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Parasite clearance following treatment with sulphadoxine-pyrimethamine for intermittent preventive treatment in Burkina-Faso and Mali: 42-day in vivo follow-up study.

Publication ,  Journal Article
Coulibaly, SO; Kayentao, K; Taylor, S; Guirou, EA; Khairallah, C; Guindo, N; Djimde, M; Bationo, R; Soulama, A; Dabira, E; Barry, B; Konate, S ...
Published in: Malar J
January 31, 2014

BACKGROUND: Intermittent Preventive Treatment in pregnancy (IPTp) with sulphadoxine-pyrimethamine (SP) is widely used for the control of malaria in pregnancy in Africa. The emergence of resistance to SP is a concern requiring monitoring the effectiveness of SP for IPTp. METHODS: This was an in-vivo efficacy study to determine the parasitological treatment response and the duration of post-treatment prophylaxis among asymptomatic pregnant women receiving SP as part of IPTp in Mali and Burkina-Faso. The primary outcome was the PCR-unadjusted % of patients with parasites recurrence by day 42 defined as a positive diagnostic test by malaria smear at any visit between days 4 and 42. Treatment failure was based on the standard World Health Organization criteria. The therapeutic response was estimated using the Kaplan-Meier curve. RESULTS: A total of 580 women were enrolled in Mali (N=268) and Burkina-Faso (N=312) and followed weekly for 42 days. Among these, 94.3% completed the follow-up. The PCR-unadjusted cumulative risk of recurrence by day 42 was 4.9% overall, and 3.2% and 6.5% in Mali and Burkina Faso respectively (Hazard Ratio [HR] =2.14, 95%, CI [0.93-4.90]; P=0.070), and higher among the primi- and secundigravida (6.4%) than multigravida (2.2%, HR=3.01 [1.04-8.69]; P=0.042). The PCR-adjusted failure risk was 1.1% overall (Mali 0.8%, Burkina-Faso 1.4%). The frequencies (95% CI) of the dhfr double and triple mutant and dhps 437 and 540 alleles mutant genotype at enrolment were 24.2% (23.7-25.0), 4.7% (4.4-5.0), and 21.4% (20.8-22.0) and 0.37% (0.29-0.44) in Mali, and 7.1% (6.5-7.7), 44.9% (43.8-46.0) and 75.3% (74.5-76.2) and 0% in Burkina-Faso, respectively. There were no dhfr 164L or dhps 581G mutations. CONCLUSION: SP remains effective at clearing existing infections when provided as IPTp to asymptomatic pregnant women in Mali and Burkina. Continued monitoring of IPTp-SP effectiveness, including of the impact on birth parameters in this region is essential.

Duke Scholars

Published In

Malar J

DOI

EISSN

1475-2875

Publication Date

January 31, 2014

Volume

13

Start / End Page

41

Location

England

Related Subject Headings

  • Young Adult
  • Tropical Medicine
  • Sulfadoxine
  • Pyrimethamine
  • Pregnancy
  • Polymerase Chain Reaction
  • Parasite Load
  • Mali
  • Malaria
  • Kaplan-Meier Estimate
 

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Coulibaly, S. O., Kayentao, K., Taylor, S., Guirou, E. A., Khairallah, C., Guindo, N., … ter Kuile, F. O. (2014). Parasite clearance following treatment with sulphadoxine-pyrimethamine for intermittent preventive treatment in Burkina-Faso and Mali: 42-day in vivo follow-up study. Malar J, 13, 41. https://doi.org/10.1186/1475-2875-13-41
Coulibaly, Sheick O., Kassoum Kayentao, Steve Taylor, Etienne A. Guirou, Carole Khairallah, Nouhoun Guindo, Moussa Djimde, et al. “Parasite clearance following treatment with sulphadoxine-pyrimethamine for intermittent preventive treatment in Burkina-Faso and Mali: 42-day in vivo follow-up study.Malar J 13 (January 31, 2014): 41. https://doi.org/10.1186/1475-2875-13-41.
Coulibaly SO, Kayentao K, Taylor S, Guirou EA, Khairallah C, Guindo N, Djimde M, Bationo R, Soulama A, Dabira E, Barry B, Niangaly M, Diakite H, Konate S, Keita M, Traore B, Meshnick SR, Magnussen P, Doumbo OK, ter Kuile FO. Parasite clearance following treatment with sulphadoxine-pyrimethamine for intermittent preventive treatment in Burkina-Faso and Mali: 42-day in vivo follow-up study. Malar J. 2014 Jan 31;13:41.
Journal cover image

Published In

Malar J

DOI

EISSN

1475-2875

Publication Date

January 31, 2014

Volume

13

Start / End Page

41

Location

England

Related Subject Headings

  • Young Adult
  • Tropical Medicine
  • Sulfadoxine
  • Pyrimethamine
  • Pregnancy
  • Polymerase Chain Reaction
  • Parasite Load
  • Mali
  • Malaria
  • Kaplan-Meier Estimate