Influence of Malaria Transmission Intensity and the 581G Mutation on the Efficacy of Intermittent Preventive Treatment in Pregnancy: Systematic Review and Meta-analysis.


Chico, RM; Cano, J; Ariti, C; Collier, TJ; Chandramohan, D; Roper, C; Greenwood, B; (2015) Influence of Malaria Transmission Intensity and the 581G Mutation on the Efficacy of Intermittent Preventive Treatment in Pregnancy: Systematic Review and Meta-analysis. Tropical medicine & international health , 20 (12). pp. 1621-33. ISSN 1360-2276 DOI: 10.1111/tmi.12595

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Abstract

OBJECTIVES: To estimate where intermittent preventive treatment (IPTp) using sulphadoxine-pyrimethamine (SP) could be withdrawn as an intervention due to declining malaria transmission intensity, or due to increasing prevalence of the Plasmodium falciparum dihydropteroate synthetase resistance mutation at codon 581G.<br/> METHODS: We conducted a systematic review and meta-analysis of protection against the incidence of low birth weight (LBW) conferred by ≥2 doses of IPTp-SP. We matched these outcomes to a proxy measure of malaria incidence in women of the same studies, applied meta-regression models to these data and conducted sensitivity analysis of the 581G mutation.<br/> RESULTS: Variation in the protective effect of IPTp-SP against LBW could not be explained by malaria transmission intensity. Among primi- and secundigravidae, IPTp-SP protected against LBW where 581G was ≤10.1% [odds ratio (OR): 0.49; 95% confidence intervals (CI): 0.29, 0.81; P = <0.01] and 581G was >10.1% (OR = 0.73; 95% CI: 0.29, 1.81; P = 0.03). Random-effects models among multigravidae showed that IPTp-SP protects against LBW where 581G was ≤10.1% (OR = 0.56; 95% CI: 0.37, 0.86; P = 0.07), a finding of borderline statistical significance. No evidence of protection against LBW was observed where 581G was >10.1% (OR = 0.96; 95% CI: 0.70, 1.34; P = 0.47).<br/> CONCLUSION: There appears to be a prevalence of 581G above which IPTp-SP no longer protects against LBW. Pregnancy studies are urgently needed where 581G is >10.1% to define the specific prevalence threshold where new strategies should be deployed.<br/>

Item Type: Article
Faculty and Department: Faculty of Infectious and Tropical Diseases > Dept of Disease Control
Faculty of Infectious and Tropical Diseases > Dept of Pathogen Molecular Biology
Faculty of Epidemiology and Population Health > Dept of Medical Statistics
Research Centre: Centre for Maternal, Reproductive and Child Health (MARCH)
PubMed ID: 26325263
Web of Science ID: 367344800003
URI: http://researchonline.lshtm.ac.uk/id/eprint/2293139

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