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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
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