MEFLOQUINE VERSUS SULPHADOXINE-PYRIMETHAMINE AS INTERMITTENT PREVENTIVE TREATMENT FOR MALARIA IN HIV POSITIVE PREGNANT WOMEN IN IBADAN: A RANDOMIZED CONTROLLED TRIAL
In resource- limited settings such as sub-Saharan Africa, Malaria and HIV are among the principal causes of morbidity and mortality. These diseases still remain serious health challengesin spite of the international community’s efforts to reduce the incidence and prevalence in tropical and sub-tropical regions of the world.
More than 4 million deaths per year are caused by either Malaria or HIV infection or a combination of the two. Malaria infestation during pregnancy has been strongly linked with increased risk of mother to child transmission of HIV hence the need for effective and safe preventive therapy for malaria in pregnancy for HIV positive pregnant patients.
To compare effectiveness of mefloquine with sulphadoxine-pyrimethamine for intermittent preventive therapy for malaria in HIV positive pregnant women with a view to decrease malaria case morbidity and mortality rate and further reduce the risk of vertical transmission of HIV.
One hundred and forty-two HIV positive pregnant patients on highly active antiretroviral therapy (HAART) attending antenatal and PMTCT clinics at UCH Ibadan and Adeoyo Maternity Hospital Ibadan, at gestational age sixteen (16) to twenty eight weeks (28) were recruited for the study after adequate counselling had been done and consent taken.
Thick and thin blood films for malaria parasite were taken at the time of recruitment. The selected drug was administered at recruitment. At delivery blood samples were taken from the
mother for malaria parasite and packed cell volume. Placental blood sample was also taken forblood film for malaria parasite test. The baby’s Apgar score and anthropometric measurementswere noted. Those found to have malaria parasites were referred for treatment.
Categorical variables were analysed using Chi-square test (Fisher’s exact test was used as appropriate) and continuous variables were analysed using the Student’s t-test. Level of statistical significance was set at P < 0.05.
One hundred and forty-two (142) participants were recruited into the study. Seventy-one participants were allocated to each study group. One hundred and twenty-four (87%) of the participants completed the study; eighteen (12%) were lost to follow up. Sixty (84%) of the participants in the mefloquine group and sixty-four (90%) of the participants in the sulphadoxine-pyrimethamine group respectively completed the study. Of the eighteen lost to follow up eleven were in the mefloquine group while seven were in the sulphadoxine- pyrimethamine group.
The socio-demographic characteristics of both groups were comparable. A total number of ten (8.1%) participants consisting of 5 (9.4%) in the mefloquine group and 5 (7.5%) in the sulphadoxine-pyrimethamine group had positive blood film for malaria parasites result at recruitment. This number increased to 13 (10.5%) at delivery, with 4 in the mefloquine group and 9 in the sulphadoxine-pyrimethamine group but there was no significant difference found (P- value=0.47, RR=0.69, 95%CI= 0.3-1.8). four (4) participants had positive placental blood film for malaria parasite with 1(1.7%) in the mefloquine group and 3(4.8%) in the sulphadoxine- pyrimethamine group.
This study demonstrated that prophylactic use of mefloquine for intermittent preventive therapy for malaria in pregnant HIV positive women is as effective as use of sulphadoxine- pyrimethamine and appears to be a feasible alternative.