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A community effectiveness trial of strategies promoting intermittent preventive treatment with sulphadoxine-pyrimethamine in pregnant women in rural Burkina Faso

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dc.contributor.author Gies, S.
dc.contributor.author Coulibaly, S. O.
dc.contributor.author Tiemegna Ouattara, F.
dc.contributor.author Ky, C.
dc.contributor.author Brabin, B. J.
dc.contributor.author D'Alessandro, U.
dc.date.accessioned 2008-10-28T13:03:21Z
dc.date.available 2008-10-28T13:03:21Z
dc.date.issued 2008
dc.identifier.issn 1475-2875
dc.identifier.doi http://dx.doi.org/10.1186/1475-2875-7-180
dc.identifier.other ITG-P1B
dc.identifier.other ITG-PLA
dc.identifier.other PARAS
dc.identifier.other U-MALAR
dc.identifier.other JIF
dc.identifier.other ELECTRONIC
dc.identifier.other DOI
dc.identifier.other URL
dc.identifier.other ABSTRACT
dc.identifier.other UPD7
dc.identifier.other FTA
dc.identifier.uri http://hdl.handle.net/10390/2401
dc.description.abstract Background: Intermittent preventive treatment with sulphadoxine-pyrimethamine for pregnant women (IPTp-SP) is currently being scaled up in many countries in sub-Saharan Africa. Despite high antenatal clinic (ANC) attendance, coverage with the required two doses of SP remains low. The study investigated whether a targeted community-based promotion campaign to increase ANC attendance and SP uptake could effectively improve pregnancy outcomes in the community. Methods: Between 2004 and 2006 twelve health centres in Boromo Health District, Burkina Faso were involved in this study. Four were strategically assigned to community promotion in addition to IPTp-SP (Intervention A) and eight were randomly allocated to either IPTp-SP (Intervention B) or weekly chloroquine (Control). Primi- and secundigravidae were enrolled at village level and thick films and packed cell volume (PCV) taken at 32 weeks gestation and at delivery. Placental smears were prepared and newborns weighed. Primary outcomes were peripheral parasitaemia during pregnancy and at delivery, placental malaria, maternal anaemia, mean and low birth weight. Secondary outcomes were the proportion of women with ≥ 3 ANC visits and ≥ 2 doses of SP. Intervention groups were compared using logistic and linear regression with linearized variance estimations to correct for the cluster-randomized design. Results: SP uptake (≥ 2 doses) was higher with (Intervention A: 70%) than without promotion (Intervention B: 49%) (OR 2.45 95%CI 1.25–4.82 p = 0.014). Peripheral (33.3%) and placental (30.3%) parasite rates were significantly higher in the control arm compared to Intervention B (peripheral: 20.1% OR 0.50 95%CI 0.37–0.69 p = 0.001; placental: 20.5% OR 0.59 95%CI 0.44–0.78 p = 0.002) but did not differ between Intervention A (17.4%; 18.1%) and Intervention B (20.1; 20.5%) (peripheral: OR 0.84 95%CI 0.60–1.18 p = 0.280; placental: OR 0.86 95%CI 0.58–1.29 p =0.430). Mean PCV and birth weight and prevalence of anaemia and low birth weight did not differ between study arms. Conclusion: The promotional campaign resulted in a major increase in IPTp-coverage, with two thirds of women at delivery having received ≥ 2 SP. Despite lower prevalence of malaria infection this did not translate into a significant difference in maternal anaemia or birth weight. This data provides evidence that, as with immunization programmes, extremely high coverage is essential for effectiveness. This critical threshold of coverage needs to be defined, possibly on a regional basis. en_US
dc.language English en_US
dc.publisher BioMed Central en_US
dc.subject Protozoal diseases en_US
dc.subject Malaria en_US
dc.subject Pregnancy en_US
dc.subject Chemoprophylaxis en_US
dc.subject Intermittent treatment en_US
dc.subject Sulfadoxine-pyrimethamine en_US
dc.subject Targeted approach en_US
dc.subject Community-based en_US
dc.subject Effectiveness en_US
dc.subject Burkina Faso en_US
dc.subject Africa, West en_US
dc.title A community effectiveness trial of strategies promoting intermittent preventive treatment with sulphadoxine-pyrimethamine in pregnant women in rural Burkina Faso en_US
dc.type Article-E en_US
dc.citation.issue 180 en_US
dc.citation.jtitle Malaria Journal en_US
dc.citation.volume 7 en_US
dc.citation.pages 14 en_US
dc.publisher.place London en_US
dc.identifier.pmid http://www.ncbi.nlm.nih.gov/pubmed/18801158
dc.identifier.url http://www.malariajournal.com/content/7/1/180
dc.citation.jabbreviation Malar J en_US


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