Intermittent preventive treatment in pregnancy with sulfadoxine–pyrimethamine and parasite resistance: cross-sectional surveys from antenatal care visit and delivery in rural Ghana

Malaria Journal

Michael F. Ofori¹  Kwadwo A. Kusi¹  Bernard Tornyigah¹  Bright Adu¹  Charity Ahiabor²  Naa Adjeley Frempong²  Abraham K. Anang²  Frédéric Ariey³  Atikatou Mama⁴  Nicaise Tuikue Ndam⁴  Philippe Deloron⁴  Sandrine Houzé⁴  David Courtin⁴ 

[1] Department of Immunology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana;Department of Parasitology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana;INSERM 1016, Service de Parasitologie-Mycologie Hôpital Cochin, Université de Paris;Université de Paris, MERIT, IRD;

关键词: Malaria;    Pregnancy;    Plasmodium falciparum;    Ghana;    IPTp-SP;    SP resistance;   

DOI  :  10.1186/s12936-022-04124-7

来源: DOAJ

【 摘 要 】

Abstract Background Despite decades of prevention efforts, the burden of malaria in pregnancy (MiP) remains a great public health concern. Sulfadoxine-pyrimethamine (SP), used as intermittent preventive treatment in pregnancy (IPTp-SP) is an important component of the malaria prevention strategy implemented in Africa. However, IPTp-SP is under constant threat from parasite resistance, thus requires regular evaluation to inform decision-making bodies. Methods In two malaria endemic communities in the Volta region (Adidome and Battor), a cross-sectional hospital-based study was conducted in pregnant women recruited at their first antenatal care (ANC) visit and at delivery. Basic clinical and demographic information were documented and their antenatal records were reviewed to confirm IPTp-SP adherence. Peripheral and placental blood were assayed for the presence of Plasmodium falciparum parasites by quantitative polymerase chain reaction (qPCR). One hundred and twenty (120) positive samples were genotyped for mutations associated with SP resistance. Results At first ANC visit, P. falciparum prevalence was 28.8% in Adidome and 18.2% in Battor. At delivery, this decreased to 14.2% and 8.2%, respectively. At delivery, 66.2% of the women had taken at least the recommended 3 or more doses of IPTp-SP and there was no difference between the two communities. Taking at least 3 IPTp-SP doses was associated with an average birth weight increase of more than 360 g at both study sites compared to women who did not take treatment (p = 0.003). The Pfdhfr/Pfdhps quintuple mutant IRNI-A/FGKAA was the most prevalent (46.7%) haplotype found and the nonsynonymous Pfdhps mutation at codon A581G was higher at delivery among post-SP treatment isolates (40.6%) compared to those of first ANC (10.22%). There was also an increase in the A581G mutation in isolates from women who took 3 or more IPTp-SP. Conclusions This study confirms a positive impact following the implementation of the new IPTp-SP policy in Ghana in increasing the birth weight of newborns. However, the selection pressure exerted by the recommended 3 or more doses of IPTp-SP results in the emergence of parasites carrying the non-synonymous mutation on codon A581G. This constant selective pressure calls into question the time remaining for the clinical utility of IPTp-SP treatment during pregnancy in Africa.

【 授权许可】

Unknown