Decrease of microscopic Plasmodium falciparum infection prevalence during pregnancy following IPTp-SP implementation in urban cities of Gabon

• Published in: Transactions of the Royal Society of Tropical Medicine and Hygiene Vol. 110; no. 6; pp. 333 - 342
• Main Authors: Bouyou-Akotet, M.K., Mawili-Mboumba, D.P., Kendjo, E., Moutandou Chiesa, S., Tshibola Mbuyi, M.L., Tsoumbou-Bakana, G., Zong, J., Ambounda, N., Kombila, M.
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01.06.2016
• Subjects: Adult; Anemia - complications; Anemia - epidemiology; Antimalarials - administration & dosage; Antimalarials - therapeutic use; Birth Weight; Cities; Cross-Sectional Studies; Drug Combinations; Female; Gabon; Gravidity; Humans; Infant, Low Birth Weight; Infant, Newborn; Infant, Premature; Malaria, Falciparum - epidemiology; Malaria, Falciparum - parasitology; Malaria, Falciparum - prevention & control; Parasitemia - epidemiology; Parasitemia - parasitology; Parasitemia - prevention & control; Placenta; Plasmodium falciparum; Pregnancy; Pregnancy Complications, Parasitic - epidemiology; Pregnancy Complications, Parasitic - parasitology; Pregnancy Complications, Parasitic - prevention & control; Pregnancy Outcome; Prevalence; Pyrimethamine - administration & dosage; Pyrimethamine - therapeutic use; Sulfadoxine - administration & dosage; Sulfadoxine - therapeutic use; Urban Population; Young Adult; Gabon; Sulfadoxine-pyrimethamine; Intermittent preventive treatment in pregnancy; Pregnancy outcomes; Plasmodium falciparum
• ISSN: 0035-9203; 1878-3503
• DOI: 10.1093/trstmh/trw034

Background Six years after the implementation of intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) in Gabon, its impact on placental malaria and pregnancy outcomes remains unknown. Methods Age, gestational data, use of IPTp-SP and birth weight were recorded during a hospital-based cross-sectional survey performed in 2011 in 387 women at the end of pregnancy. Results Malaria prevalence was 6.7 and 5.3% in peripheral and placental blood respectively. Overall, 59.0% women took at least two IPTp-SP doses which was associated with 50% reduction of Plasmodium; (P.) falciparum infection in primigravidae. Previous malaria treatment was a risk factor for peripheral P. falciparum infection, while uptake of IPTp-SP was associated with reduced parasitaemia. Anaemia prevalence was 38.0%, low birth weight and prematurity rates were 6.0 and 12.0% respectively. Young age was associated with a higher frequency of malaria, anaemia, low birth weight and preterm delivery (p<0.01). Birth weight significantly rose with increasing age (p<0.01), parity (p=0.03) and number of SP doses (p=0.03). A birth weight reduction of 230 g in case of peripheral parasitaemia (p=0.02) and of 210 g with placental parasitaemia (p=0.13) was observed. Conclusions Microscopic P. falciparum prevalence during pregnancy significantly declined between 2005 and 2011, following IPTp-SP implementation in Gabon. Young women and paucigravidae remain the most susceptible to malaria and associated outcomes.