ANTIMALARIALS DURING PREGNANCY - A COST-EFFECTIVENESS ANALYSIS

Antenatal clinics (ANC) provide an avenue for interventions that promo te maternal and infant health. In areas hyperendemic for Plasmodium fa lciparum, malaria infection during pregnancy contributes to low birth weight (LBW), which is the greatest risk factor for neonatal mortality . Using current data and costs from studies in Malawi, a decision-anal ysis model was constructed to predict the number of LBW cases prevente d by three antimalarial regimens, in an area with a high prevalence of chloroquine (CQ)-resistant malaria. Factors considered included local costs of antimalarials, number of ANC visits, compliance with dispens ed antimalarials, prevalence of placental malaria, and LBW incidence. For a hypothetical cohort of 10 000 women in their first or second pre gnancy, a regimen consisting of one dose of sulfadoxine-pyrimethamine (SP) in the second trimester followed by a second dose at the beginnin g of the third trimester would prevent 205 cases of LBW at a cost of U S$9.66 per case of LBW prevented. A regimen using a treatment dose of SP followed by CQ 300 mg (base) weekly would prevent 59 cases of LBW a t a cost of $62 per case prevented, compared with only 30 cases of LBW prevented at a cost of $113 per case when the regimen involves initia l treatment with CQ (25 mg/kg) followed by CQ 300 mg (base) weekly. In areas hyperendemic for CQ-resistant P. falciparum, a two-dose SP regi men is a cost-effective intervention to reduce LBW incidence and it sh ould be included as part of the antenatal care package.