Ce. Shulman et al., Intermittent sulphadoxine-pyrimethamine to prevent severe anaemia secondary to malaria in pregnancy: a randomised placebo-controlled trial, LANCET, 353(9153), 1999, pp. 632-636
Citations number
33
Categorie Soggetti
General & Internal Medicine","Medical Research General Topics
Background In areas of endemic transmission, malaria in pregnancy is associ
ated with severe maternal anaemia and low-birthweight babies, We studied th
e efficacy of intermittent treatment doses of sulphadoxine-pyrimethamine In
preventing malaria and severe anaemia in pregnancy in a double-blind place
bo-controlled trial among primigravid women living in Kilifi District, Keny
a.
Methods Between January, 1996, and April, 1997, 1264 primigravid women were
recruited when they attended: for antenatal care, and randomly assigned su
lphadoxine-pyrimethamine (640) or placebo (624). Women received one, two, o
r three doses of study medication depending an the duration of gestation at
enrolment. Primary outcome measures were severe anaemia (haemoglobin <8 g/
dL) and malaria parasitaemia, assessed at 34 weeks of gestation. Analyses w
ere based on intention to treat among women who had study blood tests at 34
weeks,
Findings 30 (5.3%) of 567 women in the sulphadoxine- pyrimethamine group an
d 199 (35.3%) of 564 in the placebo group had peripheral parasitaemia (prot
ecive efficacy 85% [95% CI 78-90], p < 0.0001). 82 (14.5%) and 134 (23.7%)
had severe anaemia (protective efficacy 39% [22-52], p<0.0001). Even women
who booked late and received only one dose of sulphadoxine-pyrimethamine be
nefited significantly from the intervention. The effects were, seen both in
women who owned insecticide-treated bednets and in women who did not.
Interpretation intermittent presumptive treatment with sulphadoxine-pyrimet
hamine is an effective, practicable strategy to decrease the risk of severe
anaemia in primigravidae living in malarious areas.