IST versus IPTp with SP in West Africa

Principal Investigator:              Prof. Brian Greenwood (UK)

Co-Principal investigator:       Prof. Daniel Chandramohan (UK)

Trial Coordinator:                     Dr. Harry Tagbor (Ghana)

Project Collaborators: 
Dr. Pascal Magnussen (Denmark), Dr. Sheick Coulibaly, Dr Edgar Dabira (Burkina Faso), Dr. Kalifa Bojang,  Dr. Khalifa Mohammed & Fanta Njie (The Gambia), Dr. Abraham Hodgson, Dr John Williams (Ghana), Dr. Kassoum Kayentao (Mali)


Objective:

The goal of this project was to determine whether screening and treatment for malaria at each scheduled antenatal clinic visit of pregnant women sleeping under a long lasting insecticide treated bed net is as effective in protecting them from anaemia, low birth weight and placental infection as Intermittent Preventive Treatment with sulphadoxine-pyrimethamine (SP-IPTp). It was carried out across four sites: Burkina Faso (Ziniare), Ghana (Navrongo), Mali (San & Kita) and The Gambia (Basse).

With the decline in incidence of malaria in pregnant women in general across Africa and the problem of growing resistance to SP there is a need to re-examine the efficacy and cost effectiveness of giving multiple intermittent preventive treatments with SP during pregnancy. This applies especially to areas with highly seasonal malaria transmission where women are at risk of malaria for only a short period during the year.

Results

In areas of low SP resistance intermittent screening and treatment (ISTp) is not inferior to SP-IPTp in prevention of low birth weight and maternal anaemia and was tolerated better, but more women experienced clinical malaria in the ISTp that in the IPTp group. ISTp was also costlier.  The results formed an important part of the evidence reviewed by WHO’s Evidence Review Group in 2015. The group concluded that there was no clearly defined role for ISTp at present, even in areas of SP resistance.

 

Publications

Awine, T., Williams, J. E., Belko, M. M., Oduro, A. R., Oyakhirome, S., Tagbor, H., Chandramohan, D., Milligan, P., Cairns, M. and Greenwood, B.  The risk of malaria in Ghanaian infants born to women managed in pregnancy with intermittent screening and treatment for malaria or intermittent preventive treatment with sulphadoxine/pyrimethamine. Malar J. 2016 Jan 28;15:46. doi: 10.1186/s12936-016-1094-z.

Williams, J, Njie, F, Cairns, M, Bojang, K, Coulibaly, S.O, Kayentao, K, Abubakar, I, Akor, F, Mohammed, K, Bationo, R, Dabira, E, Soulama, A, Djimdé, M, Guirou, E, Awine, T, Quaye, S. L, Ordi, J, Doumbo, O, Hodgson, A, Oduro, A, Magnussen, P, ter Kuile, F. O, Woukeu, A, Milligan, P, Tagbor, H, Greenwood, B and Chandramohan, D. Non-falciparum malaria infections in pregnant women in West Africa. Malar J. 2016 Jan 29;15:53. doi: 10.1186/s12936-016-1092-1.

Williams, J. E, Cairns, M, Njie, F, Quaye, S. L, Awine, T, Oduro, A, Tagbor, H, Bojang, K, Magnussen, P, ter Kuile, F. O, Woukeu, A, Milligan, P, Chandramohan, D and Greenwood, B.  The performance of a rapid diagnostic test in detecting malaria infection in pregnant women and the impact of missed infections. Clin Infect Dis. 2016 Apr 1;62(7):837-844. doi: 10.1093/cid/civ1198. Epub 2015 Dec 31.

Tagbor, H, Cairns, M, Bojang, K, Coulibaly, S. O, Kayentao, K, Williams, J, Abubakar, I, Akor, F, Mohammed, K, Bationo, K, Dabira, K, Soulama, A,  Djimdé, M, Guirou, E, Awine, T, Quaye, S, Njie, F, Ordi, J, Doumbo, O, Hodgson, A, Oduro, A, Meshnick, S, Taylor, S, Magnussen, P, ter Kuile, F, Woukeu, A, Milligan, P, Chandramohan, D, Greenwood, B A  Non-Inferiority, Individually Randomized Trial of Intermittent Screening and Treatment versus Intermittent Preventive Treatment in the Control of Malaria in Pregnancy.  PLoS One. 2015 Aug 10;10(8):e0132247. doi: 10.1371/journal.pone.0132247. eCollection 2015. 

Taylor, S. M, Parobek, C. M, DeConti, D. K, Kayentao, K, Coulibaly, S. O, Greenwood, B. M, Tagbor, H, Williams, J, Bojang, K, Njie, F, Desai, M, Kariuki, S, Gutman, J, Mathanga, D. P, Martensson, A, Ngasala, B , Conrad, M. D, Rosenthal, P. J, Tshefu, A. K, Moormann, A. M, Vulule, J. M, Doumbo, O. K, Ter Kuile, F. O, Meshnick, S. R, Bailey, J. A, Juliano, J. J.  Absence of Putative Artemisinin Resistance Mutations Among Plasmodium falciparum in Sub-Saharan Africa: A Molecular Epidemiologic Study. J Infect Dis. 2015 Mar 1;211(5):680-8. doi: 10.1093/infdis/jiu467. Epub 2014 Sep 1.