DOES INTERMITTENT PREVENTIVE THERAPY FOR MALARIA IN PREGNANCY ERADICATE PERIPHERAL AND PLACENTAL PARASITEMIA IN MALARIA ENDEMIC ENVIROMENT: A CASE STUDY IN A TERTIARY HOSPITAL IN ABUJA
BACKGROUND: Malaria infection during pregnancy is associated with adverse outcomes in sub-Saharan Africa. For this reason, the World Health Organization currently recommends intermittent preventive treatment of malaria in pregnancy (IPTp) with sulphadoxine-pyrimethamine (SP). This is the current standard of care for pregnant women in National Hospital Abuja
AIM: To assess whether intermittent preventive therapy eradicates peripheral and placental malaria and improves pregnancy outcome in malaria endemic area.
MATERIALS AND METHODS: The study was a cross-sectional study of 426 pregnant women who registered, attended antenatal care and delivered in the National Hospital during the period of study. The parturient women who met the inclusion criteria were enrolled consecutively as they presented in the labour ward. The presence of malaria parasite in the maternal blood and placental tissue were determined using standard microscopic method. The fetal outcome was also determined.
RESULT: The prevalence of peripheral malaria parasitaemia and placental parasitisation in booked parturient that took IPTp are 12.9%, 95% CI (10.0% - 16.6%) and 9.4%, 95% CI (7.0% -12.7%) respectively. There was statistically significant difference in peripheral parasitaemia compared with placental parasitisation, p<0.0001. The peripheral parasitaemia and placental parasitisation decrease as the number of IPTp doses increase.This difference did not reach statistical significant level (p>0.05). There was a negative correlation though weak between peripheral parasitaemia and number of Intermittent Preventive Therapy (IPTp) and; between placenta parasitisation and number of Intermittent Preventive Therapy (r=-0.089 and r=-0.056) respectively. There was statistical significant
difference in the birth weight of parturient without malaria infestation (both peripheral parasitaemia and placental parasitisation) when compare with those with malaria infestation (p<0.0001 & p-0.024). Birth weight was negatively correlated with peripheral parasitaemia and placenta parasitisation r=- 0.224 and -0.110, respectively.
Conclusion: this study showed that IPTp reduces but does not eliminate the prevalence of both peripheral parasitaemia and placental parasitisation in malaria endemic environment. Also there is a dose dependent relationship between the dose of IPTp and the level of peripheral parasitaemia and placental parasitisation as well as parasite density. Intermittent preventive therapy for malaria in pregnancy is associated with significant reduction in low birth weight.