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The impact of intermittent presumptive treatment for malaria in pregnancy on hospital birth outcomes on the Kenyan coast
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Kamau, Alice, Musau, Moses, Mwakio, Stella, Amadi, David, Nyaguara, Amek, Bejon, Philip, Seale, Anna C., Berkley, James A. and Snow, Robert W. (2023) The impact of intermittent presumptive treatment for malaria in pregnancy on hospital birth outcomes on the Kenyan coast. Clinical Infectious Diseases, 76 (3). e875-e883. doi:10.1093/cid/ciac509 ISSN 1058-4838.
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Official URL: https://doi.org/10.1093/cid/ciac509
Abstract
Background Intermittent preventive treatment (IPTp) to pregnant women with sulfadoxine–pyrimethamine (SP) is widely implemented for the prevention of malaria in pregnancy and adverse birth outcomes. The efficacy of SP is declining and there are concerns that IPTp may have reduced impact in areas of high resistance. Here we sought to determine the protection afforded by SP as part of IPTp against birth outcomes in an area with high levels of SP resistance on the Kenyan coast. Methods A secondary analysis of surveillance data on deliveries at the Kilifi County hospital between 2015 and 2021 was undertaken in an area of low malaria transmission and high parasite mutations associated with SP resistance. A multivariable logistic regression model was developed to estimate the effect of SP doses on the risk of low birthweight (LBW) deliveries and stillbirths. Results Among 27,786 deliveries, three or more doses of IPTp-SP were associated with a 27% reduction in the risk of LBW (adjusted odds ratio (aOR): 0.73; 95% CI: 0.64, 0.83; p < 0.001) compared to no-dose. A dose-response association was observed with increasing doses of SP from the second trimester linked to increasing protection against LBW deliveries. Three or more doses of IPTp-SP were also associated with a 21% reduction in stillbirth deliveries (aOR: 0.79; 95% CI: 0.65, 0.97; p= 0.044) compared to women who did not take any dose of IPTp-SP. Conclusions The continued, significant association of SP on LBW deliveries suggests that the intervention may have a non-malaria impact on pregnancy outcomes.
Item Type: | Journal Article | |||||||||||||||||||||
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Subjects: | R Medicine > RG Gynecology and obstetrics R Medicine > RJ Pediatrics |
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Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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SWORD Depositor: | Library Publications Router | |||||||||||||||||||||
Library of Congress Subject Headings (LCSH): | Pregnancy -- Complications -- Kenya, Malaria in pregnancy -- Treatment, Birth weight, Low -- Kenya, Stillbirth -- Kenya | |||||||||||||||||||||
Journal or Publication Title: | Clinical Infectious Diseases | |||||||||||||||||||||
Publisher: | University of Chicago Press | |||||||||||||||||||||
ISSN: | 1058-4838 | |||||||||||||||||||||
Official Date: | 1 February 2023 | |||||||||||||||||||||
Dates: |
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Volume: | 76 | |||||||||||||||||||||
Number: | 3 | |||||||||||||||||||||
Page Range: | e875-e883 | |||||||||||||||||||||
DOI: | 10.1093/cid/ciac509 | |||||||||||||||||||||
Status: | Peer Reviewed | |||||||||||||||||||||
Publication Status: | Published | |||||||||||||||||||||
Access rights to Published version: | Open Access (Creative Commons) | |||||||||||||||||||||
Date of first compliant deposit: | 8 September 2022 | |||||||||||||||||||||
Date of first compliant Open Access: | 8 September 2022 | |||||||||||||||||||||
RIOXX Funder/Project Grant: |
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