Decline of placental malaria in southern Ghana after the implementation of intermittent preventive treatment in pregnancy

• Published in: Malaria Journal
• Main Authors: Eggelte Teunis A, Acquah Patrick A, Holmberg Ville, Bedu-Addo George, von Oertzen Christa, Hommerich Lena, Bienzle Ulrich, Mockenhaupt Frank P
• Format: Article in Journal/Newspaper
• Language: English
• Published: BMC 2007
• Subjects: Arctic medicine. Tropical medicine; RC955-962; Infectious and parasitic diseases; RC109-216; Arctic
• Online Access: https://doi.org/10.1186/1475-2875-6-144; https://doaj.org/article/1ac5d934057d41a6bfbc942693861287

Abstract Background Intermittent preventive treatment in pregnancy with sulphadoxine-pyrimethamine (IPTp-SP) has been adopted as policy by many countries in sub-Saharan Africa. However, data on the post-implementation effectiveness of this measure are scarce. Methods Clinical and parasitological parameters were assessed among women delivering at a district hospital in rural southern Ghana in the year 2000 when pyrimethamine chemoprophylaxis was recommended ( n = 839) and in 2006 ( n = 226), approximately one year after the implementation of IPTp-SP. Examinations were performed in an identical manner in 2000 and 2006 including the detection of placental Plasmodium falciparum infection by microscopy, histidine-rich protein 2, and PCR. Results In 2006, 77% of the women reported to have taken IPTp-SP at least once (26%, twice; 24%, thrice). In 2006 as compared to 2000, placental P. falciparum infection was reduced by 43–57% ( P < 0.0001) and maternal anaemia by 33% ( P = 0.0009), and median birth weight was 130 g higher ( P = 0.02). In 2006, likewise, women who had taken ≥ 1 dose of IPTp-SP revealed less infection and anaemia and their children tended to have higher birth weights as compared to women who had not used IPTp-SP. However, placental P. falciparum infection was still observed in 11% (microscopy) to 26% (PCR) of those women who had taken three doses of IPTp-SP. Conclusion In southern Ghana, placental malaria and maternal anaemia have declined substantially and birth weight has increased after the implementation of IPTp-SP. Likely, these effects can further be increased by improving IPTp-SP coverage and adherence. However, the remnant prevalence of infection in women having taken three doses of IPTp-SP suggests that additional antimalarial measures are needed to prevent malaria in pregnancy in this region.