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Intermittent screening and treatment with artemisinin-combination therapy versus intermittent preventive treatment with sulphadoxine-pyrimethamine for malaria in pregnancy: a systematic review and individual participant data meta-analysis of randomised clinical trials.

Publication ,  Journal Article
Gutman, JR; Khairallah, C; Stepniewska, K; Tagbor, H; Madanitsa, M; Cairns, M; L'lanziva, AJ; Kalilani, L; Otieno, K; Mwapasa, V; Meshnick, S ...
Published in: EClinicalMedicine
November 2021

BACKGROUND: In sub-Saharan Africa, the efficacy of intermittent preventive therapy in pregnancy with sulphadoxine-pyrimethamine (IPTp-SP) for malaria in pregnancy is threatened by parasite resistance. We conducted an individual-participant data (IPD) meta-analysis to assess the efficacy of intermittent screening with malaria rapid diagnostic tests (RDTs) and treatment of RDT-positive women with artemisinin-based combination therapy (ISTp-ACT) compared to IPTp-SP, and understand the importance of subpatent infections. METHODS: We searched MEDLINE and the Malaria-in-Pregnancy Library on May 6, 2021 for trials comparing ISTp-ACT and IPTp-SP. Generalised linear regression was used to compare adverse pregnancy outcomes (composite of small-for-gestational-age, low birthweight (LBW), or preterm delivery) and peripheral or placental Plasmodium falciparum at delivery. The effects of subpatent (PCR-positive, RDT/microscopy-negative) infections were assessed in both arms pooled using multi-variable fixed-effect models adjusting for the number of patent infections. PROSPERO registration: CRD42016043789. FINDINGS: Five trials conducted between 2007 and 2014 contributed (10,821 pregnancies), two from high SP-resistance areas where dhfr/dhps quintuple mutant parasites are saturated, but sextuple mutants are still rare (Kenya and Malawi), and three from low-resistance areas (West-Africa). Four trials contributed IPD data (N=10,362). At delivery, the prevalence of any malaria infection (relative risk [RR]=1.08, 95% CI 1.00-1.16, I2=67.0 %) and patent infection (RR=1.02, 0.61-1.16, I2=0.0%) were similar. Subpatent infections were more common in ISTp recipients (RR=1.31, 1.05-1.62, I2=0.0%). There was no difference in adverse pregnancy outcome (RR=1.00, 0.96-1.05; studies=4, N=9,191, I2=54.5%). Subpatent infections were associated with LBW (adjusted RR=1.13, 1.07-1.19), lower mean birthweight (adjusted mean difference=32g, 15-49), and preterm delivery (aRR=1.35, 1.15-1.57). INTERPRETATION: ISTp-ACT was not superior to IPTp-SP and may result in more subpatent infections than the existing IPTp-SP policy. Subpatent infections were associated with increased LBW and preterm delivery. More sensitive diagnostic tests are needed to detect and treat low-grade infections. FUNDING: Centers for Disease Control and Prevention and Worldwide Antimalarial Resistance Network.

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Published In

EClinicalMedicine

DOI

EISSN

2589-5370

Publication Date

November 2021

Volume

41

Start / End Page

101160

Location

England

Related Subject Headings

  • 4206 Public health
  • 4203 Health services and systems
  • 3202 Clinical sciences
 

Citation

APA
Chicago
ICMJE
MLA
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Gutman, J. R., Khairallah, C., Stepniewska, K., Tagbor, H., Madanitsa, M., Cairns, M., … Ter Kuile, F. O. (2021). Intermittent screening and treatment with artemisinin-combination therapy versus intermittent preventive treatment with sulphadoxine-pyrimethamine for malaria in pregnancy: a systematic review and individual participant data meta-analysis of randomised clinical trials. EClinicalMedicine, 41, 101160. https://doi.org/10.1016/j.eclinm.2021.101160
Gutman, Julie R., Carole Khairallah, Kasia Stepniewska, Harry Tagbor, Mwayiwawo Madanitsa, Matthew Cairns, Anne Joan L’lanziva, et al. “Intermittent screening and treatment with artemisinin-combination therapy versus intermittent preventive treatment with sulphadoxine-pyrimethamine for malaria in pregnancy: a systematic review and individual participant data meta-analysis of randomised clinical trials.EClinicalMedicine 41 (November 2021): 101160. https://doi.org/10.1016/j.eclinm.2021.101160.
Gutman JR, Khairallah C, Stepniewska K, Tagbor H, Madanitsa M, Cairns M, L’lanziva AJ, Kalilani L, Otieno K, Mwapasa V, Meshnick S, Kariuki S, Chandramohan D, Desai M, Taylor SM, Greenwood B, Ter Kuile FO. Intermittent screening and treatment with artemisinin-combination therapy versus intermittent preventive treatment with sulphadoxine-pyrimethamine for malaria in pregnancy: a systematic review and individual participant data meta-analysis of randomised clinical trials. EClinicalMedicine. 2021 Nov;41:101160.
Journal cover image

Published In

EClinicalMedicine

DOI

EISSN

2589-5370

Publication Date

November 2021

Volume

41

Start / End Page

101160

Location

England

Related Subject Headings

  • 4206 Public health
  • 4203 Health services and systems
  • 3202 Clinical sciences