Influence of malaria transmission intensity and the 581G mutation on the efficacy of intermittent preventive treatment in pregnancy: systematic review and meta-analysis

Tropical Medicine & International Health : TM & IH
R Matthew ChicoBrian Greenwood

Abstract

To estimate where intermittent preventive treatment (IPTp) using sulphadoxine-pyrimethamine (SP) could be withdrawn as an intervention due to declining malaria transmission intensity, or due to increasing prevalence of the Plasmodium falciparum dihydropteroate synthetase resistance mutation at codon 581G. We conducted a systematic review and meta-analysis of protection against the incidence of low birth weight (LBW) conferred by ≥2 doses of IPTp-SP. We matched these outcomes to a proxy measure of malaria incidence in women of the same studies, applied meta-regression models to these data and conducted sensitivity analysis of the 581G mutation. Variation in the protective effect of IPTp-SP against LBW could not be explained by malaria transmission intensity. Among primi- and secundigravidae, IPTp-SP protected against LBW where 581G was ≤10.1% [odds ratio (OR): 0.49; 95% confidence intervals (CI): 0.29, 0.81; P = <0.01] and 581G was >10.1% (OR = 0.73; 95% CI: 0.29, 1.81; P = 0.03). Random-effects models among multigravidae showed that IPTp-SP protects against LBW where 581G was ≤10.1% (OR = 0.56; 95% CI: 0.37, 0.86; P = 0.07), a finding of borderline statistical significance. No evidence of protection against LBW was observed whe...Continue Reading

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Citations

Oct 3, 2015·Lancet·R Matthew Chico, William J Moss
Oct 6, 2018·Expert Opinion on Pharmacotherapy·Brioni R Moore, Timothy M E Davis
Jul 20, 2017·The American Journal of Tropical Medicine and Hygiene·Esmée RuizendaalPetra F Mens
Mar 23, 2017·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·R Matthew ChicoDaniel Chandramohan
May 4, 2021·International Journal of Infectious Diseases : IJID : Official Publication of the International Society for Infectious Diseases·Mariangela L'EpiscopiaCarlo Severini

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