EVALUATION OF MATERNAL PRACTICES, EFFICACY, AND COST-EFFECTIVENESS OFALTERNATIVE ANTIMALARIAL REGIMENS FOR USE IN PREGNANCY - CHLOROQUINE AND SULFADOXINE-PYRIMETHAMINE

With the knowledge that an efficacious antimalarial administered to pr egnant women would markedly reduce placental malaria and its associate d risk of low birth weight (LBW), investigations were conducted to ide ntify an antimalarial regimen practical for nationwide implementation through the antenatal clinic (ANC) system. Maternal practices, includi ng ANC utilization and malaria treatment and prevention during pregnan cy were evaluated as part of a national malaria knowledge, attitudes, and practices survey. A second study was conducted to evaluate the efi icacy and cost of selected alternative antimalarial regimens. Women in their first or second pregnancy were placed on chloroquine (CQ) treat ment (25 mg/kg) followed by weekly CQ (300 mg) (CQ/CQ); sulfadoxine-py rimethamine (SP) treatment followed by CQ (300 mg weekly) (SP/CQ); or SP treatment during the second trimester and repeated at the beginning of the third trimester (SP/SP). With 87% of women attending ANC two o r more times during pregnancy, most pregnant women in Malawi could be reached with an antimalarial intervention. Among 159 women in their fi rst or second pregnancy receiving CQ/CQ, SP/CQ, and SP/SP, placental m alaria parasitemia rates were 32%, 26%, and 9%, respectively (P = 0.00 6, by chi-square test). The SP/SP regimen was also markedly more cost- effective in preventing infant deaths, costing $75 per infant death pr evented, compared with $481 for SP/CQ and $542 for CQ/CQ. These invest igations suggest that a regimen consisting of two treatment doses of S P during pregnancy is an efficacious and cost-effective intervention t o prevent placental malaria, and LBW-associated mortality, that can be delivered to pregnant women through ANCs in settings similar to those found in rural Malawi.