An analysis of timing and frequency of malaria infection during pregnancy in relation to the risk of low birth weight, anaemia and perinatal mortality in Burkina Faso

Innocent Valea, Halidou Tinto, Maxime K Drabo, Lieven Huybregts, Hermann Sorgho, Jean-Bosco Ouedraogo, Robert T Guiguemde, Jean Pierre van Geertruyden, Patrick Kolsteren, Umberto D'Alessandro, FSP/MISAME study Group, J-P Ki, V Koudougbo, L Toe, H Lanou, E Da, G Lougue, B Nagalo, O Guebe, B Hien, Innocent Valea, Halidou Tinto, Maxime K Drabo, Lieven Huybregts, Hermann Sorgho, Jean-Bosco Ouedraogo, Robert T Guiguemde, Jean Pierre van Geertruyden, Patrick Kolsteren, Umberto D'Alessandro, FSP/MISAME study Group, J-P Ki, V Koudougbo, L Toe, H Lanou, E Da, G Lougue, B Nagalo, O Guebe, B Hien

Abstract

Background: A prospective study aiming at assessing the effect of adding a third dose sulphadoxine-pyrimethamine (SP) to the standard two-dose intermittent preventive treatment for pregnant women was carried out in Hounde, Burkina Faso, between March 2006 and July 2008. Pregnant women were identified as earlier as possible during pregnancy through a network of home visitors, referred to the health facilities for inclusion and followed up until delivery.

Methods: Study participants were enrolled at antenatal care (ANC) visits and randomized to receive either two or three doses of SP at the appropriate time. Women were visited daily and a blood slide was collected when there was fever (body temperature > 37.5°C) or history of fever. Women were encouraged to attend ANC and deliver in the health centre, where the new-born was examined and weighed. The timing and frequency of malaria infection was analysed in relation to the risk of low birth weight, maternal anaemia and perinatal mortality.

Results: Data on birth weight and haemoglobin were available for 1,034 women. The incidence of malaria infections was significantly lower in women having received three instead of two doses of SP. Occurrence of first malaria infection during the first or second trimester was associated with a higher risk of low birth weight: incidence rate ratios of 3.56 (p < 0.001) and 1.72 (p = 0.034), respectively. After adjusting for possible confounding factors, the risk remained significantly higher for the infection in the first trimester of pregnancy (adjusted incidence rate ratio = 2.07, p = 0.002). The risk of maternal anaemia and perinatal mortality was not associated with the timing of first malaria infection.

Conclusion: Malaria infection during first trimester of pregnancy is associated to a higher risk of low birth weight. Women should be encouraged to use long-lasting insecticidal nets before and throughout their pregnancy.

Trial registration: ClinicalTrials.gov NCT00909974.

References

    1. Dellicour S, Tatem AJ, Guerra CA, Snow RW, ter Kuile FO. Quantifying the number of pregnancies at risk of malaria in 2007: a demographic study. PLoS Med. 2010;7:e1000221. doi: 10.1371/journal.pmed.1000221.
    1. Desai M, ter Kuile FO, Nosten F, McGready R, Asamoa K, Brabin B, Newman RD. Epidemiology and burden of malaria in pregnancy. Lancet Infect Dis. 2007;7:93–104. doi: 10.1016/S1473-3099(07)70021-X.
    1. Menendez C, Fleming AF, Alonso PL. Malaria-related anaemia. Parasitol Today. 2000;16:469–476. doi: 10.1016/S0169-4758(00)01774-9.
    1. Guyatt HL, Snow RW. Impact of malaria during pregnancy on low birth weight in sub-Saharan Africa. Clin Microbiol Rev. 2004;17:760–9. doi: 10.1128/CMR.17.4.760-769.2004. table.
    1. van Geertruyden JP, Thomas F, Erhart A, d'Alessandro U. The contribution of malaria in pregnancy to perinatal mortality. Am J Trop Med Hyg. 2004;71:35–40.
    1. McCormick MC. The contribution of low birth weight to infant mortality and childhood morbidity. N Engl J Med. 1985;312:82–90. doi: 10.1056/NEJM198501103120204.
    1. Uneke CJ. Impact of placental Plasmodium falciparum malaria on pregnancy and perinatal outcome in sub-Saharan Africa: I: introduction to placental malaria. Yale J Biol Med. 2007;80:39–50.
    1. WHO/AFRO. A strategic framework for malaria prevention and control during pregnancy in the African Region. Word Health Organisation Regional Office for Africa. Brazzaville; 2004.
    1. Sirima SB, Sawadogo R, Moran AC, Konate A, Diarra A, Yameogo M, Parise ME, Newman RD. Failure of a chloroquine chemoprophylaxis program to adequately prevent malaria during pregnancy in Koupela District, Burkina Faso. Clin Infect Dis. 2003;36:1374–1382. doi: 10.1086/375077.
    1. Ministere de la Santé/Programme National de Lutte contre le Paludisme. Directives Nationales pour la prise en charge du paludisme au Burkina Faso. 2006.
    1. Gies S, Coulibaly SO, Ouattara FT, d'Alessandro U. Individual efficacy of intermittent preventive treatment with sulfadoxine-pyrimethamine in primi- and secundigravidae in rural Burkina Faso: impact on parasitaemia, anaemia and birth weight. Trop Med Int Health. 2009;14:174–182. doi: 10.1111/j.1365-3156.2008.02215.x.
    1. Shulman CE, Dorman EK, Cutts F, Kawuondo K, Bulmer JN, Peshu N, Marsh K. Intermittent sulphadoxine-pyrimethamine to prevent severe anaemia secondary to malaria in pregnancy: a randomised placebo-controlled trial. Lancet. 1999;353:632–636. doi: 10.1016/S0140-6736(98)07318-8.
    1. Sirima SB, Cotte AH, Konate A, Moran AC, Asamoa K, Bougouma EC, Diarra A, Ouedraogo A, Parise ME, Newman RD. Malaria prevention during pregnancy: assessing the disease burden one year after implementing a program of intermittent preventive treatment in Koupela District, Burkina Faso. Am J Trop Med Hyg. 2006;75:205–211.
    1. Tiono AB, Ouedraogo A, Bougouma EC, Diarra A, Konate AT, Nebie I, Sirima SB. Placental malaria and low birth weight in pregnant women living in a rural area of Burkina Faso following the use of three preventive treatment regimens. Malar J. 2009;8:224. doi: 10.1186/1475-2875-8-224.
    1. Peters PJ, Thigpen MC, Parise ME, Newman RD. Safety and toxicity of sulfadoxine/pyrimethamine: implications for malaria prevention in pregnancy using intermittent preventive treatment. Drug Saf. 2007;30:481–501. doi: 10.2165/00002018-200730060-00003.
    1. White NJ. How antimalarial drug resistance affects post-treatment prophylaxis. Malar J. 2008;7:9. doi: 10.1186/1475-2875-7-9.
    1. Kalilani L, Mofolo I, Chaponda M, Rogerson SJ, Meshnick SR. The effect of timing and frequency of Plasmodium falciparum infection during pregnancy on the risk of low birth weight and maternal anemia. Trans R Soc Trop Med Hyg. 2010;104:416–422. doi: 10.1016/j.trstmh.2010.01.013.
    1. Cottrell G, Mary JY, Barro D, Cot M. The importance of the period of malarial infection during pregnancy on birth weight in tropical Africa. Am J Trop Med Hyg. 2007;76:849–854.
    1. Cot M, Abel L, Roisin A, Barro D, Yada A, Carnevale P, Feingold J. Risk factors of malaria infection during pregnancy in Burkina Faso: suggestion of a genetic influence. Am J Trop Med Hyg. 1993;48:358–364.
    1. Huynh BT, Fievet N, Gbaguidi G, Dechavanne S, Borgella S, Guezo-Mevo B, Massougbodji A, Ndam NT, Deloron P, Cot M. Influence of the timing of malaria infection during pregnancy on birth weight and on maternal anemia in Benin. Am J Trop Med Hyg. 2011;85:214–220. doi: 10.4269/ajtmh.2011.11-0103.
    1. Coulibaly SO, Gies S, d'Alessandro U. Malaria burden among pregnant women living in the rural district of Boromo, Burkina Faso. Am J Trop Med Hyg. 2007;77:56–60.
    1. Huybregts L, Roberfroid D, Lanou H, Menten J, Meda N, Van CJ, Kolsteren P. Prenatal food supplementation fortified with multiple micronutrients increases birth length: a randomized controlled trial in rural Burkina Faso. Am J Clin Nutr. 2009;90:1593–1600. doi: 10.3945/ajcn.2009.28253.
    1. Valea I, Tinto H, Drabo MK, Huybregts L, Henry MC, Roberfroid D, Guiguemde RT, Kolsteren P, d'Alessandro U. Intermittent preventive treatment of malaria with sulphadoxine-pyrimethamine during pregnancy in Burkina Faso: effect of adding a third dose to the standard two-dose regimen on low birth weight, anaemia and pregnancy outcomes. Malaria Journal. 2010;9:324.
    1. Piola P, Nabasumba C, Turyakira E, Dhorda M, Lindegardh N, Nyehangane D, Snounou G, Ashley EA, McGready R, Nosten F, Guerin PJ. Efficacy and safety of artemether-lumefantrine compared with quinine in pregnant women with uncomplicated Plasmodium falciparum malaria: an open-label, randomised, non-inferiority trial. Lancet Infect Dis. 2010;10:762–769. doi: 10.1016/S1473-3099(10)70202-4.
    1. Rogerson SJ, Hviid L, Duffy PE, Leke RF, Taylor DW. Malaria in pregnancy: pathogenesis and immunity. Lancet Infect Dis. 2007;7:105–117. doi: 10.1016/S1473-3099(07)70022-1.
    1. Wegmann TG, Lin H, Guilbert L, Mosmann TR. Bidirectional cytokine interactions in the maternal-fetal relationship: is successful pregnancy a TH2 phenomenon? Immunol Today. 1993;14:353–356. doi: 10.1016/0167-5699(93)90235-D.
    1. Brabin BJ, Romagosa C, Abdelgalil S, Menendez C, Verhoeff FH, McGready R, Fletcher KA, Owens S, d'Alessandro U, Nosten F, Fisher PR, Ordi J. The sick placenta-the role of malaria. Placenta. 2004;25:359–378. doi: 10.1016/j.placenta.2003.10.019.
    1. Rogerson SJ, Mwapasa V, Meshnick SR. Malaria in pregnancy: linking immunity and pathogenesis to prevention. Am J Trop Med Hyg. 2007;77:14–22.
    1. Briand V, Cottrell G, Massougbodji A, Cot M. Intermittent preventive treatment for the prevention of malaria during pregnancy in high transmission areas. Malar J. 2007;6:160. doi: 10.1186/1475-2875-6-160.
    1. Bourgoing R. Bednets for malaria. Reports from the field -- Africa. Glob Impacts. 1997. pp. 14–15.
    1. Noor AM, Mutheu JJ, Tatem AJ, Hay SI, Snow RW. Insecticide-treated net coverage in Africa: mapping progress in 2000-07. Lancet. 2009;373:58–67. doi: 10.1016/S0140-6736(08)61596-2.
    1. Tagbor H, Bruce J, Agbo M, Greenwood B, Chandramohan D. Intermittent screening and treatment versus intermittent preventive treatment of malaria in pregnancy: a randomised controlled non-inferiority trial. Plos One. 2010;5:e14425. doi: 10.1371/journal.pone.0014425.
    1. Smith LA, Jones C, Adjei RO, Antwi GD, Afrah NA, Greenwood B, Chandramohan D, Tagbor H, Webster J. Intermittent screening and treatment versus intermittent preventive treatment of malaria in pregnancy: user acceptability. Malar J. 2010;9:18. doi: 10.1186/1475-2875-9-18.
    1. Grietens KP, Gies S, Coulibaly SO, Ky C, Somda J, Toomer E, Muela RJ, d'Alessandro U. Bottlenecks for high coverage of intermittent preventive treatment in pregnancy: the case of adolescent pregnancies in rural Burkina Faso. Plos One. 2010;5:e12013. doi: 10.1371/journal.pone.0012013.
    1. Brabin BJ, Warsame M, Uddenfeldt-Wort U, Dellicour S, Hill J, Gies S. Monitoring and evaluation of malaria in pregnancy-developing a rational basis for control. Malar J. 2008;7(Suppl 1):S6. doi: 10.1186/1475-2875-7-S1-S6.
    1. d'Alessandro U. Insecticide treated bed nets to prevent malaria. BMJ. 2001;322:249–250. doi: 10.1136/bmj.322.7281.249.

Source: PubMed

Sponsorer och medarbetare

Medicinska tillstånd

Läkemedelsinterventioner

3
Prenumerera