Parasite clearance following treatment with sulphadoxine-pyrimethamine for intermittent preventive treatment in Burkina-Faso and Mali: 42-day in vivo follow-up study

Malaria Journal

Research

Pascal Magnussen¹  Etienne A Guirou²  Ogobara K Doumbo²  Mohamed Keita²  Moussa Djimde²  Boubacar Traore²  Moussa Niangaly²  Hammadoun Diakite²  Nouhoun Guindo²  Sidiki Konate²  Binta Barry²  Kassoum Kayentao³  Steve R Meshnick⁴  Steve Taylor⁵  Richard Bationo⁶  Alamissa Soulama⁶  Sheick O Coulibaly⁶  Edgar Dabira⁶  Carole Khairallah⁷  Feiko O ter Kuile⁷ 

[1] Centre for Medical Parasitology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark;Department of Epidemiology of Parasitic Diseases, Malaria Research and Training Center, Faculty of Medicine and Odonto-stomatology of Bamako, University of Sciences, Technics and Technologies, BP: 1805, Bamako, Mali;Department of Epidemiology of Parasitic Diseases, Malaria Research and Training Center, Faculty of Medicine and Odonto-stomatology of Bamako, University of Sciences, Technics and Technologies, BP: 1805, Bamako, Mali;Malaria Epidemiology Unit, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK;Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA;Division of Infectious Diseases & International Health Duke University Medical Center, Durham, NC, USA;Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA;Faculty of Health, University of Ouagadougou, Ouagadougou, Burkina Faso;Malaria Epidemiology Unit, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK;

关键词: Malaria;    Pregnancy;    Intermittent;    Sulphadoxine-pyrimethamine;    Resistance;    Mali;    Burkina-Faso;   

DOI  :  10.1186/1475-2875-13-41

 received in 2013-10-07, accepted in 2014-01-28,  发布年份 2014

来源: Springer

【 摘 要 】

BackgroundIntermittent Preventive Treatment in pregnancy (IPTp) with sulphadoxine-pyrimethamine (SP) is widely used for the control of malaria in pregnancy in Africa. The emergence of resistance to SP is a concern requiring monitoring the effectiveness of SP for IPTp.MethodsThis was an in-vivo efficacy study to determine the parasitological treatment response and the duration of post-treatment prophylaxis among asymptomatic pregnant women receiving SP as part of IPTp in Mali and Burkina-Faso. The primary outcome was the PCR-unadjusted % of patients with parasites recurrence by day 42 defined as a positive diagnostic test by malaria smear at any visit between days 4 and 42. Treatment failure was based on the standard World Health Organization criteria. The therapeutic response was estimated using the Kaplan-Meier curve.ResultsA total of 580 women were enrolled in Mali (N=268) and Burkina-Faso (N=312) and followed weekly for 42 days. Among these, 94.3% completed the follow-up. The PCR-unadjusted cumulative risk of recurrence by day 42 was 4.9% overall, and 3.2% and 6.5% in Mali and Burkina Faso respectively (Hazard Ratio [HR] =2.14, 95%, CI [0.93-4.90]; P=0.070), and higher among the primi– and secundigravida (6.4%) than multigravida (2.2%, HR=3.01 [1.04-8.69]; P=0.042). The PCR-adjusted failure risk was 1.1% overall (Mali 0.8%, Burkina-Faso 1.4%). The frequencies (95% CI) of the dhfr double and triple mutant and dhps 437 and 540 alleles mutant genotype at enrolment were 24.2% (23.7-25.0), 4.7% (4.4-5.0), and 21.4% (20.8-22.0) and 0.37% (0.29-0.44) in Mali, and 7.1% (6.5-7.7), 44.9% (43.8-46.0) and 75.3% (74.5-76.2) and 0% in Burkina-Faso, respectively. There were no dhfr 164L or dhps 581G mutations.ConclusionSP remains effective at clearing existing infections when provided as IPTp to asymptomatic pregnant women in Mali and Burkina. Continued monitoring of IPTp-SP effectiveness, including of the impact on birth parameters in this region is essential.

【 授权许可】

Unknown   
© Coulibaly et al.; licensee BioMed Central Ltd. 2014. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.