scholarly journals Effectiveness of Sulfadoxine–Pyrimethamine for Intermittent Preventive Treatment of Malaria and Adverse Birth Outcomes in Pregnant Women

Pathogens ◽  
2020 ◽  
Vol 9 (3) ◽  
pp. 207 ◽  
Author(s):  
Eulambius M. Mlugu ◽  
Omary Minzi ◽  
Muhammad Asghar ◽  
Anna Färnert ◽  
Appolinary A.R. Kamuhabwa ◽  
...  
Keyword(s):  
Birth Weight ◽  
Pregnant Women ◽  
Birth Outcomes ◽  
Birth Outcome ◽  
Placental Malaria ◽  
Intermittent Preventive Treatment ◽  
Preventive Treatment ◽  
Adverse Birth Outcomes ◽  
Malaria During Pregnancy ◽  
To Receive

Effectiveness of intermittent preventive treatment in pregnancy with sulfadoxine–pyrimethamine (IPTp-SP) for prevention of malaria and adverse birth outcomes can be compromised by parasites-resistance to sulfadoxine–pyrimethamine. This study prospectively evaluated the effectiveness of IPTp-SP in Southeast Tanzania. From January 2017 to May 2019, HIV-negative and malaria-negative (mRDT) pregnant women attending their first antenatal-care visit in the second or third trimester (n = 500) were enrolled to receive monthly IPTp-SP and followed the protocol till delivery. The primary outcome was the prevalence of histopathological placental malaria. Secondary outcomes were anemia, malaria parasites detected during pregnancy and at delivery, adverse birth outcomes (low-birth-weight [LBW], premature birth, fetal anemia, still birth, and spontaneous abortion). Rates of histopathological placental malaria, any parasitemia at delivery (placental, cord or maternal), and any adverse birth outcome were 9.4%, 20.9%, and 26.5%, respectively. Rates of symptomatic malaria and parasitemia during pregnancy were 2.8% and 16%, respectively. Histopathological placental malaria significantly increased the odds of any adverse birth outcomes, particularly LBW. IPTp-SP with more than or equal to three doses significantly improved birth weight and reduced the risk of LBW by 56% compared to <3 SP doses (p = 0.009). IPTp-SP with more than or equal to three doses is still effective in improving birth weight. However, the detection of histopathological placental-malaria in one-tenth and parasitemia in one-fifth of pregnant women reflects the need to optimize the prevention of malaria during pregnancy.

Reduced birth weight caused by sextuple drug resistant Plasmodium falciparum infection in early 2nd trimester

2021 ◽  
Author(s):  
Helle Hansson ◽  
Daniel T R Minja ◽  
Sofie L Moeller ◽  
John P A Lusingu ◽  
Ib C Bygbjerg ◽  
...  
Keyword(s):  
Plasmodium Falciparum ◽  
Birth Weight ◽  
Birth Outcomes ◽  
Birth Outcome ◽  
Intermittent Preventive Treatment ◽  
Preventive Treatment ◽  
First Trimester ◽  
Close Monitoring ◽  
The Impact ◽  
Mutant Haplotype

Abstract Mutations in the Plasmodium falciparum genes Pfdhfr and Pfdhps, particularly the sextuple mutant haplotype threatens the antimalarial effectiveness of sulfadoxine-pyrimethamine as intermittent preventive treatment during pregnancy (IPTp). To explore the impact of sextuple mutant haplotype infections on outcome measures after provision of IPTp-SP, we monitored birth outcomes in women followed from prior to conception or from the first trimester until delivery. Women infected with sextuple haplotypes in early 2 nd trimester specifically, delivered newborns with a lower birth weight (-267g, 95% CI -454; -59, p=0·01) compared to women who did not have malaria during pregnancy and women infected with less SP resistant haplotypes (-461g, 95% CI -877; -44, p=0·03). Thus, sextuple haplotype infections seems to impact the effectiveness of SP for IPTp and directly impact birth outcome by lowering birth weight. Close monitoring and targeted malaria control during early pregnancy is therefore crucial to improve birth outcomes.

scholarly journals Monitoring Compliance and Acceptability of Intermittent Preventive Treatment of Malaria Using Sulfadoxine Pyrimethamine after Ten Years of Implementation in Tanzania

2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
Mdetele B. Ayubu ◽  
Winifrida B. Kidima
Keyword(s):  
Pregnant Women ◽  
Placental Malaria ◽  
Intermittent Preventive Treatment ◽  
Preventive Treatment ◽  
Antenatal Clinic ◽  
Drug Uptake ◽  
Cross Sectional ◽  
Start Date ◽  
Malaria During Pregnancy ◽  
Endemic Areas

Intermittent preventive treatment using SP (IPTp-SP) is still a superior interventional approach to control malaria during pregnancy. However its rate of use has gone down tremendously in malaria endemic areas. This study forms part of a larger study aimed at monitoring the compliance of IPTp-SP policy in malaria endemic areas of Tanzania. Two cross-sectional studies were conducted in Dar es Salaam and Njombe Regions of Tanzania. Overall, 540 pregnant women and 21 healthcare workers were interviewed using structured questionnaires. This study revealed that 63% of women were not willing to take SP during pregnancy while 91% would only take it if they tested positive for malaria during antennal visits. 63% of the interviewed women did not know the recommended dose of SP required during pregnancy, despite the fact that 82% of the women were aware of the adverse effect of malaria during pregnancy. It was found out that 54% of pregnant women (30–40 weeks) took single dose, 34% took two doses, and 16% did not take SP at the time of interview. It was also found that SP was not administered under direct observed therapy in 86% of women. There was no significant relationship between number of doses received by pregnant women and antenatal clinic (ANC) start date (r2 = 0.0033, 95% CI (−0.016 to 0.034)). However positive correlation between drug uptake and drug availability was revealed (p=0.0001). Knowledge on adverse effects of placental malaria among pregnant women was significantly associated with drug uptake (OR 11.81, 95% CI (5.755–24.23), p=0.0001). We conclude that unavailability of drugs in ANC is the major reason hindering the implementation of IPTp-SP.

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 Effects of Intervention Schemes on Sulphadoxine-Pyrimethamine Compliance Among Pregnant Women in a Health Facility in Port Harcourt, Rivers State, Nigeria

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Helen Onoja ◽  
Florence Nduka ◽  
Austin E Abah
Keyword(s):  
Birth Weight ◽  
Pregnant Women ◽  
Health Facility ◽  
Birth Outcomes ◽  
Control Measure ◽  
Intermittent Preventive Treatment ◽  
Preventive Treatment ◽  
Therapeutic Drug ◽  
Port Harcourt ◽  
Sulphadoxine Pyrimethamine

Background: Malaria causes diverse adverse effects in the fetus due to the invasion of the placenta by Plasmodium. The use of intermittent preventive treatment (Sulphadoxinepyrimethamine- IPTp-SP) as a control measure for malaria in pregnancy has been recommended and shown to reduce unwanted birth outcomes. Objectives: This work aimed to evaluate the effects of intervention schemes on sulphadoxine-pyrimethamine (SP) compliance and utilization among pregnant women in a health facility in Port Harcourt, Nigeria. Methods: A hospital-based survey was carried out among pregnant women admitted to the Labor ward of Obio-Cottage hospital. The information of mothers was collected using a well-structured and pre-tested questionnaire and from their antenatal care (ANC) records. Results: Time of ANC registration indicated that 87%, 11.33%, and 1.66% of mothers were registered during their first, second, and third trimesters, respectively. Sulphadoxinepyrimethamine was the drug of choice for 93.66% of the women while 6.33% took other drugs. The survey revealed that 97.15% and 2.85% of the women started SP usage in their second and third trimesters, respectively. It was observed that the majority of the women (69.39%) took SP thrice while 24.19% and 6.40% consumed it twice and once, respectively. Regarding knowledge about SP, 89% of the women viewed SP as a preventive drug for malaria while 11% acknowledged it as a therapeutic drug. The birth outcomes of the neonates whose mothers took SP indicated that 1.42% had low birth weight (LBW) while 98.57% had acceptable birth weight. Meanwhile, 10.53% of the babies born to the mothers who did not use SP had LBW, and 89.47% of them had acceptable birth weights. Overall, 98.93% of the neonates of SP-compliant women and 89.48% of the babies of non-compliant women were alive. Non- compliant women had higher prevalence of preterm birth (5.76%) and fetal death (5.26%) than SP-compliant women (0.7% and 0.35%, respectively). Conclusions: Adequate knowledge and compliance with SP usage were high in the studied population, which was associated with favorable birth outcomes.

The Impact of Intermittent Preventive Treatment with Sulfamethoxazole Pyrimethamine on Pregnant Women and Newborns at Bon Samaritain Hospital in N'Djamena, Chad.

2021 ◽  
Author(s):  
Ngaba Ngardig Neguemadji ◽  
Obélix Askemdet ◽  
Namrata Hange ◽  
Maria Kezia Lourdes Ligsay Pormento ◽  
Zeryab Ghous Dogar ◽  
...  
Keyword(s):  
Birth Weight ◽  
Pregnant Women ◽  
Placental Malaria ◽  
Intermittent Preventive Treatment ◽  
Preventive Treatment ◽  
Secondary School Education ◽  
Mosquito Nets ◽  
The Mean ◽  
Study Participants ◽  
The Impact

Abstract Background: The Chadian government established a program of free intermittent preventive treatment withsulfadoxine-pyrimethamine (IPTp-SP) for pregnant women. This program estimated the impact of IPTp-SP onthe malarial prevalence among women and newborn children, a study was planned for pregnant women whoconsulted in the Bon samaritain hospital in NDja mena, Chad.Methods: This 14 month study was conducted on 149 pregnant women. They were followed until delivery foroutcomes such as malaria attacks, anemia and placental malaria, low birth weight and prematurity in newborns.Data was collected with the help of a pretested questionnaire. Data was analysed with SPSS and R studio, Oddsrisk was calculated.Results: The mean age of the study participants was 25.8 ś 6.2 years with 72.5% under the age of 20 years,and half were housewives with a secondary school education. More than half of the pregnant women (84,56.3%) never used insecticide-treated mosquito nets. Among the 149 study participants, (64, 42,95%) received3 doses of IPTp-SP, while 31( 20.8%) did not receive any dose of IPTp-SP. Only 30% (45) of the total 149participants reported to be malaria positive; while 28.9% (43) were diagnosed with placental malaria. Of the43 placenta malaria cases, 21(48.83%) had not received SP. Most of the lower birth weight babies with weight< 2500g (40,81.64%) were reported in pregnant mothers who have reported administration of one or no doseof SP. Out of 31 pregnant women, 21 (67.7%) without IPTp-SP had reported at least one attack of malariaduring their pregnancy compared to 22 women out of 118(18.7%) of those who had at least one dose ofSulfamethoxazole pyrimethamine (p = 0.001 ). Out of 31 pregnant women who have not received IPTp-SP,26 women (83.9%) reported anaemiaw ith Hb <10.5g/dl while 17 (65.4%) with severeanemia Hb <8g/dl .Conclusion: The maternal rate of attack of malaria, placenta infestation, maternal anemia,and low birth weightbabies decrease considerably with administration of three or more doses of s ulfadoxine-pyrimethamine.

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.

scholarly journals Quality of Sulfadoxine-Pyrimethamine Given as Antimalarial Prophylaxis in Pregnant Women in Selected Health Facilities in Central Region of Ghana

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Danny F. Yeboah ◽  
Richmond Afoakwah ◽  
Ekene K. Nwaefuna ◽  
Orish Verner ◽  
Johnson N. Boampong
Keyword(s):  
Pregnant Women ◽  
Central Region ◽  
Malaria Infection ◽  
High Performance ◽  
Intermittent Preventive Treatment ◽  
Preventive Treatment ◽  
Health Facilities ◽  
African Countries ◽  
Malaria During Pregnancy

The use of sulfadoxine-pyrimethamine (SP) as an intermittent preventive treatment (IPT) against malaria during pregnancy has become a policy in most sub-Sahara African countries and crucially depends on the efficacy of SP. This study sets out to evaluate the effectiveness of the SP given to the pregnant women in some selected health facilities in the Central Region of Ghana to prevent maternal malaria in pregnant women. A total of 543 pregnant women recruited from 7 selected health centres in Central Region of Ghana participated in the study. Parasite density ofPlasmodium falciparumwas determined from peripheral blood of the pregnant women using microscopy. High performance liquid chromatography (HPLC) and dissolution tester were used to determine the quality of the SP. Malaria infection was recorded in 11.2% of pregnant women who had a history of SP consumption. SP failed the dissolution test. Pregnant women who did not receive IPT-SP were 44%. Low haemoglobin level was recorded in 73.5% of the pregnant women. The results indicated that SP was substandard. IPT-SP is ineffective in preventing malaria infection.

scholarly journals 1345Uptake of Intermittent Preventive Treatment for malaria during pregnancy with Sulphadoxine-Pyrimethamine in Malawi

2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Steven Azizi
Keyword(s):  
Intermittent Preventive Treatment ◽  
Preventive Treatment ◽  
Sample Design ◽  
Complex Survey ◽  
Factors Associated ◽  
Limited Effectiveness ◽  
Malaria During Pregnancy ◽  
Survey Sample ◽  
To Receive ◽  
Sulphadoxine Pyrimethamine

Abstract Background This study aimed to estimate the proportion of and identify factors associated with uptake of ≥ 3 doses of Intermittent preventive treatment of malaria during pregnancy with sulphadoxine-pyrimethamine (IPTp-SP) among pregnant women in Malawi after adoption of the 2012 updated WHO IPTp-SP policy. Methods The 2015–16 Malawi Demographic and Health Survey dataset was re-analysed. Only 1069 women were included in the analysis from 1219 women who had live births, born after July 2015. Logistic regression was used in data analysis considering complex survey sample design. Results Of the 1069 women, 447 (42%) received ≥3 doses (optimal) of IPTp-SP, while 47% managed to attend ≥4 antenatal care (ANC) clinics. Only 52% received optimal SP doses among those who made ≥4 ANC visits. The number of ANC visits was associated with the optimal uptake of SP. Women who attended ANC three times only and those who visited ANC at most twice were less likely to receive optimal doses than those who managed to attend ANC ≥4 times during pregnancy (AOR = 0.71, 95% CI 0.49–1.02) and (AOR = 0.12, 95% CI 0.06–0.21) respectively. Conclusions There is low uptake of optimal SP doses in Malawi. This seems to be associated with the number of ANC visits. However, there is limited effectiveness of increased number of ANC visits on the uptake of optimal SP doses. Key messages Increased number of ANC visits is not enough to increase uptake of optimal doses of IPTp-SP. There is need for continued and varied efforts.

scholarly journals Febrile Rhinovirus Illness During Pregnancy Is Associated With Low Birth Weight in Nepal

2017 ◽  
Vol 4 (2) ◽  
Author(s):  
Erin K Philpott ◽  
Janet A Englund ◽  
Joanne Katz ◽  
James Tielsch ◽  
Subarna Khatry ◽  
...  
Keyword(s):  
Birth Weight ◽  
Infant Mortality ◽  
Low Birth Weight ◽  
Pregnant Women ◽  
Birth Outcomes ◽  
Febrile Illness ◽  
Respiratory Illness ◽  
Adverse Birth Outcomes ◽  
Increased Risk ◽  
Febrile Respiratory Illness

Abstract Background Adverse birth outcomes, including low birth weight (LBW), defined as &lt;2500 grams, small-for-gestational-age (SGA), and prematurity, contribute to 60%–80% of infant mortality worldwide and may be related to infections during pregnancy. The aim of this study was to assess whether febrile human rhinovirus (HRV) illness is associated with adverse birth outcomes. Methods Active household-based weekly surveillance was performed for respiratory illness episodes in pregnant women as part of a community-based, prospective, randomized trial of maternal influenza immunization in rural Nepal. Rhinovirus (HRV) febrile illness episodes were defined as fever plus cough, sore throat, runny nose, and/or myalgia with HRV detected on mid-nasal swab. Multivariate regression analysis evaluated the association between febrile HRV respiratory illness and adverse birth outcomes. Results Overall, 96 (3%) of 3693 pregnant women had HRV-positive febrile respiratory illnesses. Infants born to pregnant women with HRV febrile illness had a 1.6-fold increased risk of being LBW compared with those with non-HRV febrile illness (28 of 96 [38%] vs 109 of 458 [24%]; relative risk [RR], 1.6; 95% confidence interval [CI], 1.1–2.3). No difference in risk of LBW was observed between infants born to mothers with non-HRV febrile respiratory illness and those without respiratory illness during pregnancy (109 of 458 [24%] vs 552 of 2220 [25%], respectively; RR, 1.0; 95% CI, 0.8–1.2). Conclusions Febrile illness due to rhinovirus during pregnancy was associated with increased risk of LBW in a rural South Asian population. Interventions to reduce the burden of febrile respiratory illness due to rhinovirus during pregnancy may have a significant impact on LBW and subsequent infant mortality.

scholarly journals Prevalence of Plasmodium falciparum Resistance Markers to Sulfadoxine-Pyrimethamine among Pregnant Women Receiving Intermittent Preventive Treatment for Malaria in Uganda

2015 ◽  
Vol 59 (9) ◽  
pp. 5475-5482 ◽  
Author(s):  
Anthony K. Mbonye ◽  
Josephine Birungi ◽  
Stephanie K. Yanow ◽  
Sandra Shokoples ◽  
Samuel Malamba ◽  
...  
Keyword(s):  
Plasmodium Falciparum ◽  
Birth Weight ◽  
Pregnant Women ◽  
Intermittent Preventive Treatment ◽  
Melting Curve ◽  
Preventive Treatment ◽  
Melting Curve Analysis ◽  
Content Type ◽  
Lower Birth Weight ◽  
Resistance Markers

ABSTRACTThe aim of this study was to assess the prevalence of mutations inPlasmodium falciparumdihydrofolate reductase (Pfdhfr) and dihydropteroate synthase (Pfdhps) genes among pregnant women using sulfadoxine-pyrimethamine (SP) as an intermittent preventive treatment (IPTp). A molecular epidemiological study ofP. falciparumparasite resistance markers to SP was conducted from August 2010 to February 2012 in Mukono district in central Uganda. DNA was extracted from 413P. falciparum-positive samples. Real-time PCR, followed by melting curve analysis, was used to characterize point mutations in thePfdhfrandPfdhpsgenes that are associated with SP resistance. The prevalence of the single-nucleotide mutations inPfdhfrat codons 51I, 59R, and 108N and inPfdhpsat codons 437G and 540E was high (>98%), reaching 100% fixation after one dose of SP, while the prevalence of 581G was 3.3% at baseline, reaching 12.5% after one dose of SP. At baseline, the prevalence ofPfdhfrandPfdhpsquintuple mutations was 89%, whereas the sextuple mutations (including 581G) were not prevalent (3.9%), reaching 16.7% after one dose of SP. However, the numbers of infections at follow-up visits were small, and hence there was insufficient statistical power to test whether there was a true rise in the prevalence of this allele. The overall high frequency ofPfdhfrandPfdhpsquintuple mutations throughout pregnancy excluded further analyses of possible associations between certain haplotypes and the risk of lower birth weight and anemia. However, women infected withP. falciparumhad 1.3-g/dl-lower hemoglobin levels (P= 0.001) and delivered babies with a 400-g-lower birth weight (P= 0.001) compared to nonparasitemic women. Despite this, 44 women who wereP. falciparumpositive at baseline became negative after one or two doses of SP (i.e., 50.5%), implying that SP-IPTp still has some efficacy.P. falciparumresistance markers to SP are high in this population, whereasP. falciparuminfection was associated with poor birth outcomes.

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