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A community effectiveness trial of strategies promoting intermittent preventive treatment with sulphadoxine-pyrimethamine in pregnant women in rural Burkina Faso.

Gies S, Coulibaly SO, Ouattara FT, Ky C, Brabin BJ, D'Alessandro U - Malar. J. (2008)

Bottom Line: Peripheral (33.3%) and placental (30.3%) parasite rates were significantly higher in the control arm compared to Intervention B (peripheral: 20.1% OR 0.50 95%CI 0.37-0.69 p = 0.001; placental: 20.5% OR 0.59 95%CI 0.44-0.78 p = 0.002) but did not differ between Intervention A (17.4%; 18.1%) and Intervention B (20.1; 20.5%) (peripheral: OR 0.84 95%CI 0.60-1.18 p = 0.280; placental: OR 0.86 95%CI 0.58-1.29 p = 0.430).Despite lower prevalence of malaria infection this did not translate into a significant difference in maternal anaemia or birth weight.This data provides evidence that, as with immunization programmes, extremely high coverage is essential for effectiveness.

View Article: PubMed Central - HTML - PubMed

Affiliation: Epidemiology and Control of Parasitic Diseases Unit, Department of Parasitology, Institute of Tropical Medicine, Antwerp, Belgium. sgies@itg.be

ABSTRACT

Background: Intermittent preventive treatment with sulphadoxine-pyrimethamine for pregnant women (IPTp-SP) is currently being scaled up in many countries in sub-Saharan Africa. Despite high antenatal clinic (ANC) attendance, coverage with the required two doses of SP remains low. The study investigated whether a targeted community-based promotion campaign to increase ANC attendance and SP uptake could effectively improve pregnancy outcomes in the community.

Methods: Between 2004 and 2006 twelve health centres in Boromo Health District, Burkina Faso were involved in this study. Four were strategically assigned to community promotion in addition to IPTp-SP (Intervention A) and eight were randomly allocated to either IPTp-SP (Intervention B) or weekly chloroquine (Control). Primi- and secundigravidae were enrolled at village level and thick films and packed cell volume (PCV) taken at 32 weeks gestation and at delivery. Placental smears were prepared and newborns weighed. Primary outcomes were peripheral parasitaemia during pregnancy and at delivery, placental malaria, maternal anaemia, mean and low birth weight. Secondary outcomes were the proportion of women with > or = 3 ANC visits and > or = 2 doses of SP. Intervention groups were compared using logistic and linear regression with linearized variance estimations to correct for the cluster-randomized design.

Results: SP uptake (> or = 2 doses) was higher with (Intervention A: 70%) than without promotion (Intervention B: 49%) (OR 2.45 95%CI 1.25-4.82 p = 0.014). Peripheral (33.3%) and placental (30.3%) parasite rates were significantly higher in the control arm compared to Intervention B (peripheral: 20.1% OR 0.50 95%CI 0.37-0.69 p = 0.001; placental: 20.5% OR 0.59 95%CI 0.44-0.78 p = 0.002) but did not differ between Intervention A (17.4%; 18.1%) and Intervention B (20.1; 20.5%) (peripheral: OR 0.84 95%CI 0.60-1.18 p = 0.280; placental: OR 0.86 95%CI 0.58-1.29 p = 0.430). Mean PCV and birth weight and prevalence of anaemia and low birth weight did not differ between study arms.

Conclusion: The promotional campaign resulted in a major increase in IPTp-coverage, with two thirds of women at delivery having received > or = 2 SP. Despite lower prevalence of malaria infection this did not translate into a significant difference in maternal anaemia or birth weight. This data provides evidence that, as with immunization programmes, extremely high coverage is essential for effectiveness. This critical threshold of coverage needs to be defined, possibly on a regional basis.

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Location of study health centres and dependant villages in Boromo Health District, Burkina Faso.
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Figure 1: Location of study health centres and dependant villages in Boromo Health District, Burkina Faso.

Mentions: The study was carried out between 2003 and 2006 in Western Burkina Faso, in Boromo Health District (BHD), a rural province with an estimated total population of 204,117 (Figure 1). There are three seasons: a rainy season (June to October; 20–35°C; mean annual rainfall about 800 mm/year), a cold dry season (November to February, 16–32°C) and a hot dry season (March to May, 25–40°C). Malaria is holo-endemic, with high transmission between July and December. At the time of the study, national guidelines for malaria prevention in pregnant women recommended a full treatment course of CQ (1500 mg over 3 days) at the first antenatal visit followed by 300 mg weekly until 6 weeks post partum. Antenatal care was offered free of charge and included, besides CQ prophylaxis, an ANC card, physical examination, counselling, and haematinic supplementation (200 mg ferrous sulphate and 0.25 mg folic acid). In rural Burkina Faso, antenatal coverage for at least one visit was about 70%, with 22.5% of first visits during the first trimester and 68.5% of deliveries occurring at home [25].


A community effectiveness trial of strategies promoting intermittent preventive treatment with sulphadoxine-pyrimethamine in pregnant women in rural Burkina Faso.

Gies S, Coulibaly SO, Ouattara FT, Ky C, Brabin BJ, D'Alessandro U - Malar. J. (2008)

Location of study health centres and dependant villages in Boromo Health District, Burkina Faso.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2563022&req=5

Figure 1: Location of study health centres and dependant villages in Boromo Health District, Burkina Faso.
Mentions: The study was carried out between 2003 and 2006 in Western Burkina Faso, in Boromo Health District (BHD), a rural province with an estimated total population of 204,117 (Figure 1). There are three seasons: a rainy season (June to October; 20–35°C; mean annual rainfall about 800 mm/year), a cold dry season (November to February, 16–32°C) and a hot dry season (March to May, 25–40°C). Malaria is holo-endemic, with high transmission between July and December. At the time of the study, national guidelines for malaria prevention in pregnant women recommended a full treatment course of CQ (1500 mg over 3 days) at the first antenatal visit followed by 300 mg weekly until 6 weeks post partum. Antenatal care was offered free of charge and included, besides CQ prophylaxis, an ANC card, physical examination, counselling, and haematinic supplementation (200 mg ferrous sulphate and 0.25 mg folic acid). In rural Burkina Faso, antenatal coverage for at least one visit was about 70%, with 22.5% of first visits during the first trimester and 68.5% of deliveries occurring at home [25].

Bottom Line: Peripheral (33.3%) and placental (30.3%) parasite rates were significantly higher in the control arm compared to Intervention B (peripheral: 20.1% OR 0.50 95%CI 0.37-0.69 p = 0.001; placental: 20.5% OR 0.59 95%CI 0.44-0.78 p = 0.002) but did not differ between Intervention A (17.4%; 18.1%) and Intervention B (20.1; 20.5%) (peripheral: OR 0.84 95%CI 0.60-1.18 p = 0.280; placental: OR 0.86 95%CI 0.58-1.29 p = 0.430).Despite lower prevalence of malaria infection this did not translate into a significant difference in maternal anaemia or birth weight.This data provides evidence that, as with immunization programmes, extremely high coverage is essential for effectiveness.

View Article: PubMed Central - HTML - PubMed

Affiliation: Epidemiology and Control of Parasitic Diseases Unit, Department of Parasitology, Institute of Tropical Medicine, Antwerp, Belgium. sgies@itg.be

ABSTRACT

Background: Intermittent preventive treatment with sulphadoxine-pyrimethamine for pregnant women (IPTp-SP) is currently being scaled up in many countries in sub-Saharan Africa. Despite high antenatal clinic (ANC) attendance, coverage with the required two doses of SP remains low. The study investigated whether a targeted community-based promotion campaign to increase ANC attendance and SP uptake could effectively improve pregnancy outcomes in the community.

Methods: Between 2004 and 2006 twelve health centres in Boromo Health District, Burkina Faso were involved in this study. Four were strategically assigned to community promotion in addition to IPTp-SP (Intervention A) and eight were randomly allocated to either IPTp-SP (Intervention B) or weekly chloroquine (Control). Primi- and secundigravidae were enrolled at village level and thick films and packed cell volume (PCV) taken at 32 weeks gestation and at delivery. Placental smears were prepared and newborns weighed. Primary outcomes were peripheral parasitaemia during pregnancy and at delivery, placental malaria, maternal anaemia, mean and low birth weight. Secondary outcomes were the proportion of women with > or = 3 ANC visits and > or = 2 doses of SP. Intervention groups were compared using logistic and linear regression with linearized variance estimations to correct for the cluster-randomized design.

Results: SP uptake (> or = 2 doses) was higher with (Intervention A: 70%) than without promotion (Intervention B: 49%) (OR 2.45 95%CI 1.25-4.82 p = 0.014). Peripheral (33.3%) and placental (30.3%) parasite rates were significantly higher in the control arm compared to Intervention B (peripheral: 20.1% OR 0.50 95%CI 0.37-0.69 p = 0.001; placental: 20.5% OR 0.59 95%CI 0.44-0.78 p = 0.002) but did not differ between Intervention A (17.4%; 18.1%) and Intervention B (20.1; 20.5%) (peripheral: OR 0.84 95%CI 0.60-1.18 p = 0.280; placental: OR 0.86 95%CI 0.58-1.29 p = 0.430). Mean PCV and birth weight and prevalence of anaemia and low birth weight did not differ between study arms.

Conclusion: The promotional campaign resulted in a major increase in IPTp-coverage, with two thirds of women at delivery having received > or = 2 SP. Despite lower prevalence of malaria infection this did not translate into a significant difference in maternal anaemia or birth weight. This data provides evidence that, as with immunization programmes, extremely high coverage is essential for effectiveness. This critical threshold of coverage needs to be defined, possibly on a regional basis.

Show MeSH
Related in: MedlinePlus