Intermittent sulfadoxine-pyrimethamine in pregnancy: effectiveness againstmalaria morbidity in Blantyre, Malawi, in 1997-99

Plasmodium falciparum malaria in pregnancy predisposes to maternal and foet al morbidity. In 1993 Malawi adopted intermittent presumptive therapy with sulfadoxine-pyrimethamine (SP) as malaria prophylaxis for all pregnant wome n. To assess operational effectiveness of SP, we examined tin 1997-99) the relationship between number of doses of SP prescribed in antenatal clinic a nd indicators of malaria infection and morbidity at delivery, including per ipheral and placental parasitaemia, maternal and neonatal anaemia, and birt hweight. Among Malawian women delivering in a large urban hospital, SP pres cription was associated with a decrease in placental malaria prevalence (fr om 31(.)9% with no SP prescription to 22(.)8% with greater than or equal to 2 doses SP) and density, decreased prevalence of low birthweight (from 23% in women not receiving SP to 10(.)3% in women given greater than or equal t o2 doses), and higher maternal haemoglobin concentrations. These effects we re most marked in first and second pregnancies, in which malaria prevalence was highest. Maternal and cord blood malaria prevalence and mean cord bloo d haemoglobin concentrations did not differ with SP usage. Implementation o f the SP administration policy was incomplete: 24% of women were not prescr ibed any SP, and only 30% were prescribed at least 2 doses as recommended. Intermittent presumptive treatment with SP is having a positive impact on s ome, but not all indicators of malaria infection and morbidity in Malawi. I mproved implementation and continued surveillance are essential.