Assessment of Sulphadoxine-pyrimethamine for Intermittent Preventive Treatment of Malaria in Pregnancy in Malawi

NCT ID: NCT01120145

Last Updated: 2013-02-06

Basic Information

• Recruitment Status: COMPLETED
• Total Enrollment: 1410 participants
• Study Classification: OBSERVATIONAL
• Study Start Date: 2010-03-31
• Study Completion Date: 2011-01-31

Brief Summary

The purpose of this study is to determine the efficacy and effectiveness of sulphadoxine-pyrimethamine intermittent preventive treatment in pregnancy for reducing malaria-associated morbidity in pregnant women in Malawi.

Detailed Description

Malaria infection in pregnancy is associated with severe maternal anemia, placental parasitemia, low birth weight, and increased perinatal mortality. Intermittent preventive treatment in pregnancy (IPTp) with sulphadoxine-pyrimethamine (SP) is recommended by the World Health Organization (WHO) for reducing the risks associated with malaria in pregnancy. Traditionally, the level of SP resistance has been assessed by monitoring its in vivo efficacy for treatment of uncomplicated malaria in children under five years of age. However, parasite resistance to SP has compromised its efficacy in young children, and SP is no the longer a first-line recommended treatment for malaria in most African countries. Although SP currently appears to remain effective for IPTp in pregnant women probably because they have more immunity than young children, it is important to monitor SP effectiveness in this population. Characterizing SP resistance through in vivo and molecular methods in pregnant women may be useful to predict whether to continue a policy of IPTp with SP.

There will be three parts to this study. To determine therapeutic efficacy of SP IPTp in pregnant women, a prospective in vivo study will be done in women who present for antenatal care (ANC). Women will receive SP IPTp according to national guidelines and will be followed for 42 days for clearance of peripheral parasitemia. To determine birth outcomes of women given SP IPTp, a retrospective cohort study will be performed assessing outcomes of women at delivery. Information on prior receipt of SP IPTp, peripheral and placental parasitemia at delivery, placental histology, maternal anemia, and birth weight will be collected. To characterize baseline resistance of SP in pregnant women and in the general population, parasites will be collected from both participating women and attendees at outpatient clinics to measure SP resistance markers.

The results of this study will be used by the Malawi national control program to evaluate current policy of using SP for IPTp. This study will also contribute towards an international effort led by WHO to align priorities and methodologies in gathering data on the efficacy of SP in IPTp in the face of increasing SP resistance, thus providing data to inform IPTp policy at the global level.

Conditions

Malaria in Pregnancy

Study Design

• Observational Model Type: COHORT

Study Groups

Therapeutic efficacy study

Asymptomatic parasitemic pregnant women at 16-26 weeks of gestation will be enrolled into the study and followed weekly for 42 days after the receipt of sulphadoxine-pyrimethamine intermittent preventive treatment in pregnancy to assess the clearance of parasitemia.

No interventions assigned to this group

Birth outcomes study

Women presenting for delivery will be enrolled and assessed for a history of sulphadoxine-pyrimethamine intermittent preventive treatment in pregnancy and evidence of malaria infection by placental histology, maternal peripheral parasitemia, maternal anemia and infant cord blood parasitemia.

No interventions assigned to this group

Characterizing molecular markers of SP resistance

Parasitemic outpatients attending the health facility will be tested for parasite molecular markers of sulphadoxine-pyrimethamine resistance.

No interventions assigned to this group

Eligibility Criteria

Inclusion Criteria

• 16-26 weeks gestation based on last menstrual period (LMP) or quickening
• Axillary temperature <37.5 degrees Celsius
• Informed consent

• Singleton pregnancy
• SP IPTp history available
• Informed consent

• Outpatient attending selected health facility
• Informed consent

Exclusion Criteria

• History of hypersensitivity reaction to SP or components of SP
• Axillary temperature ≥37.5 degrees C
• History of receipt of antimalarials in the past month
• Known HIV infection

Birth outcomes study:

• Blood transfusion after the 16th gestational week
• Receipt of antimalarials other than SP for IPTp after 16th gestational week
• Known HIV infection

Characterizing molecular markers of SP resistance:

• None

• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Kamuzu University of Health Sciences

OTHER

Sponsor Role: collaborator

Centers for Disease Control and Prevention

FED

Sponsor Role: lead

Responsible Party

Malaria Branch, Centers for Disease Control and Prevention

Principal Investigators

Jacek Skarbinski, MD

Role: PRINCIPAL_INVESTIGATOR

Malaria Branch, Centers for Disease Control and Prevention

Don Mathanga, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Kamuzu University of Health Sciences

Locations

Machinga District Hospital

Liwonde, Machinga District, Malawi

Countries

Malawi

References

Gutman J, Mwandama D, Wiegand RE, Abdallah J, Iriemenam NC, Shi YP, Mathanga DP, Skarbinski J. In vivo efficacy of sulphadoxine-pyrimethamine for the treatment of asymptomatic parasitaemia in pregnant women in Machinga District, Malawi. Malar J. 2015 May 13;14:197. doi: 10.1186/s12936-015-0710-7.

Reference Type: DERIVED

PMID: 25962439 (View on PubMed)

Other Identifiers

CDC-CGH-5756

Identifier Type: -

Identifier Source: org_study_id