scholarly journals PO 8502 DETERMINANTS AND PREVALENCE OF PARASITE RESISTANCE AMONG PREGNANT WOMEN RECEIVING IPTP WITH SULPHADOXINE-PYRIMETHAMINE IN NIGERIA

2019 ◽  
Vol 4 (Suppl 3) ◽  
pp. A46.3-A47
Author(s):  
Atinuke Olaleye ◽  
Noblefather Uyaiabasi ◽  
Charles Elikwu ◽  
Oladapo Walker
Keyword(s):  
Pregnant Women ◽  
Geometric Mean ◽  
Intermittent Preventive Treatment ◽  
Epidemiological Surveillance ◽  
Eligibility Criteria ◽  
Resistance Level ◽  
Gene Markers ◽  
Maternal Characteristics ◽  
Sulphadoxine Pyrimethamine ◽  
In Pregnancy

BackgroundMalaria in pregnancy carries a risk of significant adverse maternal and infant outcomes. Intermittent preventive treatment in pregnancy (IPTp) is advocated to reduce its occurrence, but resistance to sulphadoxine-pyrimethamine (SP) is being reported. This study aims to describe the burden of SP resistance and determinants of its occurrence among pregnant women receiving IPTp in Nigeria.MethodsA prospective observational study is to be conducted in Ogun State over 24 months. Pregnant women 16–28 weeks gestation meeting the eligibility criteria are being enrolled; blood samples are taken for analysis pre- and post- IPTp-SP administration at scheduled intervals. Microscopy-confirmed parasitaemic samples will be analysed using PCR to detect drug resistance markers (pfdhfr and pfdhps). Participants will be followed up until 28 days post-delivery and assessed for maternal and foetal outcomes (anaemia, low birth weight, preterm delivery, placental parasitaemia, stillbirth, neonatal death). The primary endpoint is the prevalence of the SP resistance gene markers. Secondary endpoints include the prevalence of peripheral and placental parasitaemia at delivery; incidence of maternal and newborn morbidity; parasitaemia pre-IPTp and day 28 post-IPTp; risk factors for SP resistance and haemoglobin changes at delivery.ResultsFollowing statistical analysis with STATA 14, results will be displayed in appropriate formats. Geometric mean parasite densities with 95% confidence intervals will be calculated, and proportions compared using the t-test, Chi-square or Fisher’s exact tests as appropriate. Multivariate analysis including logistic regression models will be used to test for associations between maternal characteristics and SP resistance. Level of significance will be set at p<0.05.ConclusionIn a malaria-endemic country like Nigeria with a large at-risk population, information on the effectiveness of chemoprevention is essential. Determining the proportion and extent of relevant molecular markers within the population offers an invaluable tool for epidemiological surveillance of SP resistance within this endemic setting.

scholarly journals Evaluation of the Intermittent Preventive Therapy in Pregnancy using Sulphadoxine/ Pyrimethamine (IPTp-SP) Program in Chiredzi District, Zimbabwe, 2021

2021 ◽  
Author(s):  
Amanda Sarah Thakataka ◽  
Joseph Mberikunashe ◽  
More Mungati ◽  
Tsitsi Patience Juru ◽  
Addmore Chadambuka ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Health Workers ◽  
Intermittent Preventive Treatment ◽  
Outcome Evaluation ◽  
Outcome Variable ◽  
Bivariate Analysis ◽  
Stock Management ◽  
Cross Sectional ◽  
Sulphadoxine Pyrimethamine ◽  
In Pregnancy

Abstract Background Intermittent Preventive Treatment in Pregnancy (IPTp) with Sulphadoxine/ Pyrimethamine (SP) is used for the prevention of malaria among pregnant women in Zimbabwe. The program is integrated into routine Antenatal care (ANC) where a minimum of three doses is recommended during each pregnancy. The third dose coverage for Chiredzi District has consistently been below the 80% target coverage. We evaluated IPTp implementation in Chiredzi to understand the reasons for underperformance. Methods An analytical cross-sectional study was conducted using a Process-Outcome evaluation with the Logical Framework Approach. We interviewed 50 women in postnatal care and determined ANC services accessed using their ANC booklets. Health workers were interviewed for knowledge of the program. Stock availability and drug delivery records were reviewed using checklists at five high-volume sites. Epi Info 7.2.4.0™ was used for data capturing and analysis. The software was used to calculate frequencies, medians, proportions, odds ratios and p-values at a 95% confidence interval. The outcome variable was receiving ≥3 doses of SP which was computed against the independent variables such as client-related characteristics to determine which factors were contributory using univariate and bivariate analysis. Results Only 12/50 (24%) women received ≥3 doses of SP during their pregnancy. Two (4%) women started their ANC visits in the first trimester. Thirty-three (66%) had missed at least one SP dose during their ANC visit because of medicine unavailability. Knowing the number of times SP is given (OR 11.9; 95% CI 2.54-55.8) and having attended at least 4 ANC visits (OR 13.6; 95% CI 1.59 -116.0) increased the likelihood of receiving adequate SP dosing. Conclusions The IPTp-SP program in Chiredzi District was underperforming, we attributed this largely to health system factors. Erratic supply and stock-outs of SP resulted in clients missing SP doses. Clients also missed SP doses because of late ANC booking and lack of knowledge on IPTp benefits. Improving stock management and raising community awareness on prevention of malaria among pregnant women was recommended.

scholarly journals Intermittent preventive treatment comparing two versus three doses of sulphadoxine pyrimethamine (IPTp-SP) in the prevention of anaemia in pregnancy in Ghana: A cross-sectional study

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0250350
Author(s):  
Yaa Nyarko Agyeman ◽  
Sam Newton ◽  
Raymond Boadu Annor ◽  
Ellis Owusu-Dabo
Keyword(s):  
Antenatal Care ◽  
Pregnant Women ◽  
Intermittent Preventive Treatment ◽  
Preventive Treatment ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Anaemia In Pregnancy ◽  
Sulphadoxine Pyrimethamine ◽  
In Pregnancy

In 2012 the World Health Organisation (WHO) revised the policy on Intermittent Preventive Treatment with Sulphadoxine Pyrimethamine (IPTp-SP) to at least three doses for improved protection against malaria parasitaemia and its associated effects such as anaemia during pregnancy. We assessed the different SP dosage regimen available under the new policy to determine the dose at which women obtained optimal protection against anaemia during pregnancy. A cross-sectional study was conducted among pregnant women who attended antenatal clinic at four different health facilities in Ghana. The register at the facilities served as a sampling frame and simple random sampling was used to select all the study respondents; they were enrolled consecutively as they kept reporting to the facility to receive antenatal care to obtain the required sample size. The haemoglobin level was checked using the Cyanmethemoglobin method. Multivariable logistic regression was performed to generate odds ratios, confidence intervals and p-values. The overall prevalence of anaemia among the pregnant women was 62.6%. Pregnant women who had taken 3 or more doses of IPTp-SP had anaemia prevalence of 54.1% compared to 66.6% of those who had taken one or two doses IPTp-SP. In the multivariable logistic model, primary (aOR 0.61; p = 0.03) and tertiary education (aOR 0.40; p = <0.001) decreased the odds of anaemia in pregnancy. Further, pregnant women who were anaemic at the time of enrollment (aOR 3.32; p = <0.001) to the Antenatal Care clinic and had malaria infection at late gestation (aOR 2.36; p = <0.001) had higher odds of anaemia in pregnancy. Anaemia in pregnancy remains high in the Northern region of Ghana. More than half of the pregnant women were anaemic despite the use of IPTp-SP. Maternal formal education reduced the burden of anaemia in pregnancy. The high prevalence of anaemia in pregnancy amid IPTp-SP use in Northern Ghana needs urgent attention to avert negative maternal and neonatal health outcomes.

scholarly journals Effectiveness of intermittent preventive treatment in pregnancy with sulphadoxine-pyrimethamine (IPTp-SP) in Ghana

2021 ◽  
Vol 6 (8) ◽  
pp. e005877
Author(s):  
David Kwame Dosoo ◽  
Kezia Malm ◽  
Felix Boakye Oppong ◽  
Richard Gyasi ◽  
Abraham Oduro ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Lower Risk ◽  
Dose Group ◽  
Placental Malaria ◽  
Intermittent Preventive Treatment ◽  
Preventive Treatment ◽  
Monthly Administration ◽  
To Receive ◽  
Sulphadoxine Pyrimethamine ◽  
In Pregnancy

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

scholarly journals Determinants of the Uptake of Intermittent Preventive Treatment of Malaria in Pregnancy with Sulphadoxine Pyrimethamine in Sabatia Sub County, Western Kenya

2021 ◽  
Author(s):  
Joshua Andala Mutanyi ◽  
Daniel O. Onguru ◽  
Sidney O. Ogolla ◽  
Lawrence B. Adipo
Keyword(s):  
Pregnant Women ◽  
Health Workers ◽  
Intermittent Preventive Treatment ◽  
Preventive Treatment ◽  
Malaria In Pregnancy ◽  
World Health ◽  
Maternal Knowledge ◽  
Western Kenya ◽  
Sulphadoxine Pyrimethamine ◽  
In Pregnancy

Abstract Background: Malaria in pregnancy remains a major public health problem. Annually, 125.2 million pregnant women worldwide are at risk of malaria infection including 30.3 million and 1 million pregnant women in Sub-Saharan Africa and Kenya respectively. The World Health Organization recommends that pregnant women in malaria endemic areas receive at least three doses of sulphadoxine pyrimethamine for intermittent preventive treatment of malaria in pregnancy (IPTp-SP) for optimal benefit. However, IPTp-SP optimal uptake is undesirably low in Kenya. This study investigated the prevalence of and factors influencing IPTp-SP optimal uptake in Sabatia Sub County, Western Kenya. Understanding the epidemiology of malaria in pregnancy is core for making decisions and setting priorities towards IPTp-SP optimization.Methods: This was a cross-sectional study conducted in Sabatia Sub County. Using a validated semi structured questionnaire, data were obtained from 372 randomly sampled post-delivery women aged 15 – 49 years who had a live birth within one year preceding the study. Women on cotrimoxazole prophylaxis during their pregnancy were excluded. Association between IPTp-SP uptake and independent variables was analysed using Pearson Chi-square and Fisher’s Exact test. Bivariate and multiple binary logistic regression analysed predictors of optimal IPTp-SP uptake.Results: Overall, 99.46 % of the respondents received at least one IPTp-SP dose. The prevalence of optimal IPTp-SP uptake was 79.57% (95% CI 75.47%, 83.67%). After multivariate analysis; gestational age at first antenatal care (ANC) visit (p = 0.04), frequency of ANC visits (p < 0.001), maternal knowledge of IPTp-SP benefits (p < 0.001), maternal knowledge of optimal SP dose (p = 0.03) and administration of sulphadoxine pyrimethamine at ANC clinic (p = 0.03) significantly predicted the optimal uptake of IPTp-SP.Conclusions: Optimal uptake of IPTp-SP is high in the study area. Efforts towards early and more frequent ANC attendance should be enhanced and sustained. Structured and targeted health education should be adopted and health workers should always administer SP drugs or explain to some pregnant women their ineligibility for initial IPTp-SP receipt. Future studies considering large sample drawn from the whole country and health workers’ perspective of the health system delivery factors are recommended.

scholarly journals Malaria intermittent preventive treatment in Nigeria: a qualitative study to explore barriers

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Fatima Mahmud Muhammad ◽  
Saharnaz Nedjat ◽  
Haniye Sadat Sajadi ◽  
Mahboubeh Parsaeian ◽  
Abraham Assan ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Pregnant Women ◽  
Intermittent Preventive Treatment ◽  
Sampling Strategy ◽  
Preventive Treatment ◽  
Group Discussions ◽  
Content Analysis Method ◽  
Conventional Content Analysis ◽  
Sulphadoxine Pyrimethamine ◽  
Selection Of

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.

COVID-19 during pregnancy: an overview of maternal characteristics, clinical symptoms, maternal and neonatal outcomes of 10,996 cases described in 15 countries

2020 ◽  
Vol 48 (9) ◽  
pp. 900-911 ◽  
Author(s):  
Ernesto Antonio Figueiro-Filho ◽  
Mark Yudin ◽  
Dan Farine
Keyword(s):  
General Population ◽  
Pregnant Women ◽  
Clinical Symptoms ◽  
Case Series ◽  
Perinatal Outcomes ◽  
Neonatal Outcomes ◽  
Eligibility Criteria ◽  
Maternal Characteristics ◽  
Th2 Immune Response ◽  
Maternal And Neonatal Outcomes

AbstractThe objective of this review was to identify the most significant studies reporting on COVID-19 during pregnancy and to provide an overview of SARS-CoV-2 infection in pregnant women and perinatal outcomes. Eligibility criteria included all reports, reviews; case series with more than 100 individuals and that reported at least three of the following: maternal characteristics, maternal COVID-19 clinical presentation, pregnancy outcomes, maternal outcomes and/or neonatal/perinatal outcomes. We included eight studies that met the inclusion criteria, representing 10,966 cases distributed in 15 countries around the world until July 20, 2020. The results of our review demonstrate that the maternal characteristics, clinical symptoms, maternal and neonatal outcomes almost 11,000 cases of COVID-19 and pregnancy described in 15 different countries are not worse or different from the general population. We suggest that pregnant women are not more affected by the respiratory complications of COVID-19, when compared to the outcomes described in the general population. We also suggest that the important gestational shift Th1-Th2 immune response, known as a potential contributor to the severity in cases of viral infections during pregnancy, are counter-regulated by the enhanced-pregnancy-induced ACE2-Ang-(1–7) axis. Moreover, the relatively small number of reported cases during pregnancy does not allow us to affirm that COVID-19 is more aggressive during pregnancy. Conversely, we also suggest, that down-regulation of ACE2 receptors induced by SARS-CoV-2 cell entry might have been detrimental in subjects with pre-existing ACE2 deficiency associated with pregnancy. This association might explain the worse perinatal outcomes described in the literature.

scholarly journals Interactions between Vitamin D Status, Calcium Intake and Parathyroid Hormone Concentrations in Healthy White-Skinned Pregnant Women at Northern Latitude

Nutrients ◽  
2018 ◽  
Vol 10 (7) ◽  
pp. 916 ◽  
Author(s):  
Andrea Hemmingway ◽  
Karen O’Callaghan ◽  
Áine Hennessy ◽  
George Hull ◽  
Kevin Cashman ◽  
...  
Keyword(s):  
Vitamin D ◽  
Parathyroid Hormone ◽  
Pregnant Women ◽  
Calcium Intake ◽  
Geometric Mean ◽  
Vitamin D Status ◽  
Metabolic System ◽  
Cross Sectional ◽  
The Mean ◽  
In Pregnancy

Adverse effects of low vitamin D status and calcium intakes in pregnancy may be mediated through functional effects on the calcium metabolic system. Little explored in pregnancy, we aimed to examine the relative importance of serum 25-hydroxyvitamin D (25(OH)D) and calcium intake on parathyroid hormone (PTH) concentrations in healthy white-skinned pregnant women. This cross-sectional analysis included 142 participants (14 ± 2 weeks’ gestation) at baseline of a vitamin D intervention trial at 51.9 °N. Serum 25(OH)D, PTH, and albumin-corrected calcium were quantified biochemically. Total vitamin D and calcium intakes (diet and supplements) were estimated using a validated food frequency questionnaire. The mean ± SD vitamin D intake was 10.7 ± 5.2 μg/day. With a mean ± SD serum 25(OH)D of 54.9 ± 22.6 nmol/L, 44% of women were <50 nmol/L and 13% <30 nmol/L. Calcium intakes (mean ± SD) were 1182 ± 488 mg/day and 23% of participants consumed <800 mg/day. The mean ± SD serum albumin-adjusted calcium was 2.2 ± 0.1 mmol/L and geometric mean (95% CI) PTH was 9.2 (8.4, 10.2) pg/mL. PTH was inversely correlated with serum 25(OH)D (r = −0.311, p < 0.001), but not with calcium intake or serum calcium (r = −0.087 and 0.057, respectively, both p > 0.05). Analysis of variance showed that while serum 25(OH)D (dichotomised at 50 nmol/L) had a significant effect on PTH (p = 0.025), calcium intake (<800, 800–1000, ≥1000 mg/day) had no effect (p = 0.822). There was no 25(OH)D-calcium intake interaction effect on PTH (p = 0.941). In this group of white-skinned women with largely sufficient calcium intakes, serum 25(OH)D was important for maintaining normal PTH concentration.

scholarly journals Intermittent preventive treatment for malaria in pregnancy: Is directly observed therapy still necessary? A prospective cohort study in a tertiary hospital, Southern Nigeria

2020 ◽  
Vol 4 ◽  
pp. 34-39
Author(s):  
Ubong Akpan ◽  
Udeme Asibong ◽  
Zibrin Okhormbe ◽  
Mabel Ekott ◽  
Saturday Etuk
Keyword(s):  
Cohort Study ◽  
Pregnant Women ◽  
Rural Areas ◽  
Venous Blood ◽  
Intermittent Preventive Treatment ◽  
Preventive Treatment ◽  
Tertiary Hospital ◽  
Control Group ◽  
Directly Observed Therapy ◽  
In Pregnancy

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.

scholarly journals Effect of Sulfadoxine-Pyrimethamine doses for prevention of malaria during pregnancy in hypoendemic area in Tanzania

2020 ◽  
Author(s):  
Wigilya Padili Mikomangwa ◽  
Omary Minzi ◽  
Ritah Mutagonda ◽  
Vito Baraka ◽  
Eulambius M. Mlugu ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Malaria Transmission ◽  
Geometric Mean ◽  
Placental Malaria ◽  
Intermittent Preventive Treatment ◽  
Premature Delivery ◽  
Maternal Anaemia ◽  
Malaria During Pregnancy ◽  
Placental Blood ◽  
Low Malaria Transmission

Abstract Background Malaria in pregnancy increases the risk of deleterious maternal and birth outcomes. The use of ≥3 doses of sulfadoxine-pyrimethamine (SP) for intermittent preventive treatment of malaria (IPTp-SP) is recommended for preventing the consequences of malaria during pregnancy. This study assessed the effect of IPTp-SP for prevention of malaria during pregnancy in low transmission settings. Methods A cross-sectional study that involved consecutively selected 1,161 pregnant women was conducted at Mwananyamala regional referral hospital in Dar es Salaam. Assessment of the uptake of IPTp-SP was done by extracting information from antenatal clinic cards. Maternal venous blood, cord blood, placental blood and placental biopsy were collected for assessment of anaemia and malaria. High performance liquid chromatography with ultraviolet detection (HPLC-UV) was used to detect and quantify sulfadoxine (SDX). Dried blood spots (DBS) of placental blood were collected for determination of sub-microscopic malaria using polymerase chain reaction (PCR). Results In total, 397 (34.2%) pregnant women reported to have used sub-optimal doses (≤2) while 764(65.8%) used optimal doses (≥3) of IPTp-SP at the time of delivery. The prevalence of placental malaria as determined by histology was 3.6%. Submicroscopic placental malaria was detected in 1.4% of the study participants. Women with peripheral malaria had six times risk of maternal anaemia than those who were malaria negative (aOR, 5.83; 95% CI, 1.10-30.92; p = 0.04). The geometric mean plasma SDX concentration was 10.76± 2.51μg/mL. Sub-optimal IPTp-SP dose was not associated with placental malaria, premature delivery and fetal anaemia. The use of ≤2 doses of IPTp-SP increased the risk of maternal anaemia by 1.36 fold compared to ≥3 doses (aOR, 1.36; 95%CI, 1.04-1.79; p = 0.02). Conclusion The use of <2 doses of IPTp-SP increased the risk of maternal anaemia. However, sub-optimal doses (≤2 doses) were not associated with increased the risk of malaria parasitaemia, fetal anaemia and preterm delivery among pregnant women in low malaria transmission setting. The use of optimal doses (≥3doses) of IPTp-SP and complementary interventions should continue even in areas with low malaria transmission.

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