scholarly journals Child growth and neurodevelopment after maternal antenatal antibiotic treatment

2021 ◽  
pp. archdischild-2021-322043
Author(s):  
Karoliina Videman ◽  
Lotta Hallamaa ◽  
Otto Heimonen ◽  
Charles Mangani ◽  
Mari Luntamo ◽  
...  

ObjectiveTo assess whether intermittent preventive treatment of pregnant women (IPTp) with sulfadoxine-pyrimethamine (SP) and azithromycin (AZI) in a malaria-endemic area leads to sustained gains in linear growth and development in their offspring.DesignFollow-up study of a randomised trial.SettingMangochi District in rural southern Malawi.Participants1320 pregnant women and their offspring.InterventionsIPTp monthly with SP and twice with AZI (AZI-SP group), monthly with SP but no AZI (monthly SP), or twice with SP (control). No intervention was given to children.Main outcome measuresCognitive performance using Raven’s Coloured Progressive Matrices (CPM) at 13 years of age; mean height and height-for-age Z-score (HAZ), cumulative incidence and prevalence of stunting (HAZ <−2); weight, body mass index, mid-upper-arm circumference and head circumference.ResultsAt approximately 13 years of age, the mean CPM score was 14.3 (SD 3.8, range 6–29, maximum 36), with no differences between groups. Children in the AZI-SP group were on average 0.4 cm (95% CI −0.9 to 1.7, p=0.6) taller than those in the control group. For cumulative incidence of stunting, the HR in the AZI-SP group was 0.72 (95% CI 0.61 to 0.84, p<0.001) compared with the control and 0.76 (95% CI 0.65 to 0.90, p<0.001) compared with the monthly SP groups. There was no intergroup difference in stunting prevalence or anthropometric measurements.ConclusionsIn rural Malawi, maternal intensified infection control during pregnancy reduces offspring’s cumulative incidence of ever being stunted by 13 years of age. In this study, there was no evidence of a positive impact on cognitive performance.Trial registration numberNCT00131235.

2020 ◽  
Vol 4 ◽  
pp. 34-39
Author(s):  
Ubong Akpan ◽  
Udeme Asibong ◽  
Zibrin Okhormbe ◽  
Mabel Ekott ◽  
Saturday Etuk

Objective: Malaria is a major cause of indirect maternal death. In the last two decades several efforts have been made to combat the menace of this disease especially among pregnant women and children in developing countries. Directly observed therapy (DOT) was recommended to enhance the uptake of intermittent preventive treatment (IPT) of malaria with sulfadoxine – pyrimethamine among pregnant women. Due to challenges involved in the practice of DOT especially with regards to shortage of man power and clean water in rural areas, there is need to evaluate impact of DOT on the effectiveness of treatment. Material and Methods: A cohort study was carried out among 320 healthy pregnant women receiving ante natal care with equal assignment of subjects. The study group (160) received two doses of IPT by DOT while 160 matched controls were given prescription for self- drug administration at home. Malaria tests were done using microscopy method and the hemoglobin values determined using centrifuge one month after the second dose of IPT. Umbilical cord blood samples were obtained for a repeat microscopy at delivery. Results: The results showed that there were no statistical significant differences in the venous blood parasitemia, placental parasitemia and anaemia between the DOT group and the control group (P = 0.215; P = 0.100; P = 0.966) respectively. Lower social class was the main predictor of anaemia in pregnancy (P = 0.032). Conclusion: The delivery of IPT through DOT may not influence uptake in some settings. Effort may need to be channeled into ante natal education and women empowerment.


BMJ Open ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. e053197
Author(s):  
Raquel González ◽  
Tacilta Nhampossa ◽  
Ghyslain Mombo-Ngoma ◽  
Johannes Mischlinger ◽  
Meral Esen ◽  
...  

IntroductionMalaria infection during pregnancy is an important driver of maternal and neonatal health especially among HIV-infected women. Intermittent preventive treatment in pregnancy (IPTp) with sulphadoxine–pyrimethamine is recommended for malaria prevention in HIV-uninfected women, but it is contraindicated in those HIV-infected on cotrimoxazole prophylaxis (CTXp) due to potential adverse effects. Dihydroartemisinin–piperaquine (DHA–PPQ) has been shown to improve antimalarial protection, constituting a promising IPTp candidate. This trial’s objective is to determine if monthly 3-day IPTp courses of DHA–PPQ added to daily CTXp are safe and superior to CTXp alone in decreasing the proportion of peripheral malaria parasitaemia at the end of pregnancy.Methods and analysisThis is a multicentre, two-arm, placebo-controlled, individually randomised trial in HIV-infected pregnant women receiving CTXp and antiretroviral treatment. A total of 664 women will be enrolled at the first antenatal care clinic visit in sites from Gabon and Mozambique. Participants will receive an insecticide-treated net, and they will be administered monthly IPTp with DHA-PPQ or placebo (1:1 ratio) as directly observed therapy from the second trimester of pregnancy. Primary study outcome is the prevalence of maternal parasitaemia at delivery. Secondary outcomes include prevalence of malaria-related maternal and infant outcomes and proportion of adverse perinatal outcomes. Participants will be followed until 6 weeks after the end of pregnancy and their infants until 1 year of age to also evaluate the impact of DHA–PPQ on mother-to-child transmission of HIV. The analysis will be done in the intention to treat and according to protocol cohorts, adjusted by gravidity, country, seasonality and other variables associated with malaria.Ethics and disseminationThe protocol was reviewed and approved by the institutional and national ethics committees of Gabon and Mozambique and the Hospital Clinic of Barcelona. Project results will be presented to all stakeholders and published in open-access journals.Trial registration numberNCT03671109.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Fatima Mahmud Muhammad ◽  
Saharnaz Nedjat ◽  
Haniye Sadat Sajadi ◽  
Mahboubeh Parsaeian ◽  
Abraham Assan ◽  
...  

Abstract Background While the use of sulphadoxine pyrimethamine (SP) is effective in preventing malaria infection during pregnancy, there are challenges limiting its uptake in Nigeria. This study aimed at exploring the barriers to IPTp usage among pregnant women in Kano state - Nigeria. Methods This is a qualitative study. The purposive sampling strategy was used for identification and selection of 14 key informants for interviews. In addition, six focus group discussions (FGDs) were conducted with pregnant women (3 FGDs) and married men (3 FGDs). The conventional content analysis method was used to interpret meaning from the content of the data. MAXQDA 10 software was used for data management and analysis. Results Poor policy implementation, poor antenatal care attendance, inadequate access to intermittent preventive treatment at the community levels, lack of sustainable funding, and poor community engagement emerged as major barriers to IPTp use in Nigeria. Conclusion While the political will to allocate sufficient financial resources could help improve service delivery and IPTp usage among pregnant women, community participation is critical to sustain the gains.


2021 ◽  
Author(s):  
Boroka Klara Csifo-Nagy ◽  
Eleonora Solyom ◽  
Vera Lili Bognar ◽  
Annamaria Nevelits ◽  
Ferenc Dori

Abstract Background: The aim of the study was to clinically evaluate the healing of intrabony defects after treatment with a new generation of platelet-rich fibrin (A-PRF+) respect to enamel matrix derivatives (EMD). Methods: Thirty (30) intrabony defects of 18 patients (9 males, 9 females) were randomly treated with A-PRF+ (test, n=15) or EMD (control, n=15). The following clinical parameters were recorded at baseline and 6 months after surgery: pocket depth (PD), gingival recession (GR) and clinical attachment level (CAL). After debridement the intrabony defects were filled with A-PRF+ in the test group, respectively with EMD in the control group, and fixed with sutures to ensure wound closure and stability.Results: Both treatment methods resulted in statistically significant PD reductions, respectively CAL gains six months post-operatively. No statistically significant differences were found between the two groups as the mean CAL gain was 2.33±1.58 mm in the A-PRF+ group, respectively 2.60±1.18 mm in the EMD group (p < 0.001).Conclusion: Within the limits of this study the new-generation platelet-rich fibrin seems to be as clinically effective as EMD in the surgical treatment of intrabony defects. Treatment with A-PRF+ or EMD resulted in reliable clinical outcomes. The use of A-PRF+ as a human autologous product can give a positive impact on periodontal healing.Clinical Relevance: A-PRF+ may be suitable for the treatment of intrabony periodontal defects. Trial registration number (TRN): NCT04404374 (ClinicalTrials.gov ID)Date of registration: 19.05.2020., retrospectively registered


Author(s):  
T. Kasso ◽  
I. L. Oboro ◽  
O. Maduka ◽  
A. T. O. Awopeju ◽  
N. I. Paul ◽  
...  

Background: Malaria is a serious public health problem in developing countries with Africa bearing most of its burden. Pregnant women are more susceptible to malaria and it is one of the leading causes of maternal and perinatal mortality/morbidity. Use of effective malaria preventive measures during pregnancy reduces its burden and complications. Aim: This was to determine malaria preventive practices used by pregnant women in Akwa Ibom state, Nigeria. Materials and Methods: It was a cross sectional study of pregnant women attending public and private health facilities in Akwa Ibom state. An informed written consent was obtained from the participants. Stratified sampling method was used in selecting the health facilities and the study participants. Information was obtained with pretested questionnaires by trained personnel with the aid of Open Data Kit (ODK) on android phones. Data was managed with SPSS 22.0 and P-value of <0.05 was considered statistically significant. Results: There were 935 participants in the study. Their mean age was 28.52 ± 5.09 years with 879 (94.0%) being married. Most had secondary and tertiary degrees: 451(48.2%) and 440(47.1%). Majority of them were traders/business women and self-employed (58.2%) while 7% were unemployed. Malaria preventive practices were use of window net, bed net and insecticides accounting for 659(71%), 447(48.2%) and 207(22.3%) respectively. There were 612 (65.5%) participants that received malaria drugs for prevention with 452(73.9%) receiving Intermittent Preventive Treatment in Pregnancy (IPTp) with Sulfadoxine-Pyrimethamine (SP). Only 296 (31.7%) of them slept under bed nets the night before the interview. Conclusion: Common preventive practices employed by pregnant women were IPTp with SP, window nets, ITNs and modified IRS. Majority of the women utilized widow nets, though not as effective as ITNs. Efforts should be intensified concerning awareness creation about the benefits of ITN use during pregnancy.


2010 ◽  
Vol 104 (11) ◽  
pp. 1655-1661 ◽  
Author(s):  
Ai Guo Ma ◽  
Evert G. Schouten ◽  
Yong Ye Sun ◽  
Fang Yang ◽  
Xiu Xia Han ◽  
...  

Pregnancy is a condition exhibiting increased susceptibility to oxidative stress, and Fe plays a central role in generating harmful oxygen species. The objective of the present study is to investigate the changes in haematological status, oxidative stress and erythrocyte membrane fluidity in anaemic pregnant women after Fe supplementation with and without combined vitamins. The study was a 2 months double-blind, randomised trial. Pregnant women (n 164) were allocated to four groups: group C was the placebo control group; group I was supplemented daily with 60 mg Fe (ferrous sulphate) daily; group IF was supplemented daily with Fe plus 400 μg folic acid; group IM was supplemented daily with Fe plus 2 mg retinol and 1 mg riboflavin, respectively. After the 2-month trial, Hb significantly increased by 15·8, 17·3 and 21·8 g/l, and ferritin by 2·8, 3·6 and 11·0 μg/l, in the I, IF and IM groups compared with placebo. Polarisation (ρ) and microviscosity (η) decreased significantly in other groups compared with placebo, indicating an increase in membrane fluidity. Significant decreases of ρ and η values compared with group C were 0·033 and 0·959 for group I, 0·037 and 1·074 for group IF and 0·064 and 1·865 for group IM, respectively. In addition, significant increases of glutathione peroxidase activities and decreases of malondialdehyde were shown in all treated groups, as well as increases of plasma retinol and urine riboflavin in group IM. The findings show that supplementation with Fe and particularly in combination with vitamins could improve the haematological status as well as oxidative stress and erythrocyte membrane fluidity.


2017 ◽  
Vol 216 (1) ◽  
pp. 29-35 ◽  
Author(s):  
Paul Natureeba ◽  
Abel Kakuru ◽  
Mary Muhindo ◽  
Teddy Ochieng ◽  
John Ategeka ◽  
...  

2020 ◽  
Vol 64 (6) ◽  
Author(s):  
Bernard Tornyigah ◽  
Romain Coppée ◽  
Pascal Houze ◽  
Kwadwo A. Kusi ◽  
Bright Adu ◽  
...  

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 IRNI-A/FGKGS/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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