 DOI: 10.1136/bmjopen-2018-027946] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE In Ghana, intermittent preventive treatment during pregnancy with sulphadoxine-pyrimethamine (IPTp-SP) is recommended for the prevention of malaria-related adverse outcomes. This study demonstrates the coverage of IPTp-SP use among pregnant women over a period (2011-2015) and the impact of various sociodemographic groups on the uptake of IPTp-SP. DESIGN Retrospective analysis using data from all pregnant women in the Kintampo Health and Demographic Surveillance System area on the uptake of IPTp-SP. SETTING Kintampo North Municipality and Kintampo South District of Ghana. PARTICIPANTS All pregnant women in the Kintampo Health and Demographic Surveillance System area. PRIMARY AND SECONDARY OUTCOME MEASURES The number of doses of IPTp-SP taken by pregnant women were examined. Logistic regression was used to assess the determinant of uptake of IPTp-SP while adjusting for within-subject correlation from women with multiple pregnancies. RESULTS Data from 2011 to 2015 with a total of 17 484 pregnant women were used. The coverage of the recommended three or more doses of IPTp-SP among all pregnant women was 40.6%, 44.0%, 45.9%, 20.9% and 32.4% in 2011, 2012, 2013, 2014 and 2015, respectively. In the adjusted analysis, age, household size, education, religion, number of antenatal care visits, ethnicity, marital status, wealth index and place of residence were significantly associated with the uptake of three or more doses of IPTp-SP. Having middle school education or higher, aged 20 years and above, visiting antenatal care five times or more (OR 2.83, 95% CI 2.64 to 3.03), being married (OR 1.10, 95% CI 1.02 to 1.19) and those in higher wealth quintiles were significantly more likely to take three or more doses of IPTp-SP. CONCLUSION The uptake of the recommended three or more doses of IPTp-SP is low in the study area. We recommend a community-based approach to identify women during early pregnancy and to administer IPTp-SP.
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Affiliation(s)
| | | | | | | | | | | | - Robert Adda
- Kintampo Health Research Centre, Kintampo, Ghana
| | | | - Seth Owusu-Agyei
- Kintampo Health Research Centre, Kintampo, Ghana
- Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
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Owusu-Boateng I, Anto F. Intermittent preventive treatment of malaria in pregnancy: a cross-sectional survey to assess uptake of the new sulfadoxine-pyrimethamine five dose policy in Ghana. Malar J 2017; 16:323. [PMID: 28797296 PMCID: PMC5553599 DOI: 10.1186/s12936-017-1969-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 08/03/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malaria in pregnancy poses a great risk to both mother and fetus. In Ghana, malaria accounts for 3.4% of deaths and 16.8% of all hospital admissions in pregnant women. In 2014, Ghana updated her policy on intermittent preventive treatment of malaria in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) to reflect the updated policy of the WHO. This study determined the level of uptake of sulfadoxine pyrimethamine (SP) to serve as baseline for monitoring progress and also reviewed stock levels of SP, a key factor in the programme implementation. METHODS A cross-sectional hospital-based study was carried out among nursing mothers who had delivered within 12 weeks and were seeking postnatal care at Osu Government Maternity Home in Accra. Antenatal record books of the mothers were reviewed and data collected on number of visits and receipt of IPTp-SP. Mothers were interviewed and data collected on their background characteristics and obstetric history. Data on SP stock levels for the past 6 months were also reviewed. Logistic regression analysis was carried out to determine antenatal indicators on uptake of IPTp-SP using Stata version 12. RESULTS The proportion of uptake of three-five doses of SP were: IPT3 (87.5%), IPT4 (55.7%) and IPT5 (14.5%). The proportion of women who received the first dose of SP at 16 weeks of gestation was 21.3%. Women who made ≥4 visits were more likely to receive ≥3 doses of SP than those who made <4 visits (AOR = 4.57, 95% CI 1.15-18.16, p < 0.05). Women receiving the first dose of SP in the third trimester were less likely to receive ≥3 doses of SP than those who received the drug in the second trimester (AOR = 0.04, 95% CI 0.01-0.16, p < 0.05). Stock levels of SP were adequate to meet the demands by the pregnant women at the Maternity Home for the period under review. CONCLUSIONS The uptake of ≥3 doses of SP was high in the study area. Frequent visits to the antenatal clinic and early uptake of the first dose of SP by pregnant women are necessary to achieve the new target of five or more doses of SP.
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Affiliation(s)
- Ivy Owusu-Boateng
- School of Public Health, University of Ghana, Legon, Ghana.,Civil Service Polyclinic, Accra, Ghana
| | - Francis Anto
- School of Public Health, University of Ghana, Legon, Ghana.
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Kaingona-Daniel EPS, Gomes LR, Gama BE, Almeida-de-Oliveira NK, Fortes F, Ménard D, Daniel-Ribeiro CT, Ferreira-da-Cruz MDF. Low-grade sulfadoxine-pyrimethamine resistance in Plasmodium falciparum parasites from Lubango, Angola. Malar J 2016; 15:309. [PMID: 27267365 PMCID: PMC4895897 DOI: 10.1186/s12936-016-1358-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 05/24/2016] [Indexed: 11/10/2022] Open
Abstract
Background Malaria is a major parasitic disease, affecting millions of people in endemic areas. Plasmodium falciparum parasites are responsible for the most severe cases and its resistance to anti-malarial drugs is notorious. This is a possible obstacle to the effectiveness of intermittent preventive treatment (IPT) based on sulfadoxine–pyrimethamine (SP) cures administrated to pregnant women (IPTp) during their pregnancy. As this intervention is recommended in Angola since 2006, it has assessed, in this country, the molecular profiles in P. falciparumdhfr and dhps, two polymorphic genes associated to pyrimethamine and sulfadoxine resistance, respectively. Methods Blood samples from 52 falciparum patients were collected in Lubango, Angola and pfdhfr and pfdhps polymorphisms were analysed using nested-PCR and DNA sequencing. Results In the pfdhfr gene, the 108N mutation was almost fixed (98 %), followed by 59R (63 %), 51I (46 %), 50R and 164L (2 %, respectively). No 16V/S mutations were found. The most common double mutant genotype was CNRN (59 + 108; 46 %), followed by CICN (51 + 108; 29 %) whereas IRN (51 + 59 + 108; 15 %), CNRNVL (59 + 108 + 164; 2 %) and RICN (50 + 51 + 108; 2 %) triple mutant genotypes were detected. Investigations of the pfdhps gene showed that the 437G mutation was the most prevalent (97 %). Only two and one samples disclosed the 540E (7 %) and the 436A (3 %), respectively. Single mutant SGKAA (437; 86 %) was higher than SGEAA (437 + 540; 7 %) or AGKAA (436 + 437; 3 %) double mutants genotypes. No polymorphism was detected at codons 581G and 613T/S. Combining pfdhfr and pfdhps alleles two triple mutant haplotypes (double mutant in dhfr and single mutant in dhps) were observed: the ACICNVI/SGKAA in 14 (56 %) samples and the ACNRNVI/SGKAA in five (20 %) samples. One quadruple mutant haplotype was detected (ACIRNVI/SGKAA) in six (24 %) P. falciparum samples. No quintuple pfdhfr–pfdhps mutant was noted. Conclusion pfdhfr and pfdhps gene mutations in isolates from Lubango are suggestive of a low-grade SP resistance and IPT for pregnant women and infant based on SP treatment could be effective. Routine molecular studies targeting polymorphism in these two genes need to be routinely conducted at country level.
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Affiliation(s)
- Elsa P S Kaingona-Daniel
- Laboratório de Pesquisa em Malária-Instituto Oswaldo Cruz, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil.,Centro de Pesquisa, Diagnóstico e Treinamento em Malária (CPD-Mal) Fiocruz, Rio de Janeiro, Brazil.,Hospital Central Dr. António Agostinho Neto, Lubango, Angola.,Health Progress and Investigation Network of the Portuguese-Speaking Countries Community (RIDESMal/CPLP), Lisbon, Portugal
| | - Larissa Rodrigues Gomes
- Laboratório de Pesquisa em Malária-Instituto Oswaldo Cruz, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil.,Centro de Pesquisa, Diagnóstico e Treinamento em Malária (CPD-Mal) Fiocruz, Rio de Janeiro, Brazil.,Health Progress and Investigation Network of the Portuguese-Speaking Countries Community (RIDESMal/CPLP), Lisbon, Portugal
| | - Bianca E Gama
- Laboratório de Pesquisa em Malária-Instituto Oswaldo Cruz, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil.,Laboratory of Oncovirology, Instituto Nacional de Câncer, Rio de Janeiro, Brazil
| | - Natália K Almeida-de-Oliveira
- Laboratório de Pesquisa em Malária-Instituto Oswaldo Cruz, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil.,Centro de Pesquisa, Diagnóstico e Treinamento em Malária (CPD-Mal) Fiocruz, Rio de Janeiro, Brazil.,Health Progress and Investigation Network of the Portuguese-Speaking Countries Community (RIDESMal/CPLP), Lisbon, Portugal
| | - Filomeno Fortes
- Angolan National Malaria Control Programme, National Institute of Public Health, Luanda, Angola.,Health Progress and Investigation Network of the Portuguese-Speaking Countries Community (RIDESMal/CPLP), Lisbon, Portugal
| | - Didier Ménard
- Malaria Molecular Epidemiology Unit, Institut Pasteur in Cambodia, Phnom Penh, Cambodia
| | - Cláudio Tadeu Daniel-Ribeiro
- Laboratório de Pesquisa em Malária-Instituto Oswaldo Cruz, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil.,Centro de Pesquisa, Diagnóstico e Treinamento em Malária (CPD-Mal) Fiocruz, Rio de Janeiro, Brazil.,Health Progress and Investigation Network of the Portuguese-Speaking Countries Community (RIDESMal/CPLP), Lisbon, Portugal
| | - Maria de Fátima Ferreira-da-Cruz
- Laboratório de Pesquisa em Malária-Instituto Oswaldo Cruz, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil. .,Centro de Pesquisa, Diagnóstico e Treinamento em Malária (CPD-Mal) Fiocruz, Rio de Janeiro, Brazil. .,Health Progress and Investigation Network of the Portuguese-Speaking Countries Community (RIDESMal/CPLP), Lisbon, Portugal.
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15
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Orish VN, Onyeabor OS, Boampong JN, Afoakwah R, Nwaefuna E, Acquah S, Sanyaolu AO, Iriemenam NC. Prevalence of intermittent preventive treatment with sulphadoxine-pyrimethamine (IPTp-SP) use during pregnancy and other associated factors in Sekondi-Takoradi, Ghana. Afr Health Sci 2015; 15:1087-96. [PMID: 26958008 DOI: 10.4314/ahs.v15i4.6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Intermittent preventive treatment in pregnancy (IPTp) with sulphadoxine-pyrimethamine (SP) has been adopted as policy by most countries in sub-Saharan Africa. This cross-sectional study assessed the prevalence of IPTp-SP usage for prevention of malaria among pregnant women as well as evaluated factors associated with IPTp-SP use during pregnancy in Sekondi-Takoradi region of Ghana. METHODS Pregnant women attending their antenatal-care with either clinical/ultrasound evidence of pregnancy were recruited. Venous blood was screened for malaria using RAPID response antibody kit and Giemsa staining. Haemoglobin estimations were done by cyanmethemoglobin method while Human Immunodeficiency Virus (HIV) screening was performed by the national diagnostic algorithm of two rapid antibody test and western blot confirmation. RESULTS Of the 754 consented pregnant women interviewed in this study, 57.8% had received IPTp-SP while 42.2% had not at their first contact with the study personnel. Furthermore, 18.6% (81/436) of those that received IPTp-SP were malaria positive while 81.4% (355/436) were malaria negative. The results also indicated that 47.7% (51/107) of the pregnant women in their third trimester who were meant to have received at least two-doses of SP had received ≥2 doses while 35.5% (38/107) had received 1 dose. In multivariable logistic regression analysis, pregnant women in their third trimester who received ≥2 doses of SP showed decreased likelihoods of malaria (adjusted OR, 0.042; 95% CI, 0.003-0.51; P = 0.013). CONCLUSION IPTp-SP usage among pregnant women in Sekondi-Takoradi reduces malaria and its use for malaria prevention should be strengthened with proper dosage completion and coverage.
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16
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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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Cisse M, Sangare I, Lougue G, Bamba S, Bayane D, Guiguemde RT. Prevalence and risk factors for Plasmodium falciparum malaria in pregnant women attending antenatal clinic in Bobo-Dioulasso (Burkina Faso). BMC Infect Dis 2014; 14:631. [PMID: 25408152 PMCID: PMC4240871 DOI: 10.1186/s12879-014-0631-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 11/11/2014] [Indexed: 11/10/2022] Open
Abstract
Background Malaria during pregnancy remains a serious public health problem. The aim of this study was to determine the prevalence and possible risk factors for malaria in pregnant women attending antenatal clinic at two primary health facilities in Bobo-Dioulasso. Methods We conducted a cross sectional study from September to December 2010 in two primary health facilities located in the periurban area of Bobo-Dioulasso. Pregnant women attending antenatal clinic (ANC) were included in the study after signing informed consent. For each participant, the social-demographic profile, malaria and obstetric histories were investigated through a questionnaire. Peripheral blood was collected and thick and thin blood smears were prepared to check Plasmodium falciparum parasitaemia. Hemoglobin concentration was measured. The associations between age, parity, gestational age, schooling, number of ANC visits, use of IPTp-SP, use of insecticide-treated nets (ITN) and anemia with the occurrence of P. falciparum malaria infection during pregnancy were analyzed through logistic regression. Results During the period of study, 105 (18.1%) out of 579 pregnant women were infected by P. falciparum. The hemoglobin concentration mean was 10.5 ± 1.7/dL and was significantly lower in pregnant women with malaria infection (9.8 g/dL ±1.6) than in those who had no malaria infection (10.6 g/dL ±1.7) (P < 0.001). Multivariate analysis indicated that, education (AOR 1.9, 95% CI = [1.2-3.2]), parity [primigravidae (AOR 5.0, 95% CI = [2.5-9.8]) and secundigravidae (AOR 2.1, 95% CI = [1.2-3.8])], and anaemia (AOR 2.1, 95% CI = [1.3-3.5]) were significantly associated with P. falciparum malaria infection. The use of IPTp-SP was not associated with P. falciparum malaria infection. Conclusions P. falciparum malaria infection is common in pregnant women attending antenatal clinic and anaemia is an important complication. The results show that the use of IPTp-SP does not reduce the risk of malaria incidence during pregnancy. Electronic supplementary material The online version of this article (doi:10.1186/s12879-014-0631-z) contains supplementary material, which is available to authorized users.
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Tonga C, Kimbi HK, Anchang-Kimbi JK, Nyabeyeu HN, Bissemou ZB, Lehman LG. Malaria risk factors in women on intermittent preventive treatment at delivery and their effects on pregnancy outcome in Sanaga-Maritime, Cameroon. PLoS One 2013; 8:e65876. [PMID: 23762446 PMCID: PMC3675062 DOI: 10.1371/journal.pone.0065876] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 04/29/2013] [Indexed: 11/18/2022] Open
Abstract
Malaria is known to have a negative impact on pregnant women and their foetuses. The efficacy of Sulfadoxine-Pyrimethamine (SP) used for intermittent preventive treatment (IPT) is being threatened by increasing levels of resistance. This study assessed malaria risk factors in women on intermittent preventive treatment with SP (IPTp-SP) at delivery and their effects on pregnancy outcome in Sanaga-Maritime Division, Cameroon. Socio-economic and obstetrical data of mothers and neonate birth weights were documented. Peripheral blood from 201 mothers and newborns as well as placental and cord blood were used to prepare thick and thin blood films. Maternal haemoglobin concentration was measured. The overall malaria parasite prevalence was 22.9% and 6.0% in mothers and newborns respectively. Monthly income lower than 28000 FCFA and young age were significantly associated with higher prevalence of placental malaria infection (p = 0.0048 and p = 0.019 respectively). Maternal infection significantly increased the risk of infection in newborns (OR = 48.4; p<0.0001). Haemoglobin concentration and birth weight were lower in infected mothers, although not significant. HIV infection was recorded in 6.0% of mothers and increased by 5-folds the risk of malaria parasite infection (OR = 5.38, p = 0.007). Attendance at antenatal clinic and level of education significantly influenced the utilisation of IPTp-SP (p<0.0001 and p = 0.018 respectively). Use of SP and mosquito net resulted in improved pregnancy outcome especially in primiparous, though the difference was not significant. Malaria infection in pregnancy is common and increases the risk of neonatal malaria infection. Preventive strategies are poorly implemented and their utilization has overall reasonable effect on malaria infection and pregnancy outcome.
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Affiliation(s)
- Calvin Tonga
- Department of Zoology and Animal Physiology, University of Buea, Buea, South-West Region, Cameroon
| | - Helen Kuokuo Kimbi
- Department of Zoology and Animal Physiology, University of Buea, Buea, South-West Region, Cameroon
- * E-mail:
| | | | | | | | - Léopold G. Lehman
- Department of Animal Biology, University of Douala, Douala, Littoral Region, Cameroon
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Folate metabolism in human malaria parasites—75 years on. Mol Biochem Parasitol 2013; 188:63-77. [DOI: 10.1016/j.molbiopara.2013.02.008] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Revised: 02/15/2013] [Accepted: 02/19/2013] [Indexed: 12/21/2022]
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