The Effect of Monthly Sulfadoxine-Pyrimethamine, Alone or with Azithromycin, on PCR-Diagnosed Malaria at Delivery: A Randomized Controlled Trial

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dc.contributor.author Luntamo, Mari
dc.contributor.author Rantala, Anne-Maria
dc.contributor.author Meshnick, Steven R
dc.contributor.author Yin Bun, Cheung
dc.contributor.author Kulmala, Teija
dc.contributor.author Maleta, Kenneth
dc.contributor.author Ashorn, Per
dc.date.accessioned 2012-09-04T08:55:42Z
dc.date.available 2012-09-04T08:55:42Z
dc.date.issued 2012
dc.identifier.issn 1932-6203 -
dc.identifier.uri http://tampub.uta.fi/handle/10024/66327
dc.description Public Library of Science open access -
dc.description.abstract Background New regimens for intermittent preventive treatment in pregnancy (IPTp) against malaria are needed as the effectiveness of the standard two-dose sulfadoxine-pyrimethamine (SP) regimen is under threat. Previous trials have shown that IPTp with monthly SP benefits HIV-positive primi- and secundigravidae, but there is no conclusive evidence of the possible benefits of this regimen to HIV-negative women, or to a population comprising of both HIV-positive and –negative women of different gravidities. Methods This study analyzed 484 samples collected at delivery as part of a randomized, partially placebo controlled clinical trial, conducted in rural Malawi between 2003 and 2007. The study included pregnant women regardless of their gravidity or HIV-infection status. The participants received SP twice (controls), monthly SP, or monthly SP and two doses of azithromycin (AZI-SP). The main outcome was the prevalence of peripheral Plasmodium falciparum malaria at delivery diagnosed with a real-time polymerase chain reaction (PCR) assay. Findings Overall prevalence of PCR-diagnosed peripheral P. falciparum malaria at delivery was 10.5%. Compared with the controls, participants in the monthly SP group had a risk ratio (95% CI) of 0.33 (0.17 to 0.64, P<0.001) and those in the AZI-SP group 0.23 (0.11 to 0.48, P<0.001) for malaria at delivery. When only HIV-negative participants were analyzed, the corresponding figures were 0.26 (0.12 to 0.57, P<0.001) for women in the monthly SP group, and 0.24 (0.11 to 0.53, P<0.001) for those in the AZI-SP group. Conclusions Our results suggest that increasing the frequency of SP administration during pregnancy improves the efficacy against malaria at delivery among HIV-negative women, as well as a population consisting of both HIV-positive and –negative pregnant women of all gravidities, in a setting of relatively low but holoendemic malaria transmission, frequent use of bed nets and high SP resistance. -
dc.language.iso en -
dc.title The Effect of Monthly Sulfadoxine-Pyrimethamine, Alone or with Azithromycin, on PCR-Diagnosed Malaria at Delivery: A Randomized Controlled Trial -
dc.type fi=Artikkeli aikakauslehdessä | en=Journal Article|
dc.identifier.urn URN:NBN:fi:uta-201209041030 -
dc.identifier.doi doi:10.1371/journal.pone.0041123 -
dc.type.version fi=Kustantajan versio | en=Publisher's version| -
dc.subject.okm fi=Oikeuslääketiede ja muut lääketieteet | en=Forensic science and other medical sciences| -
dc.administrativeunit fi=Lääketieteen yksikkö | en=School of Medicine| -
dc.journal.title Plos ONE -
dc.journal.volume 7 -
dc.journal.number 7 -
dc.journal.volumepagerange 1-8 -
dc.journal.url http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0041123 -

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