The effect of intermittent preventive therapy for malaria on pregnancy outcome at the umth maiduguri.

Abstract

The World Health Organisation (WHO) recommends the use of intermittent preventive therapy with sulphadoxine-pyramethamine (IPT-SP) for prevention of malaria in pregnancy and this is the priority of the Roll Back Malaria partnership. Objectives: To determine the effect of IPT-SP on pregnancy outcome in our environment. Methods: Four hundred pregnant women among a cohort recruited for a larger study evaluating the prevalence of malaria parasitaemia in pregnancy in UMTH Maiduguri from 24 July 2007 to 12 January 2008 were used for this study. All pregnancies and deliveries were supervised at the UMTH. They were followed from booking to delivery to observe the effect of IPT-SP on pregnancy outcome. Blood samples were collected at booking and delivery for malaria parasite and packed cell volume. Malaria parasite was also looked for in the cord blood and placenta. Socio-demographic characteristics and pregnancy outcome were also obtained. Results: The mean age and parity of the patients were 27.2+5.5 years and 2.3+2.1 respectively. Majority of the patients (80.0%) have had at least a dose of the IPT-SP. The prevalence of malaria parasitaemia at booking was 60.3% with a mean parasite density of 701.04 + 382.22parasites/µl. However, the prevalence at delivery fell to 28.8% (p<0.001) and the mean parasite density reduced to 405.187 + 310.43 parasites/µl (p<0.001). In spite of the similar mean parasite density at booking in the 3 groups, the mean parasite density at delivery was lowest in the patients that had 2 doses of IPT-SP and highest among those that did not take IPT-SP (P<0.001). The use of IPT-SP also significantly protects from maternal anemia at delivery, preterm delivery, low birth weight, placental malaria, and cord parasitaemia. Conclusion: There is a high prevalence of malaria parasitaemia with a high parasite density among pregnant women at booking, both of which decline remarkably at delivery most likely due to ITP-SP during antenatal care. It is recommended that the use of intermittent preventive treatment should be intensified.