Sulfadoxine–pyrimethamine resistance and intermittent preventive treatment during pregnancy: a retrospective analysis of birth weight data in the Democratic Republic of Congo (DRC)
Objective To assess the effect of intermittent preventive treatment with sulfadoxine–pyrimethamine (IPTp‐SP) on birth weight in sites with varying degrees of drug resistance.
Methods Birth weight data from three regions in Democratic Republic of Congo with varying degrees of sulfadoxine–pyrimethamine (SP) resistance (1.6% in Mikalayi, 21.7% in Kisangani and 60.6% in Rutshuru) were analysed retrospectively by means of a logistic model that included the number of SP doses taken by the mother and other potentials confounding factors.
Results The IPTp‐SP reduced the risk of low birth weight (LBW) in Kisangani (adjusted OR, 0.15; IC95%, 0.05–0.46) and in Mikalayi (adjusted OR, 0.12; IC95%, 0.01–0.89). In both sites, the average birth weight was higher for mothers having received two rather than one or no SP doses (P < 0.001). In Rutshuru, IPTp‐SP had an effect in primigravidae but not in multigravidae. However, after adjustment for other LBW risk factors, there was no difference in the proportion of LBW (adjusted OR 0.92; IC95%, 0.37–2.25) between women having taken at least 2 SP doses and those with only one dose or none.
Conclusion IPT‐SP remains an effective strategy in Kisangani and Mikalayi where the therapeutic failure to SP in children with clinical malaria was 21.7% and 1.6%, respectively, while IPTp‐SP effect seems lower in Rutshuru where the therapeutic failure to SP was 60.6%. The threshold value of SP resistance at which IPTp‐SP fails to have a significant impact on birth weight and LBW is unknown. Considering that no alternative is currently available, additional studies on the efficacy of IPTp‐SP in the areas of high SP resistance such as Rutshuru are needed so that the threshold at which this intervention fails to provide any benefit is determined with some precision.
Document Type: Research Article
Affiliations: 1: Université Libre de Bruxelles, Brussels, Belgium 2: Epidemiology and control of parasitic diseases unit, Institute of Tropical Medicine, Antwerp, Belgium 3: Département de Gynécologie-Obstétrique, Faculté de Médecine, Université de Kisangani, DR Congo 4: Labo d’Hormonologie expérimentale, Faculté de Médecine, Université Libre de Bruxelles, Belgium 5: Département de Biostatistiques, Ecole de Santé Publique, Université Libre de Bruxelles, Belgium
Publication date: 2012-03-01