- - - MALARIA PREVENTION WITH IPTp DURING PREGNANCY REDUCES NEONATAL MORTALITY

Wednesday, 17th of April 2013

MALARIA PREVENTION WITH IPTp DURING PREGNANCY REDUCES NEONATAL MORTALITY

Abstract below; full text, with figures, is at http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0009438

Background

In the global context of a reduction of under-five mortality, neonatal mortality is an increasingly relevant component of this mortality. Malaria in pregnancy may affect neonatal survival, though no strong evidence exists to support this association.

Methods

In the context of a randomised, placebo-controlled trial of intermittent preventive treatment (IPTp) with sulphadoxine-pyrimethamine (SP) in 1030 Mozambican pregnant women, 997 newborns were followed up until 12 months of age. There were 500 live borns to women who received placebo and 497 to those who received SP.

Findings

There were 58 infant deaths; 60.4% occurred in children born to women who received placebo and 39.6% to women who received IPTp (p = 0.136). There were 25 neonatal deaths; 72% occurred in the placebo group and 28% in the IPTp group (p = 0.041). Of the 20 deaths that occurred in the first week of life, 75% were babies born to women in the placebo group and 25% to those in the IPTp group (p = 0.039). IPTp reduced neonatal mortality by 61.3% (95% CI 7.4%, 83.8%); p = 0.024].

Conclusions

Malaria prevention with SP in pregnancy can reduce neonatal mortality. Mechanisms associated with increased malaria infection at the end of pregnancy may explain the excess mortality in the malaria less protected group. Alternatively, SP may have reduced the risk of neonatal infections. These findings are of relevance to promote the implementation of IPTp with SP, and provide insights into the understanding of the pathophysiological mechanisms through which maternal malaria affects fetal and neonatal health.

Trial Registration

ClinicalTrials.gov NCT00209781

Citation: Menéndez C, Bardají A, Sigauque B, Sanz S, Aponte JJ, et al. (2010) Malaria Prevention with IPTp during Pregnancy Reduces Neonatal Mortality. PLoS ONE 5(2): e9438. doi:10.1371/journal.pone.0009438

Editor: Nicholas J. White, Mahidol University, Thailand

Received: September 7, 2009; Accepted: January 28, 2010; Published: February 26, 2010

Copyright: © 2010 Menéndez et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Funding: The study received financial support from the Banco de Bilbao, Vizcaya, Argentaria Foundation (grant number BBVA 02-0). The Centro de Investigacao em Saude de Manhiça(CISM), receives major core funding from the Spanish Agency for International Cooperation (AECI). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.