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Opoku KB, Tompkins K, Waltmann A, Ciccone EJ, Bartlelt L, Andermann T, Chinkhumba J, Mathanga DP, Gutman JR, Juliano JJ. Impact of Sulfadoxine-Pyrimethamine and Dihydroartemisinin-Piperaquine as Intermittent Preventive Treatment in Pregnancy on Stool Antimicrobial Resistance Gene Abundance. Am J Trop Med Hyg 2024; 111:43-47. [PMID: 38806022 PMCID: PMC11229632 DOI: 10.4269/ajtmh.23-0824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 03/11/2024] [Indexed: 05/30/2024] Open
Abstract
Increasing antimicrobial resistance (AMR) is a global public health emergency. Although chemoprevention has improved malaria-related pregnancy outcomes, the downstream effects on AMR have not been characterized. We compared the abundance of 10 AMR genes in stool samples from pregnant women receiving sulfadoxine-pyrimethamine (SP) as intermittent preventive treatment against malaria in pregnancy (IPTp) to that in samples from women receiving dihydroartemisinin-piperaquine (DP) for IPTp. All participants had at least one AMR gene at baseline. Mean quantities of the antifolate gene dfrA17 were increased after two or more doses of SP (mean difference = 1.6, 95% CI: 0.4-2.7, P = 0.008). Antimicrobial resistance gene abundance tended to increase from baseline in SP recipients compared with a downward trend in the DP group. Overall, IPTp-SP had minimal effects on the abundance of antifolate resistance genes (except for dfrA17), potentially owing to a high starting prevalence. However, the trend toward increasing AMR in SP recipients warrants further studies.
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Affiliation(s)
- Kofi B. Opoku
- Applied Epidemiology Program, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Kathleen Tompkins
- Division of Infectious Diseases, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Andreea Waltmann
- Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina
- Division of Infectious Diseases, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Emily J. Ciccone
- Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina
- Division of Infectious Diseases, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Luther Bartlelt
- Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina
- Division of Infectious Diseases, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Tessa Andermann
- Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina
- Division of Infectious Diseases, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | | | - Don P. Mathanga
- Malaria Alert Center, Malawi College of Medicine, Blantyre, Malawi
| | - Julie R. Gutman
- Division of Parasitic Diseases and Malaria, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jonathan J. Juliano
- Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina
- Division of Infectious Diseases, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
- Curriculum in Genetics and Molecular Biology, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
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Tong Y, Ratnasiri K, Hanif S, Nguyen AT, Roh ME, Dorsey G, Kakuru A, Jagannathan P, Benjamin-Chung J. Pathways through which intermittent preventive treatment for malaria in pregnancy influences child growth faltering: a mediation analysis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.06.09.24308656. [PMID: 38947035 PMCID: PMC11213035 DOI: 10.1101/2024.06.09.24308656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
Background Intermittent preventive treatment for malaria in pregnancy (IPTp) can improve birth outcomes, but whether it confers benefits to postnatal growth is unclear. We investigated the effect of IPTp on infant growth in Uganda and its pathways of effects using causal mediation analyses. Methods We analyzed data from 633 infants born to mothers enrolled in a randomized trial of monthly IPTp with dihydroartemisinin-piperaquine (DP) vs sulfadoxine-pyrimethamine (SP) (NCT02793622). Weight and length were measured from 0-12 months of age. Using generalized linear models, we estimated effects of DP vs. SP on gravidity-stratified mean length-for-age (LAZ) and weight-for-length Z-scores (WLZ). We investigated mediation by placental malaria, gestational weight change, maternal anemia, maternal inflammation-related proteins, preterm birth, birth length, and birth weight. Mediation models adjusted for infant sex, gravidity, gestational age at enrollment, maternal age, maternal parasitemia at enrollment, education, and wealth. Findings SP increased LAZ by 0.18-0.28 Z from birth through age 4 months compared to DP, while DP increased WLZ by 0.11-0.28 Z from 2-8 months compared to SP among infants of multigravidae. We did not observe these differences among primigravida. Mediators of SP included increased birth weight and length and maternal stem cell factor at delivery. Mediators of DP included placental malaria and birth length, maternal IL-18, CDCP1, and CD6 at delivery. Interpretation In high malaria transmission settings, different IPTp regimens influenced infant growth among multigravidae through distinct pathways in the period of exclusive breastfeeding, when few other interventions are available. Funding Stanford Center for Innovation and Global Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bill & Melinda Gates Foundation.
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Affiliation(s)
- Yanwei Tong
- Department of Statistics, Stanford University, Stanford, United States
| | - Kalani Ratnasiri
- Department of Epidemiology and Population Health, Stanford University, Stanford, United States
- Department of Microbiology and Immunology, Stanford University, Stanford, United States
| | - Suhi Hanif
- Department of Epidemiology and Population Health, Stanford University, Stanford, United States
| | - Anna T. Nguyen
- Department of Epidemiology and Population Health, Stanford University, Stanford, United States
| | - Michelle E. Roh
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, United States
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, United States
| | - Grant Dorsey
- Department of Medicine, Division of HIV, ID, and Global Medicine, University of California San Francisco, San Francisco
| | - Abel Kakuru
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | | | - Jade Benjamin-Chung
- Department of Epidemiology and Population Health, Stanford University, Stanford, United States
- Chan Zuckerberg Biohub, San Francisco, United States
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Lee JJ, Kakuru A, Jacobson KB, Kamya MR, Kajubi R, Ranjit A, Gaw SL, Parsonnet J, Benjamin-Chung J, Dorsey G, Jagannathan P, Roh ME. Monthly Sulfadoxine-Pyrimethamine During Pregnancy Prevents Febrile Respiratory Illnesses: A Secondary Analysis of a Malaria Chemoprevention Trial in Uganda. Open Forum Infect Dis 2024; 11:ofae143. [PMID: 38585183 PMCID: PMC10995957 DOI: 10.1093/ofid/ofae143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 03/18/2024] [Indexed: 04/09/2024] Open
Abstract
Background Trials evaluating antimalarials for intermittent preventive treatment in pregnancy (IPTp) have shown that dihydroartemisinin-piperaquine (DP) is a more efficacious antimalarial than sulfadoxine-pyrimethamine (SP); however, SP is associated with higher birthweight, suggesting that SP demonstrates "nonmalarial" effects. Chemoprevention of nonmalarial febrile illnesses (NMFIs) was explored as a possible mechanism. Methods In this secondary analysis, we leveraged data from 654 pregnant Ugandan women without HIV infection who participated in a randomized controlled trial comparing monthly IPTp-SP with IPTp-DP. Women were enrolled between 12 and 20 gestational weeks and followed through delivery. NMFIs were measured by active and passive surveillance and defined by the absence of malaria parasitemia. We quantified associations among IPTp regimens, incident NMFIs, antibiotic prescriptions, and birthweight. Results Mean "birthweight for gestational age" Z scores were 0.189 points (95% CI, .045-.333) higher in women randomized to IPTp-SP vs IPTp-DP. Women randomized to IPTp-SP had fewer incident NMFIs (incidence rate ratio, 0.74; 95% CI, .58-.95), mainly respiratory NMFIs (incidence rate ratio, 0.69; 95% CI, .48-1.00), vs IPTp-DP. Counterintuitively, respiratory NMFI incidence was positively correlated with birthweight in multigravidae. In total 75% of respiratory NMFIs were treated with antibiotics. Although overall antibiotic prescriptions were similar between arms, for each antibiotic prescribed, "birthweight for gestational age" Z scores increased by 0.038 points (95% CI, .001-.074). Conclusions Monthly IPTp-SP was associated with reduced respiratory NMFI incidence, revealing a potential nonmalarial mechanism of SP and supporting current World Health Organization recommendations for IPTp-SP, even in areas with high-grade SP resistance. While maternal respiratory NMFIs are known risk factors of lower birthweight, most women in our study were presumptively treated with antibiotics, masking the potential benefit of SP on birthweight mediated through preventing respiratory NMFIs.
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Affiliation(s)
- Jordan John Lee
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University, Stanford, California, USA
- Department of Epidemiology and Population Health, Stanford University, Stanford, California, USA
| | - Abel Kakuru
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Karen B Jacobson
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University, Stanford, California, USA
- Kaiser Permanente Northern California Division of Research, Vaccine Study Center, Oakland, California, USA
| | - Moses R Kamya
- Infectious Diseases Research Collaboration, Kampala, Uganda
- Department of Medicine, Makerere University, Kampala, Uganda
| | - Richard Kajubi
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Anju Ranjit
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, California, USA
| | - Stephanie L Gaw
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, California, USA
| | - Julie Parsonnet
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University, Stanford, California, USA
- Department of Epidemiology and Population Health, Stanford University, Stanford, California, USA
| | - Jade Benjamin-Chung
- Department of Epidemiology and Population Health, Stanford University, Stanford, California, USA
- Chan Zuckerberg Biohub, San Francisco, California, USA
| | - Grant Dorsey
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Prasanna Jagannathan
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University, Stanford, California, USA
- Department of Microbiology and Immunology, Stanford University, Stanford, California, USA
| | - Michelle E Roh
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
- Malaria Elimination Initiative, Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, USA
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Oldenburg CE, Ouattara M, Bountogo M, Boudo V, Ouedraogo T, Compaoré G, Dah C, Zakane A, Coulibaly B, Bagagnan C, Hu H, O’Brien KS, Nyatigo F, Keenan JD, Doan T, Porco TC, Arnold BF, Lebas E, Sié A, Lietman TM. Mass Azithromycin Distribution to Prevent Child Mortality in Burkina Faso: The CHAT Randomized Clinical Trial. JAMA 2024; 331:482-490. [PMID: 38349371 PMCID: PMC10865159 DOI: 10.1001/jama.2023.27393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 12/14/2023] [Indexed: 02/15/2024]
Abstract
Importance Repeated mass distribution of azithromycin has been shown to reduce childhood mortality by 14% in sub-Saharan Africa. However, the estimated effect varied by location, suggesting that the intervention may not be effective in different geographical areas, time periods, or conditions. Objective To evaluate the efficacy of twice-yearly azithromycin to reduce mortality in children in the presence of seasonal malaria chemoprevention. Design, Setting, and Participants This cluster randomized placebo-controlled trial evaluating the efficacy of single-dose azithromycin for prevention of all-cause childhood mortality included 341 communities in the Nouna district in rural northwestern Burkina Faso. Participants were children aged 1 to 59 months living in the study communities. Interventions Communities were randomized in a 1:1 ratio to receive oral azithromycin or placebo distribution. Children aged 1 to 59 months were offered single-dose treatment twice yearly for 3 years (6 distributions) from August 2019 to February 2023. Main Outcomes and Measures The primary outcome was all-cause childhood mortality, measured during a twice-yearly enumerative census. Results A total of 34 399 children (mean [SD] age, 25.2 [18] months) in the azithromycin group and 33 847 children (mean [SD] age, 25.6 [18] months) in the placebo group were included. A mean (SD) of 90.1% (16.0%) of the censused children received the scheduled study drug in the azithromycin group and 89.8% (17.1%) received the scheduled study drug in the placebo group. In the azithromycin group, 498 deaths were recorded over 60 592 person-years (8.2 deaths/1000 person-years). In the placebo group, 588 deaths were recorded over 58 547 person-years (10.0 deaths/1000 person-years). The incidence rate ratio for mortality was 0.82 (95% CI, 0.67-1.02; P = .07) in the azithromycin group compared with the placebo group. The incidence rate ratio was 0.99 (95% CI, 0.72-1.36) in those aged 1 to 11 months, 0.92 (95% CI, 0.67-1.27) in those aged 12 to 23 months, and 0.73 (95% CI, 0.57-0.94) in those aged 24 to 59 months. Conclusions and Relevance Mortality in children (aged 1-59 months) was lower with biannual mass azithromycin distribution in a setting in which seasonal malaria chemoprevention was also being distributed, but the difference was not statistically significant. The study may have been underpowered to detect a clinically relevant difference. Trial Registration ClinicalTrials.gov Identifier: NCT03676764.
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Affiliation(s)
- Catherine E. Oldenburg
- Francis I. Proctor Foundation, University of California, San Francisco
- Department of Epidemiology & Biostatistics, University of California, San Francisco
- Department of Ophthalmology, University of California, San Francisco
- Institute for Global Health Sciences, University of California, San Francisco
| | | | | | | | | | | | - Clarisse Dah
- Centre de Recherche en Santé de Nouna, Burkina Faso
| | | | | | | | - Huiyu Hu
- Francis I. Proctor Foundation, University of California, San Francisco
| | - Kieran S. O’Brien
- Francis I. Proctor Foundation, University of California, San Francisco
- Department of Epidemiology & Biostatistics, University of California, San Francisco
| | - Fanice Nyatigo
- Francis I. Proctor Foundation, University of California, San Francisco
| | - Jeremy D. Keenan
- Francis I. Proctor Foundation, University of California, San Francisco
- Department of Ophthalmology, University of California, San Francisco
| | - Thuy Doan
- Francis I. Proctor Foundation, University of California, San Francisco
- Department of Ophthalmology, University of California, San Francisco
| | - Travis C. Porco
- Francis I. Proctor Foundation, University of California, San Francisco
- Department of Epidemiology & Biostatistics, University of California, San Francisco
- Department of Ophthalmology, University of California, San Francisco
| | - Benjamin F. Arnold
- Francis I. Proctor Foundation, University of California, San Francisco
- Department of Ophthalmology, University of California, San Francisco
| | - Elodie Lebas
- Francis I. Proctor Foundation, University of California, San Francisco
| | - Ali Sié
- Centre de Recherche en Santé de Nouna, Burkina Faso
| | - Thomas M. Lietman
- Francis I. Proctor Foundation, University of California, San Francisco
- Department of Epidemiology & Biostatistics, University of California, San Francisco
- Department of Ophthalmology, University of California, San Francisco
- Institute for Global Health Sciences, University of California, San Francisco
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Li R, Shen X, Li Z, Shen J, Tang H, Xu H, Shen J, Xu Y. Combination of AS101 and Mefloquine Inhibits Carbapenem-Resistant Pseudomonas aeruginosa in vitro and in vivo. Infect Drug Resist 2023; 16:7271-7288. [PMID: 38023412 PMCID: PMC10664714 DOI: 10.2147/idr.s427232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 10/27/2023] [Indexed: 12/01/2023] Open
Abstract
Background In recent years, carbapenem-resistant Pseudomonas aeruginosa (CRPA) has spread around the world, leading to a high mortality and close attention of medical community. In this study, we aim to find a new strategy of treatment for CRPA infections. Methods Eight strains of CRPA were collected, and PCR detected the multi-locus sequence typing (MLST). The antimicrobial susceptibility test was conducted using the VITEK@2 compact system. The minimum inhibitory concentration (MIC) for AS101 and mefloquine was determined using the broth dilution method. Antibacterial activity was tested in vitro and in vivo through the chessboard assay, time killing assay, and a mouse model. The mechanism of AS101 combined with mefloquine against CRPA was assessed through the biofilm formation inhibition assay, electron microscopy, and detection of reactive oxygen species (ROS). Results The results demonstrated that all tested CRPA strains exhibited multidrug resistance. Moreover, our investigation revealed a substantial synergistic antibacterial effect of AS101-mefloquine in vitro. The assay for inhibiting biofilm formation indicated that AS101-mefloquine effectively suppressed the biofilm formation of CRPA-5 and CRPA-6. Furthermore, AS101-mefloquine were observed to disrupt the bacterial cell wall and enhance the permeability of the cell membrane. This effect was achieved by stimulating the production of ROS, which in turn hindered the growth of CRPA-3. To evaluate the therapeutic potential, a murine model of CRPA-3 peritoneal infection was established. Notably, AS101-mefloquine administration resulted in a significant reduction in bacterial load within the liver, kidney, and spleen of mice after 72 hours of treatment. Conclusion The present study showed that the combination of AS101 and mefloquine yielded a notable synergistic bacteriostatic effect both in vitro and in vivo, suggesting a potential clinical application of this combination in the treatment of CRPA.
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Affiliation(s)
- Rongrong Li
- Department of Clinical Laboratory, The First Affiliated Hospital of Anhui Medical University, Hefei, People’s Republic of China
- Provincial Laboratories of Pathogen Biology and Zoonoses, Anhui Medical University, Hefei, People’s Republic of China
| | - Xuhang Shen
- Department of Gastroenterology, The First Affiliated Hospital of Anhui Medical University, Hefei, People’s Republic of China
| | - Zhengyuan Li
- Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, People’s Republic of China
| | - Jilong Shen
- Provincial Laboratories of Pathogen Biology and Zoonoses, Anhui Medical University, Hefei, People’s Republic of China
| | - Hao Tang
- Department of Clinical Laboratory, the Second Affiliated Hospital of Anhui Medical University, Hefei, People’s Republic of China
| | - Huaming Xu
- Department of Clinical Laboratory, the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, People’s Republic of China
| | - Jilu Shen
- Department of Clinical Laboratory, The First Affiliated Hospital of Anhui Medical University, Hefei, People’s Republic of China
- Anhui Public Health Clinical Center, Hefei, People’s Republic of China
| | - Yuanhong Xu
- Department of Clinical Laboratory, The First Affiliated Hospital of Anhui Medical University, Hefei, People’s Republic of China
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Davi SD, Okwu DG, Luetgehetmann M, Abba FM, Aepfelbacher M, Endamne LR, Alabi A, Zoleko-Manego R, Mombo-Ngoma G, Mahmoudou S, Addo MM, Ramharter M, Mischlinger J. Epidemiology of co-infections in pregnant women living with human immunodeficiency virus 1 in rural Gabon: a cross-sectional study. Infect Dis Poverty 2023; 12:64. [PMID: 37408012 DOI: 10.1186/s40249-023-01114-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 06/06/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND There is no recent epidemiological data on HIV infection in Gabon, particularly in pregnant women. To close this gap, an HIV-prevalence survey was conducted among Gabonese pregnant women, followed by a cross-sectional case-control study in which the prevalence of various co-infections was compared between HIV-positive and HIV-negative pregnant women. METHODS Between 2018 and 2019, data for the HIV-prevalence survey were collected retrospectively in 21 Gabonese antenatal care centres (ANCs). Subsequently, for the prospective co-infection study, all HIV-positive pregnant women were recruited who frequented the ANC in Lambaréné and a comparator sub-sample of HIV-negative pregnant women was recruited; these activities were performed from February 2019 to February 2020. The mean number of co-infections was ascertained and compared between HIV-positive and HIV-negative women. Additionally, the odds for being co-infected with at least one co-infection was evaluated and compared between HIV-positive and HIV-negative women. RESULTS HIV-positivity was 3.9% (646/16,417) among pregnant women. 183 pregnant women were recruited in the co-infection study. 63% of HIV-positive and 75% of HIV-negative pregnant women had at least one co-infection. There was a trend indicating that HIV-negative women were more often co-infected with sexually transmitted infections (STIs) than HIV-positive women [mean (standard deviation, SD): 2.59 (1.04) vs 2.16 (1.35), respectively; P = 0.056]; this was not the case for vector-borne infections [mean (SD): 0.47 (0.72) vs 0.43 (0.63), respectively; P = 0.59]. CONCLUSIONS Counterintuitively, the crude odds for concomitant STIs was lower in HIV-positive than in HIV-negative women. The change of magnitude from the crude to adjusted OR is indicative for a differential sexual risk factor profile among HIV-positive and HIV-negative women in this population. This might potentially be explained by the availability of sexual health care counselling for HIV-positive women within the framework of the national HIV control programme, while no such similar overall service exists for HIV-negative women. This highlights the importance of easy access to sexual healthcare education programmes for all pregnant women irrespective of HIV status.
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Affiliation(s)
- Saskia Dede Davi
- Centre of Tropical Medicine, Bernhard-Nocht Institute for Tropical Medicine and I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Centre for Infection Research, Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
| | | | - Marc Luetgehetmann
- Center for Diagnostics, Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | | | - Martin Aepfelbacher
- Center for Diagnostics, Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | | | - Ayodele Alabi
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- Department of Parasitology, Leiden University Medical Center, Albinusdreef, The Netherlands
| | | | - Ghyslain Mombo-Ngoma
- Centre of Tropical Medicine, Bernhard-Nocht Institute for Tropical Medicine and I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
| | | | - Marylyn Martina Addo
- German Centre for Infection Research, Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany
- Department for Clinical Immunology of Infectious Diseases and I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Ramharter
- Centre of Tropical Medicine, Bernhard-Nocht Institute for Tropical Medicine and I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Centre for Infection Research, Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
| | - Johannes Mischlinger
- Centre of Tropical Medicine, Bernhard-Nocht Institute for Tropical Medicine and I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
- German Centre for Infection Research, Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany.
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7
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Kalenda NK, Tshibangu-Kabamba E, Nakagama Y, Kaku N, Kaneko A, Speybroeck N, Kido Y. Usefulness of seasonal malaria chemoprevention in the Sahel. THE LANCET. INFECTIOUS DISEASES 2023; 23:269-270. [PMID: 36327998 DOI: 10.1016/s1473-3099(22)00654-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 09/20/2022] [Indexed: 02/25/2023]
Affiliation(s)
- Nadine Kayiba Kalenda
- Institute of Health and Society, Faculty of Public Health, Université Catholique de Louvain, Brussels 1200, Belgium; Department of Public Health, University of Mbujimayi, Mbujimayi, DR Congo.
| | - Evariste Tshibangu-Kabamba
- Departments of Internal Medicine & Basic Sciences, University of Mbujimayi, Mbujimayi, DR Congo; Departments of Virology and Parasitology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan; Research Center of Infectious Disease Sciences, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Yu Nakagama
- Departments of Virology and Parasitology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan; Research Center of Infectious Disease Sciences, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Natsuko Kaku
- Departments of Virology and Parasitology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan; Research Center of Infectious Disease Sciences, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Akira Kaneko
- Departments of Virology and Parasitology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan; Research Center of Infectious Disease Sciences, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Niko Speybroeck
- Institute of Health and Society, Faculty of Public Health, Université Catholique de Louvain, Brussels 1200, Belgium
| | - Yasutoshi Kido
- Departments of Virology and Parasitology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan; Research Center of Infectious Disease Sciences, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
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8
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Kamau A, Musau M, Mwakio S, Amadi D, Nyaguara A, Bejon P, Seale AC, Berkley JA, Snow RW. Impact of Intermittent Presumptive Treatment for Malaria in Pregnancy on Hospital Birth Outcomes on the Kenyan Coast. Clin Infect Dis 2022; 76:e875-e883. [PMID: 35731850 PMCID: PMC9907553 DOI: 10.1093/cid/ciac509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/10/2022] [Accepted: 06/17/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Intermittent preventive treatment (IPTp) for pregnant women with sulfadoxine-pyrimethamine (SP) is widely implemented for the prevention of malaria in pregnancy and adverse birth outcomes. The efficacy of SP is declining, and there are concerns that IPTp may have reduced impact in areas of high resistance. We sought to determine the protection afforded by SP as part of IPTp against adverse birth outcomes in an area with high levels of SP resistance on the Kenyan coast. METHODS A secondary analysis of surveillance data on deliveries at the Kilifi County Hospital between 2015 and 2021 was undertaken in an area of low malaria transmission and high parasite mutations associated with SP resistance. A multivariable logistic regression model was developed to estimate the effect of SP doses on the risk of low birthweight (LBW) deliveries and stillbirths. RESULTS Among 27 786 deliveries, 3 or more doses of IPTp-SP were associated with a 27% reduction in the risk of LBW (adjusted odds ratio [aOR], 0.73; 95% confidence interval [CI], .64-.83; P < .001) compared with no dose. A dose-response association was observed with increasing doses of SP from the second trimester linked to increasing protection against LBW deliveries. Three or more doses of IPTp-SP were also associated with a 21% reduction in stillbirth deliveries (aOR, 0.79; 95% CI, .65-.97; P = .044) compared with women who did not take any dose of IPTp-SP. CONCLUSIONS The continued significant association of SP on LBW deliveries suggests that the intervention may have a non-malaria impact on pregnancy outcomes.
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Affiliation(s)
- Alice Kamau
- Correspondence: A. Kamau, KEMRI/Wellcome Trust Research Programme, PO Box 43640-00100, Nairobi, Kenya ()
| | - Moses Musau
- Public Health Research, Kenya Medical Research Institute–Wellcome Trust Research Programme, Nairobi, Kenya
| | - Stella Mwakio
- Epidemiology and Demography, Kenya Medical Research Institute–Wellcome Trust Research Programme, Kilifi, Kenya
| | - David Amadi
- Epidemiology and Demography, Kenya Medical Research Institute–Wellcome Trust Research Programme, Kilifi, Kenya
| | - Amek Nyaguara
- Epidemiology and Demography, Kenya Medical Research Institute–Wellcome Trust Research Programme, Kilifi, Kenya
| | - Philip Bejon
- Epidemiology and Demography, Kenya Medical Research Institute–Wellcome Trust Research Programme, Kilifi, Kenya,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Anna C Seale
- Epidemiology and Demography, Kenya Medical Research Institute–Wellcome Trust Research Programme, Kilifi, Kenya,Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom,College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia,Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - James A Berkley
- Public Health Research, Kenya Medical Research Institute–Wellcome Trust Research Programme, Nairobi, Kenya,Centre for Clinical Vaccinology and Tropical Medicine, Churchill Hospital, University of Oxford, Oxford, United Kingdom
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Waltmann A, McQuade ETR, Chinkhumba J, Operario DJ, Mzembe E, Itoh M, Kayange M, Puerto-Meredith SM, Mathanga DP, Juliano JJ, Carroll I, Bartelt LA, Gutman JR, Meshnick SR. The positive effect of malaria IPTp-SP on birthweight is mediated by gestational weight gain but modifiable by maternal carriage of enteric pathogens. EBioMedicine 2022; 77:103871. [PMID: 35217408 PMCID: PMC8866062 DOI: 10.1016/j.ebiom.2022.103871] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 01/24/2022] [Accepted: 01/24/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Poor pregnancy and birth outcomes are common in sub-Saharan Africa and have complex aetiologies. Sulfadoxine-pyrimethamine (SP), given for intermittent preventive therapy of malaria in pregnancy (IPTp), is one of few existing interventions that improves outcomes of both mother and baby despite widespread SP-resistant malaria. Compelling evidence exists that malaria-independent pathways contribute to this protective effect, but the exact sources of non anti-malarial protection remained unknown. We hypothesized that the beneficial effect of SP on birthweight is mediated by SP activity on maternal factors, including increased gestational weight gain and antibiotic activity on pathogens in the maternal gut. METHODS Expectant mothers from a larger randomized control trial comparing the efficacy of IPTp-SP to IPTp with dihydroartemisinin-piperaquine (DP) were also enrolled in this sub-study study at their first antenatal care visit before commencement of IPTp (n = 105). Participants were followed monthly until delivery. Weights and mid-to-upper-arm circumferences (MUAC) were recorded. Monthly stool samples were collected and screened for five Escherichia coli pathotypes, Shigella spp., Vibrio cholerae, Salmonella, Campylobacter coli/jejuni, and three protozoa (Giardia spp., Entameba histolytica, and Cryptosporidium spp.) using previously validated molecular assays. FINDINGS IPTp-SP vs. IPTP-DP was associated with higher maternal gestational weight gain (GWG) and nutritional indicators (MUAC and body-mass index, BMI). GWG was found to be a mediator of the birthweight and IPTp-SP relationship, as the birthweight of SP infants, but not DP infants, varied according to maternal GWG. The burden of maternal enteric infections was high. The three most commonly observed pathogens were enteroaggregative E. coli (EAEC), atypical enteropathogenic E.coli/enterohaemorrhagic E. coli (aEPEC/EHEC), and typical enteropathogenic E.coli (tEPEC). We found that SP reduced the prevalence of EAEC in a dose-dependent manner. After 3 or more doses, SP-recipients were 90% less likely to be infected with EAEC compared to DP-recipients (ORadj = 0.07, CI95 = 0.12, 0.39, p = 0.002). Compared to DP, this coincided with higher maternal gestational weight gain (GWG) and nutritional indicators (MUAC and body-mass index, BMI). The beneficial effect of SP on maternal GWG, MUAC and BMI, was lower if SP mothers had detectable EAEC, aEPEC/EHEC, tEPEC, and LT-ETEC at baseline. Maternal EAEC and tEPEC at baseline associated with lower birthweight for babies of both SP mothers and DP mothers. When comparing IPTp regimens, the positive effect of SP on birthweight compared to DP was only observed for infants of women who did not test positive for EAEC at baseline (adjusted mean birthweight difference SP vs. DP = 156.0 g, CI95 = -18.0 g, 336.9 g, p = 0.087), though confidence intervals crossed the null. INTERPRETATION Our findings indicate that in pregnant Malawian women, IPTp-SP vs. IPTp-DP is consistently associated with higher MUAC, BMI, and GWG following the WHO-recommended regimen of at least 3 doses, but carriage of maternal gut pathogens before initiation of IPTp lessens this effect. Because GWG was a mediator of the association between birthweight and SP, we show that SP's previously proven positive effect on birthweight is by promoting maternal weight gain. Overall, our results present one plausible pathway SP exerts malaria-independent protection against poor birth outcomes in the context of its waning antimalarial activity and warrants further investigation. FUNDING A full list of funding bodies that contributed to this study can be found in the Acknowledgements section.
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Affiliation(s)
- Andreea Waltmann
- Institute for Global Health and Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, NC, USA.
| | | | - Jobiba Chinkhumba
- Malaria Alert Centre (MAC), University of Malawi College of Medicine, Blantyre, Malawi
| | - Darwin J Operario
- Division of Infectious Diseases & International Health, Department of Medicine, University of Virginia, VA, USA
| | - Enala Mzembe
- Malaria Alert Centre (MAC), University of Malawi College of Medicine, Blantyre, Malawi
| | - Megumi Itoh
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Don P Mathanga
- Malaria Alert Centre (MAC), University of Malawi College of Medicine, Blantyre, Malawi
| | - Jonathan J Juliano
- Institute for Global Health and Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, NC, USA; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Ian Carroll
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Luther A Bartelt
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Julie R Gutman
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Steven R Meshnick
- Institute for Global Health and Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, NC, USA; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
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10
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Prevalence and Factors Associated with Low Birth Weight and Preterm Delivery in the Ho Municipality of Ghana. ADVANCES IN PUBLIC HEALTH 2022. [DOI: 10.1155/2022/3955869] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background. Low birth weight and preterm delivery are birth outcomes that can predict newborns’ survival, development, and long-term health outcomes. This study assessed the prevalence and factors associated with low birth weight and preterm delivery in the Ho Municipality of Ghana. Methods. This retrospective, cross-sectional study analysed data from 680 birth records between October and December 2018. Univariate and multivariate logistic regression models predicted low birth weight and preterm delivery factors. Results. The prevalence of low birth weight and preterm delivery was 12.9% and 14.1%, respectively. Increasing maternal age (AOR: 0.52; 95% CI: 0.28–0.98), multiparity (AOR: 0.54; 95% CI: 0.30–0.94) and increasing doses of sulphadoxine-pyrimethamine (AOR: 0.43; 95% CI: 0.22–0.84) significantly reduced the odds of low birth weight. However, caesarean section (AOR: 1.94; 95% CI: 0.1.16–3.27) and hypertension (AOR: 2.06; 95% CI: 1.27–03.33) significantly increased the likelihood of low birth weight. An increasing number of antenatal care visits (AOR: 0.38; 95% CI: 0.18–0.80) and doses of sulphadoxine-pyrimethamine (AOR: 0.43; 95% CI: 0.19–0.97) were significantly associated with decreased odds of preterm delivery, while caesarean section increased the odds of preterm delivery by two folds (AOR: 2.14; 95% CI: 1.15–3.99). Conclusion. This study shows that maternal age, parity, number of antenatal care visits, hypertension, SP/IPTp, and caesarean section were independently associated with low birth weight and preterm delivery. Education and interventions should be prioritised as vitally important on these factors to reduce the risk and complications associated with these birth outcomes.
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11
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Grant J, Sagara I, Zongo I, Cairns M, Yerbanga RS, Diarra M, Zoungrana C, Issiaka D, Nikièma F, Sompougdou F, Tapily A, Kaya M, Haro A, Sanogo K, Sienou AA, Traore S, Thera I, Yalcouye H, Kuepfer I, Snell P, Milligan P, Ockenhouse C, Ofori-Anyinam O, Tinto H, Djimde A, Chandramohan D, Greenwood B, Dicko A, Ouédraogo JB. Impact of seasonal RTS,S/AS01 E vaccination plus seasonal malaria chemoprevention on the nutritional status of children in Burkina Faso and Mali. Malar J 2022; 21:59. [PMID: 35193608 PMCID: PMC8864823 DOI: 10.1186/s12936-022-04077-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 02/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A recent trial in Burkina Faso and Mali showed that combining seasonal RTS,S/AS01E malaria vaccination with seasonal malaria chemoprevention (SMC) substantially reduced the incidence of uncomplicated and severe malaria in young children compared to either intervention alone. Given the possible negative effect of malaria on nutrition, the study investigated whether these children also experienced lower prevalence of acute and chronic malnutrition. METHODS In Burkina Faso and Mali 5920 children were randomized to receive either SMC alone, RTS,S/AS01E alone, or SMC combined with RTS,S/AS01E for three malaria transmission seasons (2017-2019). After each transmission season, anthropometric measurements were collected from all study children at a cross-sectional survey and used to derive nutritional status indicators, including the binary variables wasted and stunted (weight-for-height and height-for-age z-scores below - 2, respectively). Binary and continuous outcomes between treatment groups were compared by Poisson and linear regression. RESULTS In 2017, compared to SMC alone, the combined intervention reduced the prevalence of wasting by approximately 12% [prevalence ratio (PR) = 0.88 (95% CI 0.75, 1.03)], and approximately 21% in 2018 [PR = 0.79 (95% CI 0.62, 1.01)]. Point estimates were similar for comparisons with RTS,S/AS01E, but there was stronger evidence of a difference. There was at least a 30% reduction in the point estimates for the prevalence of severe wasting in the combined group compared to the other two groups in 2017 and 2018. There was no difference in the prevalence of moderate or severe wasting between the groups in 2019. The prevalence of stunting, low-MUAC-for-age or being underweight did not differ between groups for any of the three years. The prevalence of severe stunting was higher in the combined group compared to both other groups in 2018, and compared to RTS,S/AS01E alone in 2017; this observation does not have an obvious explanation and may be a chance finding. Overall, malnutrition was very common in this cohort, but declined over the study as the children became older. CONCLUSIONS Despite a high burden of malnutrition and malaria in the study populations, and a major reduction in the incidence of malaria in children receiving both interventions, this had only a modest impact on nutritional status. Therefore, other interventions are needed to reduce the high burden of malnutrition in these areas. TRIAL REGISTRATION https://www.clinicaltrials.gov/ct2/show/NCT03143218 , registered 8th May 2017.
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Affiliation(s)
- Jane Grant
- London School of Hygiene and Tropical Medicine, Keppel St., London, WC1E 7HT, UK.
| | - Issaka Sagara
- Malaria Research and Training Center, University of Science, Techniques, and Technologies of Bamako, Bamako, Mali
| | - Issaka Zongo
- Institut de Recherche en Sciences de La Santé, Bobo-Dioulasso, Burkina Faso
| | - Matthew Cairns
- London School of Hygiene and Tropical Medicine, Keppel St., London, WC1E 7HT, UK
| | | | - Modibo Diarra
- Malaria Research and Training Center, University of Science, Techniques, and Technologies of Bamako, Bamako, Mali
| | - Charles Zoungrana
- Institut de Recherche en Sciences de La Santé, Bobo-Dioulasso, Burkina Faso
| | - Djibrilla Issiaka
- Malaria Research and Training Center, University of Science, Techniques, and Technologies of Bamako, Bamako, Mali
| | - Frédéric Nikièma
- Institut de Recherche en Sciences de La Santé, Bobo-Dioulasso, Burkina Faso
| | | | - Amadou Tapily
- Malaria Research and Training Center, University of Science, Techniques, and Technologies of Bamako, Bamako, Mali
| | - Mahamadou Kaya
- Malaria Research and Training Center, University of Science, Techniques, and Technologies of Bamako, Bamako, Mali
| | - Alassane Haro
- Institut de Recherche en Sciences de La Santé, Bobo-Dioulasso, Burkina Faso
| | - Koualy Sanogo
- Malaria Research and Training Center, University of Science, Techniques, and Technologies of Bamako, Bamako, Mali
| | - Abdoul Aziz Sienou
- Institut de Recherche en Sciences de La Santé, Bobo-Dioulasso, Burkina Faso
| | - Seydou Traore
- Malaria Research and Training Center, University of Science, Techniques, and Technologies of Bamako, Bamako, Mali
| | - Ismaila Thera
- Malaria Research and Training Center, University of Science, Techniques, and Technologies of Bamako, Bamako, Mali
| | - Hama Yalcouye
- Malaria Research and Training Center, University of Science, Techniques, and Technologies of Bamako, Bamako, Mali
| | - Irene Kuepfer
- London School of Hygiene and Tropical Medicine, Keppel St., London, WC1E 7HT, UK
| | - Paul Snell
- London School of Hygiene and Tropical Medicine, Keppel St., London, WC1E 7HT, UK
| | - Paul Milligan
- London School of Hygiene and Tropical Medicine, Keppel St., London, WC1E 7HT, UK
| | | | | | - Halidou Tinto
- Institut de Recherche en Sciences de La Santé, Bobo-Dioulasso, Burkina Faso
| | - Abdoulaye Djimde
- Malaria Research and Training Center, University of Science, Techniques, and Technologies of Bamako, Bamako, Mali
| | - Daniel Chandramohan
- London School of Hygiene and Tropical Medicine, Keppel St., London, WC1E 7HT, UK
| | - Brian Greenwood
- London School of Hygiene and Tropical Medicine, Keppel St., London, WC1E 7HT, UK
| | - Alassane Dicko
- Malaria Research and Training Center, University of Science, Techniques, and Technologies of Bamako, Bamako, Mali
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Evaluation of the usefulness of intermittent preventive treatment of malaria in pregnancy with sulfadoxine-pyrimethamine in a context with increased resistance of Plasmodium falciparum in Kingasani Hospital, Kinshasa in the Democratic Republic of Congo. INFECTION GENETICS AND EVOLUTION 2021; 94:105009. [PMID: 34284138 DOI: 10.1016/j.meegid.2021.105009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 07/14/2021] [Accepted: 07/15/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Increasing resistance of Plasmodium falciparum to sulfadoxine-pyrimethamine (SP) threatens its usefulness for intermittent preventive treatment in pregnancy (IPTp-SP). The prophylactic effects of IPTp-SP on maternal malaria and adverse pregnancy outcomes were evaluated in Kingasani Hospital, Kinshasa in the Democratic Republic of Congo (DRC). METHODS Laboring women (n = 844) and respective newborns were investigated. Blood samples collected from women were tested for malaria using rapid diagnostic test (RDT), blood smears examination, and real-time PCR. The hemoglobin level was measured by HemoCue© analyzer. A PCR-RFLP method was applied for detecting N51I, C59R, and S108N mutations on dhfr along with A437G and K540E mutations on dhps in P. falciparum positive samples. Logistic regression models assessed relationships between IPTp-SP uptake and pregnancy outcomes. RESULTS P. falciparum malaria was detected at delivery in 10.8% of women and was statistically associated with fever during the pregnancy (OR = 2.9 [1.5; 6.3]; p = 0.004) and maternal anemia (OR = 3.9 [2.4; 6.3]; p < 0.001). One out of five parasites was a quintuple mutant encoding dhfr mutations 51I, 59R, and 108 N along with dhps mutations 437G and 540E. The molecular profile of parasites (i.e., 32.6% of parasites carrying dhps K540E) was suitable with continued use of SP for IPTp. IPTp-SP uptake was not associated with reduced maternal malaria, fever reported in pregnancy, or fetal deaths (p > 0.05). Conversely, three or more doses of SP were associated with reduced maternal anemia at delivery (OR = 0.4 [0.2; 0.9]; p = 0.024), shortened gestation (OR = 0.4 [0.2; 0.8]; p = 0.009), and low-birth weights (OR = 0.2 [0.1; 0.5]; p < 0.001). CONCLUSION IPTp-SP was not associated with reduced maternal malaria in our study, but evidence was found of a prophylactic effect against adverse pregnancy outcomes. To counteract further loss of clinical effects of IPTp-SP in the study population, alternative strategies able to improve its anti-malarial efficacy such as combination of SP with partner molecules should be implemented.
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13
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Roux AT, Maharaj L, Oyegoke O, Akoniyon OP, Adeleke MA, Maharaj R, Okpeku M. Chloroquine and Sulfadoxine-Pyrimethamine Resistance in Sub-Saharan Africa-A Review. Front Genet 2021; 12:668574. [PMID: 34249090 PMCID: PMC8267899 DOI: 10.3389/fgene.2021.668574] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 04/20/2021] [Indexed: 12/20/2022] Open
Abstract
Malaria is a great concern for global health and accounts for a large amount of morbidity and mortality, particularly in Africa, with sub-Saharan Africa carrying the greatest burden of the disease. Malaria control tools such as insecticide-treated bed nets, indoor residual spraying, and antimalarial drugs have been relatively successful in reducing the burden of malaria; however, sub-Saharan African countries encounter great challenges, the greatest being antimalarial drug resistance. Chloroquine (CQ) was the first-line drug in the 20th century until it was replaced by sulfadoxine–pyrimethamine (SP) as a consequence of resistance. The extensive use of these antimalarials intensified the spread of resistance throughout sub-Saharan Africa, thus resulting in a loss of efficacy for the treatment of malaria. SP was replaced by artemisinin-based combination therapy (ACT) after the emergence of resistance toward SP; however, the use of ACTs is now threatened by the emergence of resistant parasites. The decreased selective pressure on CQ and SP allowed for the reintroduction of sensitivity toward those antimalarials in regions of sub-Saharan Africa where they were not the primary drug for treatment. Therefore, the emergence and spread of antimalarial drug resistance should be tracked to prevent further spread of the resistant parasites, and the re-emergence of sensitivity should be monitored to detect the possible reappearance of sensitivity in sub-Saharan Africa.
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Affiliation(s)
- Alexandra T Roux
- Discipline of Genetics, School of Life Sciences, University of KwaZulu-Natal, Westville, South Africa
| | - Leah Maharaj
- Discipline of Genetics, School of Life Sciences, University of KwaZulu-Natal, Westville, South Africa
| | - Olukunle Oyegoke
- Discipline of Genetics, School of Life Sciences, University of KwaZulu-Natal, Westville, South Africa
| | - Oluwasegun P Akoniyon
- Discipline of Genetics, School of Life Sciences, University of KwaZulu-Natal, Westville, South Africa
| | - Matthew Adekunle Adeleke
- Discipline of Genetics, School of Life Sciences, University of KwaZulu-Natal, Westville, South Africa
| | - Rajendra Maharaj
- Office of Malaria Research, South African Medical Research Council, Cape Town, South Africa
| | - Moses Okpeku
- Discipline of Genetics, School of Life Sciences, University of KwaZulu-Natal, Westville, South Africa
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Hu Y, Coates A. Mefloquine enhances the activity of colistin against antibiotic-resistant Enterobacterales in vitro and in an in vivo animal study. Int J Antimicrob Agents 2021; 57:106309. [PMID: 33609719 DOI: 10.1016/j.ijantimicag.2021.106309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 02/10/2021] [Accepted: 02/14/2021] [Indexed: 11/16/2022]
Abstract
Infections caused by carbapenem-resistant Enterobacterales are difficult to treat. Colistin is the last-resort drug for the treatment of these infections, however colistin resistance has emerged in animals and humans. This study investigated the in vitro efficacy of mefloquine in combination with colistin against 114 antibiotic-resistant Enterobacterales isolates including NDM-1, extended-spectrum β-lactamase (ESBL) and mcr-1 containing strains from a broad range of origins. The effect of the mefloquine and colistin combination was examined in vitro by chequerboard method and time-kill analysis and in vivo in a murine peritoneal infection model. The fractional inhibitory concentration index (FICI) of the combination indicated that synergy was detected for all NDM-1 and mcr-1 containing strains, 87.5% of ESBL producing Escherichia coli and 97.9% of ESBL producing Klebsiella pneumoniae strains. Time-kill curves demonstrated significant synergistic activity with low concentrations of colistin that were boosted by mefloquine. The combination showed enhanced activity against infection with NDM-1- or mcr-1 containing Enterobacteriaceae in mice at 4 h and 6 h after treatment. These findings suggest that the combination of mefloquine and colistin has the potential for rejuvenating the activity of colistin against multidrug-resistant Enterobacterales.
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Affiliation(s)
- Yanmin Hu
- Institute for Infection and Immunity, St George's, University of London, London, UK.
| | - Anthony Coates
- Institute for Infection and Immunity, St George's, University of London, London, UK; Helperby Therapeutics Group plc, London, UK
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15
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Villa M, Buysse M, Berthomieu A, Rivero A. The transmission-blocking effects of antimalarial drugs revisited: fitness costs and sporontocidal effects of artesunate and sulfadoxine-pyrimethamine. Int J Parasitol 2021; 51:279-289. [PMID: 33508331 DOI: 10.1016/j.ijpara.2020.09.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 09/22/2020] [Accepted: 09/23/2020] [Indexed: 12/31/2022]
Abstract
Assays used to evaluate the transmission-blocking activity of antimalarial drugs are largely focused on their potential to inhibit or reduce the infectivity of gametocytes, the blood stages of the parasite that are responsible for the onward transmission to the mosquito vector. For this purpose, the drug is administered concomitantly with gametocyte-infected blood, and the results are evaluated as the percentage of reduction in the number of oocysts in the mosquito midgut. We report the results of a series of experiments that explore the transmission-blocking potential of two key antimalarial drugs, artesunate and sulfadoxine-pyrimethamine, when administered to mosquitoes already infected from a previous blood meal. For this purpose, uninfected mosquitoes and mosquitoes carrying a 6 day old Plasmodium relictum infection (early oocyst stages) were allowed to feed either on a drug-treated or an untreated host in a fully factorial experiment. This protocol allowed us to bypass the gametocyte stages and establish whether the drugs have a sporontocidal effect, i.e. whether they are able to arrest the ongoing development of oocysts and sporozoites, as would be the case when a mosquito takes a post-infection treated blood meal. In a separate experiment, we also explored whether a drug-treated blood meal impacted key life history traits of the mosquito relevant for transmission, and if this depended on their infection status. Our results showed that feeding on an artesunate- or sulfadoxine-pyrimethamine-treated hosts has no epidemiologically relevant effects on the fitness of infected or uninfected mosquitoes. In contrast, when infected mosquitoes fed on an sulfadoxine-pyrimethamine-treated host, we observed both a significant increase in the number of oocysts in the midgut, and a drastic decrease in both sporozoite prevalence (-30%) and burden (-80%) compared with the untreated controls. We discuss the potential mechanisms underlying these seemingly contradictory results and contend that, provided the results are translatable to human malaria, the potential epidemiological and evolutionary consequences of the current preventive use of sulfadoxine-pyrimethamine in malaria-endemic countries could be substantial.
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Affiliation(s)
- M Villa
- MIVEGEC (CNRS - IRD - Université de Montpellier), France.
| | - M Buysse
- MIVEGEC (CNRS - IRD - Université de Montpellier), France
| | - A Berthomieu
- MIVEGEC (CNRS - IRD - Université de Montpellier), France; CREES (Centre d'Écologie et Évolution de la Santé, Montpellier), 911 avenue Agropolis, 34394 Montpellier, France
| | - A Rivero
- MIVEGEC (CNRS - IRD - Université de Montpellier), France; CREES (Centre d'Écologie et Évolution de la Santé, Montpellier), 911 avenue Agropolis, 34394 Montpellier, France
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16
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Zango SH, Lingani M, Valea I, Samadoulougou OS, Bihoun B, Rouamba T, Derra K, Rouamba E, Donnen P, Dramaix M, Tinto H, Robert A. Malaria and curable sexually transmitted infections in pregnant women: A two-years observational study in rural Burkina Faso. PLoS One 2020; 15:e0242368. [PMID: 33196665 PMCID: PMC7668607 DOI: 10.1371/journal.pone.0242368] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 10/30/2020] [Indexed: 01/26/2023] Open
Abstract
Background Malaria and curable sexually transmitted infections (STI) are the most common curable infections known to have a severe impact on pregnancy outcomes in sub-Saharan Africa. This study aims to assess the marginal and joint prevalence of symptomatic cases of malaria and STI in pregnant women living in rural settings of Burkina Faso and their associated factors, after more than a decade of the introduction of intermittent preventive treatment (IPT-SP). Methods We carried out an observational study in two health districts in rural Burkina, namely Nanoro and Yako. Routine data were collected during antenatal and delivery visits for all women who delivered in the year 2016 and 2017. Logistic regression models were used to assess factors associated with infections. Results We collected data from 31639 pregnant women attending health facilities. Malaria, curable STI and their coinfections were diagnosed in 7747 (24.5%; 95%CI: 24.0–25.0%), 1269 (4.0%; 95%CI: 3.8–4.2%) and 388 (1.2%; 95%CI: 1.1–1.4%) women, respectively. In multivariate logistic regression, malaria occurrence was significantly higher in pregnant women < 20 years (Adjusted OR = 2.36; 95% CI: 2.07–2.69) than in women ≥30 years. The prevalence of curable STI was also significantly higher in students (Adjusted OR = 1.93; 95% CI: 1.26–2.95) and compensated workers (Adjusted OR = 1.52; 95% CI: 1.01–2.17) than in uncompensated workers. Women who received no IPT-SP had higher prevalence of malaria (Adjusted OR = 3.33; 95%CI: 3.00–3.70), curable STI (Adjusted OR = 1.96 95%CI: 1.60–2.39) and coinfections (Adjusted OR = 2.11; 95% CI: 1.50–2.95) compared to women who received SP. Conclusion Malaria and curable STI remain highly prevalent in rural settings of Burkina Faso, with young pregnant women and women who received no IPT-SP being the most affected. Prevention must be reinforced to improve maternal and infant health.
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Affiliation(s)
- Serge Henri Zango
- Pôle d’Epidémiologie et biostatistique, Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain (UCLouvain), Brussels, Belgique
- Institut de Recherche en Sciences de la Santé, Direction Régionale du Centre Ouest (IRSS/DRCO), Bobo-Dioulasso, Burkina Faso
- Centre MURAZ, Institut National de Santé Publique (INSP), Bobo-Dioulasso, Burkina Faso
- * E-mail: ,
| | - Moussa Lingani
- Institut de Recherche en Sciences de la Santé, Direction Régionale du Centre Ouest (IRSS/DRCO), Bobo-Dioulasso, Burkina Faso
- École de santé publique, Université Libre de Bruxelles, Bruxelles, Belgique
| | - Innocent Valea
- Institut de Recherche en Sciences de la Santé, Direction Régionale du Centre Ouest (IRSS/DRCO), Bobo-Dioulasso, Burkina Faso
- Centre MURAZ, Institut National de Santé Publique (INSP), Bobo-Dioulasso, Burkina Faso
| | - Ouindpanga Sékou Samadoulougou
- Pôle d’Epidémiologie et biostatistique, Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain (UCLouvain), Brussels, Belgique
| | - Biebo Bihoun
- Pôle d’Epidémiologie et biostatistique, Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain (UCLouvain), Brussels, Belgique
- Institut de Recherche en Sciences de la Santé, Direction Régionale du Centre Ouest (IRSS/DRCO), Bobo-Dioulasso, Burkina Faso
| | - Toussaint Rouamba
- Institut de Recherche en Sciences de la Santé, Direction Régionale du Centre Ouest (IRSS/DRCO), Bobo-Dioulasso, Burkina Faso
- École de santé publique, Université Libre de Bruxelles, Bruxelles, Belgique
| | - Karim Derra
- Institut de Recherche en Sciences de la Santé, Direction Régionale du Centre Ouest (IRSS/DRCO), Bobo-Dioulasso, Burkina Faso
| | - Eli Rouamba
- Institut de Recherche en Sciences de la Santé, Direction Régionale du Centre Ouest (IRSS/DRCO), Bobo-Dioulasso, Burkina Faso
| | - Phillipe Donnen
- École de santé publique, Université Libre de Bruxelles, Bruxelles, Belgique
| | - Michele Dramaix
- École de santé publique, Université Libre de Bruxelles, Bruxelles, Belgique
| | - Halidou Tinto
- Institut de Recherche en Sciences de la Santé, Direction Régionale du Centre Ouest (IRSS/DRCO), Bobo-Dioulasso, Burkina Faso
- Centre MURAZ, Institut National de Santé Publique (INSP), Bobo-Dioulasso, Burkina Faso
| | - Annie Robert
- Pôle d’Epidémiologie et biostatistique, Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain (UCLouvain), Brussels, Belgique
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17
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Salman S, Davis TME, Moore B. Defining the combined benefit of intermittent preventive malaria treatment in pregnancy. LANCET GLOBAL HEALTH 2020; 8:e871-e872. [PMID: 32562642 DOI: 10.1016/s2214-109x(20)30216-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 04/17/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Sam Salman
- Medical School, University of Western Australia, Perth, WA 6009, Australia.
| | - Tim M E Davis
- Medical School, University of Western Australia, Perth, WA 6009, Australia
| | - Brioni Moore
- Medical School, University of Western Australia, Perth, WA 6009, Australia; School of Pharmacy and Biomedical Sciences, Curtin University, Perth, WA, Australia
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Overall, anti-malarial, and non-malarial effect of intermittent preventive treatment during pregnancy with sulfadoxine-pyrimethamine on birthweight: a mediation analysis. Lancet Glob Health 2020; 8:e942-e953. [PMID: 32562650 PMCID: PMC7303957 DOI: 10.1016/s2214-109x(20)30119-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 03/19/2020] [Accepted: 03/23/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Trials of intermittent preventive treatment (IPTp) of malaria in pregnant women that compared dihydroartemisinin-piperaquine with the standard of care, sulfadoxine-pyrimethamine, showed dihydroartemisinin-piperaquine was superior at preventing malaria infection, but not at improving birthweight. We aimed to assess whether sulfadoxine-pyrimethamine shows greater non-malarial benefits for birth outcomes than does dihydroartemisinin-piperaquine, and whether dihydroartemisinin-piperaquine shows greater antimalarial benefits for birth outcomes than does sulfadoxine-pyrimethamine. METHODS We defined treatment as random assignment to sulfadoxine-pyrimethamine or dihydroartemisinin-piperaquine before pooling individual participant-level data from 1617 HIV-uninfected pregnant women in Kenya (one trial; n=806) and Uganda (two trials; n=811). We quantified the relative effect of treatment on birthweight (primary outcome) attributed to preventing placental malaria infection (mediator). We estimated antimalarial (indirect) and non-malarial (direct) effects of IPTp on birth outcomes using causal mediation analyses, accounting for confounders. We used two-stage individual participant data meta-analyses to calculate pooled-effect sizes. FINDINGS Overall, birthweight was higher among neonates of women randomly assigned to sulfadoxine-pyrimethamine compared with women assigned to dihydroartemisinin-piperaquine (mean difference 69 g, 95% CI 26 to 112), despite placental malaria infection being lower in the dihydroartemisinin-piperaquine group (relative risk [RR] 0·64, 95% CI 0·39 to 1·04). Mediation analyses showed sulfadoxine-pyrimethamine conferred a greater non-malarial effect than did dihydroartemisinin-piperaquine (mean difference 87 g, 95% CI 43 to 131), whereas dihydroartemisinin-piperaquine conferred a slightly larger antimalarial effect than did sulfadoxine-pyrimethamine (8 g, -9 to 26), although more frequent dosing increased the antimalarial effect (31 g, 3 to 60). INTERPRETATION IPTp with sulfadoxine-pyrimethamine appears to have potent non-malarial effects on birthweight. Further research is needed to evaluate monthly dihydroartemisinin-piperaquine with sulfadoxine-pyrimethamine (or another compound with non-malarial effects) to achieve greater protection against malarial and non-malarial causes of low birthweight. FUNDING Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bill & Melinda Gates Foundation, and Worldwide Antimalarial Resistance Network.
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Mikomangwa WP, Minzi O, Mutagonda R, Baraka V, Mlugu EM, Aklillu E, Kamuhabwa AAR. Effect of sulfadoxine-pyrimethamine doses for prevention of malaria during pregnancy in hypoendemic area in Tanzania. Malar J 2020; 19:160. [PMID: 32306955 PMCID: PMC7168863 DOI: 10.1186/s12936-020-03234-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 04/11/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malaria in pregnancy increases the risk of deleterious maternal and birth outcomes. The use of ≥ 3 doses of sulfadoxine-pyrimethamine (SP) for intermittent preventive treatment of malaria (IPTp-SP) is recommended for preventing the consequences of malaria during pregnancy. This study assessed the effect of IPTp-SP for prevention of malaria during pregnancy in low transmission settings. METHODS A cross-sectional study that involved consecutively selected 1161 pregnant women was conducted at Mwananyamala regional referral hospital in Dar es Salaam. Assessment of the uptake of IPTp-SP was done by extracting information from antenatal clinic cards. Maternal venous blood, cord blood, placental blood and placental biopsy were collected for assessment of anaemia and malaria. High performance liquid chromatography with ultraviolet detection (HPLC-UV) was used to detect and quantify sulfadoxine (SDX). Dried blood spots (DBS) of placental blood were collected for determination of sub-microscopic malaria using polymerase chain reaction (PCR). RESULTS In total, 397 (34.2%) pregnant women reported to have used sub-optimal doses (≤ 2) while 764 (65.8%) used optimal doses (≥ 3) of IPTp-SP at the time of delivery. The prevalence of placental malaria as determined by histology was 3.6%. Submicroscopic placental malaria was detected in 1.4% of the study participants. Women with peripheral malaria had six times risk of maternal anaemia than those who were malaria negative (aOR, 5.83; 95% CI 1.10-30.92; p = 0.04). The geometric mean plasma SDX concentration was 10.76 ± 2.51 μg/mL. Sub-optimal IPTp-SP dose was not associated with placental malaria, premature delivery and fetal anaemia. The use of ≤ 2 doses of IPTp-SP increased the risk of maternal anaemia by 1.36-fold compared to ≥ 3 doses (aOR, 1.36; 95% CI 1.04-1.79; p = 0.02). CONCLUSION The use of < 2 doses of IPTp-SP increased the risk of maternal anaemia. However, sub-optimal doses (≤ 2 doses) were not associated with increased the risk of malaria parasitaemia, fetal anaemia and preterm delivery among pregnant women in low malaria transmission setting. The use of optimal doses (≥ 3 doses) of IPTp-SP and complementary interventions should continue even in areas with low malaria transmission.
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Affiliation(s)
- Wigilya P Mikomangwa
- Clinical Pharmacy and Pharmacology Department, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania.
| | - Omary Minzi
- Clinical Pharmacy and Pharmacology Department, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Ritah Mutagonda
- Clinical Pharmacy and Pharmacology Department, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Vito Baraka
- National Institute for Medical Research, Tanga Centre, Tanga, United Republic of Tanzania
| | - Eulambius M Mlugu
- Pharmaceutics and Pharmacy Practice Department, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Eleni Aklillu
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital-Huddinge C1:68, 141 86, Stockholm, Sweden
| | - Appolinary A R Kamuhabwa
- Clinical Pharmacy and Pharmacology Department, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
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20
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Mlugu EM, Minzi O, Asghar M, Färnert A, Kamuhabwa AA, Aklillu E. Effectiveness of Sulfadoxine-Pyrimethamine for Intermittent Preventive Treatment of Malaria and Adverse Birth Outcomes in Pregnant Women. Pathogens 2020; 9:pathogens9030207. [PMID: 32168945 PMCID: PMC7157612 DOI: 10.3390/pathogens9030207] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 03/09/2020] [Accepted: 03/10/2020] [Indexed: 12/28/2022] Open
Abstract
Effectiveness of intermittent preventive treatment in pregnancy with sulfadoxine–pyrimethamine (IPTp-SP) for prevention of malaria and adverse birth outcomes can be compromised by parasites-resistance to sulfadoxine–pyrimethamine. This study prospectively evaluated the effectiveness of IPTp-SP in Southeast Tanzania. From January 2017 to May 2019, HIV-negative and malaria-negative (mRDT) pregnant women attending their first antenatal-care visit in the second or third trimester (n = 500) were enrolled to receive monthly IPTp-SP and followed the protocol till delivery. The primary outcome was the prevalence of histopathological placental malaria. Secondary outcomes were anemia, malaria parasites detected during pregnancy and at delivery, adverse birth outcomes (low-birth-weight [LBW], premature birth, fetal anemia, still birth, and spontaneous abortion). Rates of histopathological placental malaria, any parasitemia at delivery (placental, cord or maternal), and any adverse birth outcome were 9.4%, 20.9%, and 26.5%, respectively. Rates of symptomatic malaria and parasitemia during pregnancy were 2.8% and 16%, respectively. Histopathological placental malaria significantly increased the odds of any adverse birth outcomes, particularly LBW. IPTp-SP with more than or equal to three doses significantly improved birth weight and reduced the risk of LBW by 56% compared to <3 SP doses (p = 0.009). IPTp-SP with more than or equal to three doses is still effective in improving birth weight. However, the detection of histopathological placental-malaria in one-tenth and parasitemia in one-fifth of pregnant women reflects the need to optimize the prevention of malaria during pregnancy.
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Affiliation(s)
- Eulambius M. Mlugu
- Department of Pharmaceutics, School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam 0702172, Tanzania;
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet at Karolinska University Hospital, 141 86 Stockholm, Sweden
| | - Omary Minzi
- Department of Clinical Pharmacy and Pharmacology, School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam 0702172, Tanzania; (O.M.)
| | - Muhammad Asghar
- Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, 171 76 Stockholm, Sweden; (M.A.); (A.F.)
- Department of Infectious Diseases, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Anna Färnert
- Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, 171 76 Stockholm, Sweden; (M.A.); (A.F.)
- Department of Infectious Diseases, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Appolinary A.R. Kamuhabwa
- Department of Clinical Pharmacy and Pharmacology, School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam 0702172, Tanzania; (O.M.)
| | - Eleni Aklillu
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet at Karolinska University Hospital, 141 86 Stockholm, Sweden
- Correspondence:
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21
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Mikomangwa WP, OMS M, Aklillu E, Kamuhabwa AAR. Adverse birth outcomes among mothers who received intermittent preventive treatment with Sulphadoxine-Pyrimethamine in the low malaria transmission region. BMC Pregnancy Childbirth 2019; 19:236. [PMID: 31286878 PMCID: PMC6615266 DOI: 10.1186/s12884-019-2397-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 07/03/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Malaria in pregnancy increases the risk of adverse birth outcomes such as low birth weight (LBW), maternal and foetal anemia. In Tanzania, some areas have attained low malaria transmission. However, data on the burden of preterm delivery, LBW, maternal and foetal anemia following substantial reduction of malaria transmission in recent years is still scarce in these settings. METHODS A study involving 631 pregnant women was conducted at Mwananyamala referral hospital in Dar es Salaam from April to August, 2018. Study enrollment was done prior to delivery. Structured interview and antenatal clinic cards were used to obtain data including the use of intermittent preventive therapy in pregnancy using sulfadoxine-pyrimethamine (IPTp-SP). Infants birth weights were recorded, maternal venous and cord blood were taken for testing of malaria and determination of haemoglobin (Hb) levels. Chi-square test and regression analysis were done to identify risk factors for preterm delivery, LBW, maternal and foetal anemia. RESULTS The prevalence of malaria among mothers who used at least one dose of IPTp-SP was 0.6% (4/631). Fourteen mothers (2.2%) did not use IPTp-SP and had no malaria infection. The prevalence of maternal anemia, LBW, foetal anemia and preterm delivery was 40.6, 6.5, 5.9 and 9.2% respectively. Participants who were malaria positive had 11 times more risk of LBW compared to those who were negative (AOR, 11; 95%, CI 1.07-132.2; p = 0.04). The risk of delivering babies with LBW was 1.12 times high among mothers who were ≤ 36 weeks of gestation (AOR, 1.12; 95% CI, 0.06-0.25; p = < 0.001). The use of ≥3 doses of IPTp-SP was associated with 83% decrease in risk of LBW compared to those who did not use any dose of IPTp-SP (AOR, 0.17; 95% CI, 0.03-0.88; p = 0.05). Severe anaemia at delivery was associated with seven times increased risk of preterm delivery compared to non-anemic participants (AOR, 6.5; 95% CI, 1.49-28.16; p = 0.013). CONCLUSION Despite the reduced malaria transmission and use of IPTp-SP, prevalence of preterm delivery, maternal anemia, LBW and foetal anemia is still high in Tanzania. The recommended ≥3 doses of IPTp-SP should continue be provided even in areas with substantial reduction of malaria.
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Affiliation(s)
- Wigilya P. Mikomangwa
- Clinical Pharmacy and Pharmacology Department, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Minzi OMS
- Clinical Pharmacy and Pharmacology Department, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Eleni Aklillu
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital-Huddinge C1:68, SE-141 86 Stockholm, Sweden
| | - Appolinary A. R. Kamuhabwa
- Clinical Pharmacy and Pharmacology Department, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Shukla S, Bishnoi A, Devi P, Kumar S, Srivastava A, Srivastava K, Fatma S. Synthesis, Characterization, and in vitro Antibacterial Evaluation of Barbituric Acid Derivatives. RUSSIAN JOURNAL OF ORGANIC CHEMISTRY 2019; 55:860-865. [DOI: 10.1134/s1070428019060174] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Revised: 12/29/2018] [Accepted: 12/30/2018] [Indexed: 10/30/2023]
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23
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van Eijk AM, Larsen DA, Kayentao K, Koshy G, Slaughter DEC, Roper C, Okell LC, Desai M, Gutman J, Khairallah C, Rogerson SJ, Hopkins Sibley C, Meshnick SR, Taylor SM, Ter Kuile FO. Effect of Plasmodium falciparum sulfadoxine-pyrimethamine resistance on the effectiveness of intermittent preventive therapy for malaria in pregnancy in Africa: a systematic review and meta-analysis. THE LANCET. INFECTIOUS DISEASES 2019; 19:546-556. [PMID: 30922818 DOI: 10.1016/s1473-3099(18)30732-1] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 10/30/2018] [Accepted: 11/20/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND Resistance of Plasmodium falciparum to sulfadoxine-pyrimethamine threatens the antimalarial effectiveness of intermittent preventive treatment during pregnancy (IPTp) in sub-Saharan Africa. We aimed to assess the associations between markers of sulfadoxine-pyrimethamine resistance in P falciparum and the effectiveness of sulfadoxine-pyrimethamine IPTp for malaria-associated outcomes. METHODS For this systematic review and meta-analysis, we searched databases (from Jan 1, 1990 to March 1, 2018) for clinical studies (aggregated data) or surveys (individual participant data) that reported data on low birthweight (primary outcome) and malaria by sulfadoxine-pyrimethamine IPTp dose, and for studies that reported on molecular markers of sulfadoxine-pyrimethamine resistance. Studies that involved only HIV-infected women or combined interventions were excluded. We did a random-effects meta-analysis (clinical studies) or multivariate log-binomial regression (surveys) to obtain summarised dose-response data (relative risk reduction [RRR]) and multivariate meta-regression to explore the modifying effects of sulfadoxine-pyrimethamine resistance (as indicated by Ala437Gly, Lys540Glu, and Ala581Gly substitutions in the dhps gene). This study is registered with PROSPERO, number 42016035540. FINDINGS Of 1097 records screened, 57 studies were included in the aggregated-data meta-analysis (including 59 457 births). The RRR for low birthweight declined with increasing prevalence of dhps Lys540Glu (ptrend=0·0060) but not Ala437Gly (ptrend=0·35). The RRR was 7% (95% CI 0 to 13) in areas of high resistance to sulfadoxine-pyrimethamine (Lys540Glu ≥90% in east and southern Africa; n=11), 21% (14 to 29) in moderate-resistance areas (Ala437Gly ≥90% [central and west Africa], or Lys540Glu ≥30% to <90% [east and southern Africa]; n=16), and 27% (21 to 33) in low-resistance areas (Ala437Gly <90% [central and west Africa], or Lys540Glu <30% [east and southern Africa]; n=30; ptrend=0·0054 [univariate], I2=69·5%). The overall RRR in all resistance strata was 21% (17 to 25). In the analysis of individual participant data from 13 surveys (42 394 births), sulfadoxine-pyrimethamine IPTp was associated with reduced prevalence of low birthweight in areas with a Lys540Glu prevalence of more than 90% and Ala581Gly prevalence of less than 10% (RRR 10% [7 to 12]), but not in those with an Ala581Gly prevalence of 10% or higher (pooled Ala581Gly prevalence 37% [range 29 to 46]; RRR 0·5% [-16 to 14]; 2326 births). INTERPRETATION The effectiveness of sulfadoxine-pyrimethamine IPTp is reduced in areas with high resistance to sulfadoxine-pyrimethamine among P falciparum parasites, but remains associated with reductions in low birthweight even in areas where dhps Lys540Glu prevalence exceeds 90% but where the sextuple-mutant parasite (harbouring the additional dhps Ala581Gly mutation) is uncommon. Therapeutic alternatives to sulfadoxine-pyrimethamine IPTp are needed in areas where the prevalence of the sextuple-mutant parasite exceeds 37%. FUNDING US Centers for Disease Control and Prevention, the Malaria in Pregnancy Consortium (funded through a grant from the Bill & Melinda Gates Foundation to the Liverpool School of Tropical Medicine), Worldwide Antimalarial Resistance Network, European and Developing Countries Clinical Trials Partnership.
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Affiliation(s)
- Anna Maria van Eijk
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - David A Larsen
- Department of Public Health, Food Studies and Nutrition, Syracuse University, Syracuse, NY, USA
| | - Kassoum Kayentao
- Malaria Research and Training Centre, Department of Epidemiology of Parasitic Diseases, Faculty of Medicine, Pharmacy, and Dentistry, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali
| | - Gibby Koshy
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Cally Roper
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Lucy C Okell
- MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Meghna Desai
- Malaria Branch, US Centers for Diseases Control and Prevention, Atlanta, GA, USA
| | - Julie Gutman
- Malaria Branch, US Centers for Diseases Control and Prevention, Atlanta, GA, USA
| | - Carole Khairallah
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Stephen J Rogerson
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Carol Hopkins Sibley
- Department of Genome Sciences, University of Washington, Seattle, WA, USA; WorldWide Antimalarial Resistance Network, University of Oxford, Oxford, UK
| | - Steven R Meshnick
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Steve M Taylor
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA; Division of Infectious Diseases and Duke Global Health Institute, Duke University Medical Center, Durham, NC, USA
| | - Feiko O Ter Kuile
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
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24
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Vallely AJ, Pomat WS, Homer C, Guy R, Luchters S, Mola GDL, Kariwiga G, Vallely LM, Wiseman V, Morgan C, Wand H, Rogerson SJ, Tabrizi SN, Whiley DM, Low N, Peeling R, Siba P, Riddell M, Laman M, Bolnga J, Robinson LJ, Morewaya J, Badman SG, Batura N, Kelly-Hanku A, Toliman PJ, Peter W, Babona D, Peach E, Garland SM, Kaldor JM. Point-of-care testing and treatment of sexually transmitted infections to improve birth outcomes in high-burden, low-income settings: Study protocol for a cluster randomized crossover trial (the WANTAIM Trial, Papua New Guinea). Wellcome Open Res 2019; 4:53. [PMID: 32030356 PMCID: PMC6979472 DOI: 10.12688/wellcomeopenres.15173.2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2019] [Indexed: 12/14/2022] Open
Abstract
Background: Chlamydia trachomatis,
Neisseria gonorrhoeae,
Trichomonas vaginalis and bacterial vaginosis have been associated with preterm birth and low birth weight, and are highly prevalent among pregnant women in many low- and middle-income settings. There is conflicting evidence on the potential benefits of screening and treating these infections in pregnancy. Newly available diagnostic technologies make it possible, for the first time, to conduct definitive field trials to fill this knowledge gap. The primary aim of this study is to evaluate whether antenatal point-of-care testing and immediate treatment of these curable sexually transmitted and genital infections (STIs) leads to reduction in preterm birth and low birth weight. Methods: The Women and Newborn Trial of Antenatal Interventions and Management (WANTAIM) is a cluster-randomised crossover trial in Papua New Guinea to compare point-of-care STI testing and immediate treatment with standard antenatal care (which includes the WHO-endorsed STI ‘syndromic’ management strategy based on clinical features alone without laboratory confirmation). The unit of randomisation is a primary health care facility and its catchment communities. The primary outcome is a composite measure of two events: the proportion of women and their newborns in each trial arm, who experience either preterm birth (delivery <37 completed weeks of gestation as determined by ultrasound) and/or low birth weight (<2500 g measured within 72 hours of birth). The trial will also evaluate neonatal outcomes, as well as the cost-effectiveness, acceptability and health system requirements of this strategy, compared with standard care. Conclusions: WANTAIM is the first randomised trial to evaluate the effectiveness, cost-effectiveness, acceptability and health system requirements of point-of-care STI testing and treatment to improve birth outcomes in high-burden settings. If the intervention is proven to have an impact, the trial will hasten access to these technologies and could improve maternal and neonatal health in high-burden settings worldwide. Registration: ISRCTN37134032.
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Affiliation(s)
- Andrew J Vallely
- Papua New Guinea Institute of Medical Research, Goroka, EHP, 441, Papua New Guinea.,The Kirby Institute for infection and immunity in society, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - William S Pomat
- Papua New Guinea Institute of Medical Research, Goroka, EHP, 441, Papua New Guinea
| | - Caroline Homer
- Macfarlane Burnet Institute for Medical Research and Public Health, Melbourne, VIC, 3004, Australia
| | - Rebecca Guy
- The Kirby Institute for infection and immunity in society, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Stanley Luchters
- Macfarlane Burnet Institute for Medical Research and Public Health, Melbourne, VIC, 3004, Australia
| | - Glen D L Mola
- School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, NCD, Papua New Guinea
| | - Grace Kariwiga
- Milne Bay Provincial Health Authority, Alotau, MBP, Papua New Guinea
| | - Lisa M Vallely
- Papua New Guinea Institute of Medical Research, Goroka, EHP, 441, Papua New Guinea.,The Kirby Institute for infection and immunity in society, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Virginia Wiseman
- The Kirby Institute for infection and immunity in society, UNSW Sydney, Sydney, NSW, 2052, Australia.,London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Chris Morgan
- Macfarlane Burnet Institute for Medical Research and Public Health, Melbourne, VIC, 3004, Australia
| | - Handan Wand
- The Kirby Institute for infection and immunity in society, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Stephen J Rogerson
- Doherty Institute, Department of Medicine, University of Melbourne, Melbourne, VIC, 3050, Australia
| | - Sepehr N Tabrizi
- Department of Microbiology, The Royal Women's Hospital Melbourne, Parkville, VIC, 3052, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Carlton, VIC, 3053, Australia
| | - David M Whiley
- UQ Centre for Clinical Research, University of Queensland, Herston, QLD, 4029, Australia
| | - Nicola Low
- Institute of Social and Preventive Medicine, University of Bern, Bern, 3012, Switzerland
| | - Rosanna Peeling
- London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Peter Siba
- Papua New Guinea Institute of Medical Research, Goroka, EHP, 441, Papua New Guinea
| | - Michaela Riddell
- Papua New Guinea Institute of Medical Research, Goroka, EHP, 441, Papua New Guinea.,The Kirby Institute for infection and immunity in society, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Moses Laman
- Papua New Guinea Institute of Medical Research, Goroka, EHP, 441, Papua New Guinea
| | - John Bolnga
- Department of Obstetrics & Gynaecology, Modilon General Hospital, Madang, MP, Papua New Guinea
| | - Leanne J Robinson
- Papua New Guinea Institute of Medical Research, Goroka, EHP, 441, Papua New Guinea.,Macfarlane Burnet Institute for Medical Research and Public Health, Melbourne, VIC, 3004, Australia
| | - Jacob Morewaya
- Milne Bay Provincial Health Authority, Alotau, MBP, Papua New Guinea
| | - Steven G Badman
- The Kirby Institute for infection and immunity in society, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Neha Batura
- Centre for Global Health Economics, Institute for Global Health, University College London, London, WC1N 1EH, UK
| | - Angela Kelly-Hanku
- Papua New Guinea Institute of Medical Research, Goroka, EHP, 441, Papua New Guinea.,The Kirby Institute for infection and immunity in society, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Pamela J Toliman
- Papua New Guinea Institute of Medical Research, Goroka, EHP, 441, Papua New Guinea.,The Kirby Institute for infection and immunity in society, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Wilfred Peter
- Provincial Health Office, Madang, MP, Papua New Guinea
| | - Delly Babona
- St Mary's Vunapope Rural Hospital, Kokopo, ENBP, 613, Papua New Guinea
| | - Elizabeth Peach
- Macfarlane Burnet Institute for Medical Research and Public Health, Melbourne, VIC, 3004, Australia
| | - Suzanne M Garland
- Department of Microbiology, The Royal Women's Hospital Melbourne, Parkville, VIC, 3052, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Carlton, VIC, 3053, Australia
| | - John M Kaldor
- The Kirby Institute for infection and immunity in society, UNSW Sydney, Sydney, NSW, 2052, Australia
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25
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Vallely AJ, Pomat WS, Homer C, Guy R, Luchters S, Mola GDL, Kariwiga G, Vallely LM, Wiseman V, Morgan C, Wand H, Rogerson SJ, Tabrizi SN, Whiley DM, Low N, Peeling R, Siba P, Riddell M, Laman M, Bolnga J, Robinson LJ, Morewaya J, Badman SG, Batura N, Kelly-Hanku A, Toliman PJ, Peter W, Babona D, Peach E, Garland SM, Kaldor JM. Point-of-care testing and treatment of sexually transmitted infections to improve birth outcomes in high-burden, low-income settings: Study protocol for a cluster randomized crossover trial (the WANTAIM Trial, Papua New Guinea). Wellcome Open Res 2019. [PMID: 32030356 DOI: 10.12688/wellcomeopenres.15173.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Background: Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis and bacterial vaginosis have been associated with preterm birth and low birth weight, and are highly prevalent among pregnant women in many low- and middle-income settings. There is conflicting evidence on the potential benefits of screening and treating these infections in pregnancy. Newly available diagnostic technologies make it possible, for the first time, to conduct definitive field trials to fill this knowledge gap. The primary aim of this study is to evaluate whether antenatal point-of-care testing and immediate treatment of these curable sexually transmitted and genital infections (STIs) leads to reduction in preterm birth and low birth weight. Methods: The Women and Newborn Trial of Antenatal Interventions and Management (WANTAIM) is a cluster-randomised crossover trial in Papua New Guinea to compare point-of-care STI testing and immediate treatment with standard antenatal care (which includes the WHO-endorsed STI 'syndromic' management strategy based on clinical features alone without laboratory confirmation). The unit of randomisation is a primary health care facility and its catchment communities. The primary outcome is a composite measure of two events: the proportion of women and their newborns in each trial arm, who experience either preterm birth (delivery <37 completed weeks of gestation as determined by ultrasound) and/or low birth weight (<2500 g measured within 72 hours of birth). The trial will also evaluate neonatal outcomes, as well as the cost-effectiveness, acceptability and health system requirements of this strategy, compared with standard care. Conclusions: WANTAIM is the first randomised trial to evaluate the effectiveness, cost-effectiveness, acceptability and health system requirements of point-of-care STI testing and treatment to improve birth outcomes in high-burden settings. If the intervention is proven to have an impact, the trial will hasten access to these technologies and could improve maternal and neonatal health in high-burden settings worldwide. Registration: ISRCTN37134032.
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Affiliation(s)
- Andrew J Vallely
- Papua New Guinea Institute of Medical Research, Goroka, EHP, 441, Papua New Guinea.,The Kirby Institute for infection and immunity in society, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - William S Pomat
- Papua New Guinea Institute of Medical Research, Goroka, EHP, 441, Papua New Guinea
| | - Caroline Homer
- Macfarlane Burnet Institute for Medical Research and Public Health, Melbourne, VIC, 3004, Australia
| | - Rebecca Guy
- The Kirby Institute for infection and immunity in society, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Stanley Luchters
- Macfarlane Burnet Institute for Medical Research and Public Health, Melbourne, VIC, 3004, Australia
| | - Glen D L Mola
- School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, NCD, Papua New Guinea
| | - Grace Kariwiga
- Milne Bay Provincial Health Authority, Alotau, MBP, Papua New Guinea
| | - Lisa M Vallely
- Papua New Guinea Institute of Medical Research, Goroka, EHP, 441, Papua New Guinea.,The Kirby Institute for infection and immunity in society, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Virginia Wiseman
- The Kirby Institute for infection and immunity in society, UNSW Sydney, Sydney, NSW, 2052, Australia.,London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Chris Morgan
- Macfarlane Burnet Institute for Medical Research and Public Health, Melbourne, VIC, 3004, Australia
| | - Handan Wand
- The Kirby Institute for infection and immunity in society, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Stephen J Rogerson
- Doherty Institute, Department of Medicine, University of Melbourne, Melbourne, VIC, 3050, Australia
| | - Sepehr N Tabrizi
- Department of Microbiology, The Royal Women's Hospital Melbourne, Parkville, VIC, 3052, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Carlton, VIC, 3053, Australia
| | - David M Whiley
- UQ Centre for Clinical Research, University of Queensland, Herston, QLD, 4029, Australia
| | - Nicola Low
- Institute of Social and Preventive Medicine, University of Bern, Bern, 3012, Switzerland
| | - Rosanna Peeling
- London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Peter Siba
- Papua New Guinea Institute of Medical Research, Goroka, EHP, 441, Papua New Guinea
| | - Michaela Riddell
- Papua New Guinea Institute of Medical Research, Goroka, EHP, 441, Papua New Guinea.,The Kirby Institute for infection and immunity in society, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Moses Laman
- Papua New Guinea Institute of Medical Research, Goroka, EHP, 441, Papua New Guinea
| | - John Bolnga
- Department of Obstetrics & Gynaecology, Modilon General Hospital, Madang, MP, Papua New Guinea
| | - Leanne J Robinson
- Papua New Guinea Institute of Medical Research, Goroka, EHP, 441, Papua New Guinea.,Macfarlane Burnet Institute for Medical Research and Public Health, Melbourne, VIC, 3004, Australia
| | - Jacob Morewaya
- Milne Bay Provincial Health Authority, Alotau, MBP, Papua New Guinea
| | - Steven G Badman
- The Kirby Institute for infection and immunity in society, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Neha Batura
- Centre for Global Health Economics, Institute for Global Health, University College London, London, WC1N 1EH, UK
| | - Angela Kelly-Hanku
- Papua New Guinea Institute of Medical Research, Goroka, EHP, 441, Papua New Guinea.,The Kirby Institute for infection and immunity in society, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Pamela J Toliman
- Papua New Guinea Institute of Medical Research, Goroka, EHP, 441, Papua New Guinea.,The Kirby Institute for infection and immunity in society, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Wilfred Peter
- Provincial Health Office, Madang, MP, Papua New Guinea
| | - Delly Babona
- St Mary's Vunapope Rural Hospital, Kokopo, ENBP, 613, Papua New Guinea
| | - Elizabeth Peach
- Macfarlane Burnet Institute for Medical Research and Public Health, Melbourne, VIC, 3004, Australia
| | - Suzanne M Garland
- Department of Microbiology, The Royal Women's Hospital Melbourne, Parkville, VIC, 3052, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Carlton, VIC, 3053, Australia
| | - John M Kaldor
- The Kirby Institute for infection and immunity in society, UNSW Sydney, Sydney, NSW, 2052, Australia
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Moore BR, Davis TME. Pharmacotherapy for the prevention of malaria in pregnant women: currently available drugs and challenges. Expert Opin Pharmacother 2018; 19:1779-1796. [PMID: 30289730 DOI: 10.1080/14656566.2018.1526923] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Malaria in pregnancy continues to be a significant public health burden globally, with over 100 million women at risk each year. Sulfadoxine-pyrimethamine (SP) is the only antimalarial recommended for intermittent preventive therapy in pregnancy (IPTp) but increasing parasite resistance threatens its viability. There are few other available antimalarial therapies that currently have sufficient evidence of tolerability, safety, and efficacy to replace SP. AREAS COVERED Novel antimalarial combinations are under investigation for potential use as chemoprophylaxis and in IPTp regimens. The present review summarizes currently available therapies, emerging candidate combination therapies, and the potential challenges to integrating these into mainstream policy. EXPERT OPINION Alternative drugs or combination therapies to SP for IPTp are desperately required. Dihydroartemisinin-piperaquine and azithromycin-based combinations are showing great promise as potential candidates for IPTp but pharmacokinetic data suggest that dose modification may be required to ensure adequate prophylactic efficacy. If a suitable candidate regimen is not identified in the near future, the success of chemopreventive strategies such as IPTp may be in jeopardy.
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Affiliation(s)
- Brioni R Moore
- a School of Pharmacy and Biomedical Sciences , Curtin University , Bentley , Western Australia , Australia.,b Medical School , University of Western Australia , Crawley , Western Australia , Australia
| | - Timothy M E Davis
- b Medical School , University of Western Australia , Crawley , Western Australia , Australia
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27
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Chico RM, ter Kuile FO. Back to chloroquine for malaria prophylaxis in pregnancy? THE LANCET. INFECTIOUS DISEASES 2018; 18:1051-1052. [DOI: 10.1016/s1473-3099(18)30427-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 07/04/2018] [Indexed: 10/28/2022]
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28
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Divala TH, Mungwira RG, Mawindo PM, Nyirenda OM, Kanjala M, Ndaferankhande M, Tsirizani LE, Masonga R, Muwalo F, Boudová S, Potter GE, Kennedy J, Goswami J, Wylie BJ, Muehlenbachs A, Ndovie L, Mvula P, Mbilizi Y, Tomoka T, Laufer MK. Chloroquine as weekly chemoprophylaxis or intermittent treatment to prevent malaria in pregnancy in Malawi: a randomised controlled trial. THE LANCET. INFECTIOUS DISEASES 2018; 18:1097-1107. [PMID: 30195996 PMCID: PMC6217965 DOI: 10.1016/s1473-3099(18)30415-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 06/01/2018] [Accepted: 06/19/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND Sulfadoxine-pyrimethamine resistance threatens efficacy of intermittent preventive treatment of malaria during pregnancy, and alternative regimens need to be identified. With the return of chloroquine efficacy in southern Africa, we postulated that chloroquine either as an intermittent therapy or as weekly chemoprophylaxis would be more efficacious than intermittent sulfadoxine-pyrimethamine for prevention of malaria in pregnancy and associated maternal and newborn adverse outcomes. METHODS We did an open-label, single-centre, randomised controlled trial at Ndirande Health Centre, Blantyre, in southern Malawi. We enrolled pregnant women (first or second pregnancy) at 20-28 weeks' gestation who were HIV negative. Participants were randomly assigned in a 1:1:1 ratio using a computer-generated list to either intermittent sulfadoxine-pyrimethamine (two doses of 1500 mg sulfadoxine and 75 mg pyrimethamine, 4 weeks apart), intermittent chloroquine (two doses of 600 mg on day 1, 600 mg on day 2, and 300 mg on day 3), or chloroquine prophylaxis (600 mg on day 1 then 300 mg every week). The primary endpoint was placental malaria in the modified intent-to-treat population, which consisted of participants who contributed placental histopathology data at birth. Secondary outcomes included clinical malaria, maternal anaemia, low birthweight, and safety. This trial is registered with ClinicalTrials.gov, number NCT01443130. FINDINGS Between February, 2012, and May, 2014, we enrolled and randomly allocated 900 women, of whom 765 contributed histopathological data and were included in the primary analysis. 108 (14%) women had placental malaria, which was lower than the anticipated prevalence of placental malaria infection. Protection from placental malaria was not improved by chloroquine as either prophylaxis (30 [12%] of 259 had positive histopathology; relative risk [RR] 0·75, 95% CI 0·48-1·17) or intermittent therapy (39 [15%] of 253; RR 1·00, 0·67-1·50) compared with intermittent sulfadoxine-pyrimethamine (39 [15%] of 253). In protocol-specified analyses adjusted for maternal age, gestational age at enrolment, bednet use the night before enrolment, anaemia at enrolment, and malaria infection at enrolment, women taking chloroquine as prophylaxis had 34% lower placental infections than did those allocated intermittent sulfadoxine-pyrimethamine (RR 0·66, 95% CI 0·46-0·95). Clinical malaria was reported in nine women assigned intermittent sulfadoxine-pyrimethamine, four allocated intermittent chloroquine (p=0·26), and two allocated chloroquine prophylaxis (p=0·063). Maternal anaemia was noted in five women assigned intermittent sulfadoxine-pyrimethamine, 15 allocated intermittent chloroquine (p=0·038), and six assigned chloroquine prophylaxis (p>0·99). Low birthweight was recorded for 31 babies born to women allocated intermittent sulfadoxine-pyrimethamine, 29 assigned intermittent chloroquine (p=0·78), and 41 allocated chloroquine prophylaxis (p=0·28). Four women assigned intermittent sulfadoxine-pyrimethamine had adverse events possibly related to study product compared with 94 women allocated intermittent chloroquine (p<0·0001) and 26 allocated chloroquine prophylaxis (p<0·0001). Three women had severe or life-threatening adverse events related to study product, of whom all were assigned intermittent chloroquine (p=0·25). INTERPRETATION Chloroquine administered as intermittent therapy did not provide better protection from malaria and related adverse effects compared with intermittent sulfadoxine-pyrimethamine in a setting of high resistance to sulfadoxine-pyrimethamine. Chloroquine chemoprophylaxis might provide benefit in protecting against malaria during pregnancy, but studies with larger sample sizes are needed to confirm these results. FUNDING US National Institutes of Health.
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Affiliation(s)
- Titus H Divala
- Blantyre Malaria Project, University of Malawi College of Medicine, Blantyre, Malawi
| | - Randy G Mungwira
- Blantyre Malaria Project, University of Malawi College of Medicine, Blantyre, Malawi
| | - Patricia M Mawindo
- Blantyre Malaria Project, University of Malawi College of Medicine, Blantyre, Malawi
| | - Osward M Nyirenda
- Blantyre Malaria Project, University of Malawi College of Medicine, Blantyre, Malawi
| | - Maxwell Kanjala
- Blantyre Malaria Project, University of Malawi College of Medicine, Blantyre, Malawi
| | - Masiye Ndaferankhande
- Blantyre Malaria Project, University of Malawi College of Medicine, Blantyre, Malawi
| | - Lufina E Tsirizani
- Blantyre Malaria Project, University of Malawi College of Medicine, Blantyre, Malawi
| | - Rhoda Masonga
- Blantyre Malaria Project, University of Malawi College of Medicine, Blantyre, Malawi
| | - Francis Muwalo
- Blantyre Malaria Project, University of Malawi College of Medicine, Blantyre, Malawi
| | - Sarah Boudová
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | | | - Jaya Goswami
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Blair J Wylie
- Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | | | - Lughano Ndovie
- Department of Obstetrics and Gynaecology, University of Malawi College of Medicine, Blantyre, Malawi
| | - Priscilla Mvula
- Department of Obstetrics and Gynaecology, University of Malawi College of Medicine, Blantyre, Malawi
| | - Yamikani Mbilizi
- Department of Obstetrics and Gynaecology, University of Malawi College of Medicine, Blantyre, Malawi
| | - Tamiwe Tomoka
- Pathology Department, University of Malawi College of Medicine, Blantyre, Malawi
| | - Miriam K Laufer
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA.
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Prevention of malaria in pregnancy. THE LANCET. INFECTIOUS DISEASES 2018; 18:e119-e132. [PMID: 29395997 DOI: 10.1016/s1473-3099(18)30064-1] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 10/23/2017] [Accepted: 10/27/2017] [Indexed: 12/15/2022]
Abstract
Malaria remains one of the most preventable causes of adverse birth outcomes. Intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine-pyrimethamine is used to prevent malaria, but resistance to this drug combination has decreased its efficacy and new alternatives are needed. In Africa, a meta-analysis showed three-course or monthly IPTp with sulfadoxine-pyrimethamine to be safe and more effective than the original two-course sulfadoxine-pyrimethamine strategy, prompting WHO to update its policy in 2012. Although resistance to sulfadoxine-pyrimethamine reduces the parasitological efficacy of IPTp, this drug combination remains associated with reduced incidence of low birthweight in areas where prevalence of parasites with quintuple Plasmodium falciparum dihydrofolate reductase (Pfdhfr) and dihydropteroate synthetase (Pfdhps) mutations is greater than 90%. Nevertheless, its effectiveness is compromised in women infected with sextuple mutant parasites. Six trials of IPTp showed that neither amodiaquine, mefloquine, nor chloroquine-azithromycin are suitable replacements for sulfadoxine-pyrimethamine because of poor tolerability. Furthermore, four trials showed that intermittent screening and treatment with the current generation of malaria rapid diagnostic tests was not a suitable alternative strategy to IPTp with sulfadoxine-pyrimethamine, even in areas with high prevalence of quintuple mutations. Two trials showed that IPTp with dihydroartemisinin-piperaquine was well tolerated, effective, and acceptable for IPTp, with monthly regimens being the most effective. Coverage of IPTp and insecticide-treated nets continues to lag behind targets. The key barriers to uptake are well documented, and many are open to intervention. Outside of Africa, a single trial suggests a potential role for integrated approaches that combine sulfadoxine-pyrimethamine with azithromycin for IPTp in areas of Papua New Guinea where malaria transmission is high. Modelling analysis suggests the importance of the prevention of malaria early in pregnancy and the need to protect pregnant women declines more slowly than the rate at which transmission declines. Improved funding has led to an increase in the number of prevention trials in the past decade, showing the value of more sustained protection with monthly IPTp regimens. There is a need for confirmatory trials of the safety, efficacy, and feasibility of IPTp with dihydroartemisinin-piperaquine, for studies of intermittent screening and treatment with more sensitive rapid diagnostic tests, for studies of integrated strategies for malaria and other co-infections, and for studies of prevention strategies for malaria in pregnant women who are HIV-positive and living outside of Africa. Additional research is required on how to improve uptake of WHO's updated policy on IPTp with sulfadoxine-pyrimethamine and insecticide-treated nets.
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30
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Gutman J, Slutsker L. Intermittent Preventive Treatment with Sulfadoxine-Pyrimethamine: More Than Just an Antimalarial? Am J Trop Med Hyg 2016; 96:9-10. [PMID: 27994102 PMCID: PMC5239716 DOI: 10.4269/ajtmh.16-0888] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 11/11/2016] [Indexed: 11/17/2022] Open
Affiliation(s)
- Julie Gutman
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Laurence Slutsker
- Malaria and Neglected Tropical Diseases, Center for Malaria Control and Elimination, PATH, Seattle, Washington
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31
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Madanitsa M, Kalilani L, Mwapasa V, van Eijk AM, Khairallah C, Ali D, Pace C, Smedley J, Thwai KL, Levitt B, Wang D, Kang’ombe A, Faragher B, Taylor SM, Meshnick S, ter Kuile FO. Scheduled Intermittent Screening with Rapid Diagnostic Tests and Treatment with Dihydroartemisinin-Piperaquine versus Intermittent Preventive Therapy with Sulfadoxine-Pyrimethamine for Malaria in Pregnancy in Malawi: An Open-Label Randomized Controlled Trial. PLoS Med 2016; 13:e1002124. [PMID: 27622558 PMCID: PMC5021271 DOI: 10.1371/journal.pmed.1002124] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 08/05/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In Africa, most plasmodium infections during pregnancy remain asymptomatic, yet are associated with maternal anemia and low birthweight. WHO recommends intermittent preventive therapy in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP). However, sulfadoxine-pyrimethamine (SP) efficacy is threatened by high-level parasite resistance. We conducted a trial to evaluate the efficacy and safety of scheduled intermittent screening with malaria rapid diagnostic tests (RDTs) and treatment of RDT-positive women with dihydroartemisinin-piperaquine (DP) as an alternative strategy to IPTp-SP. METHODS AND FINDINGS This was an open-label, two-arm individually randomized superiority trial among HIV-seronegative women at three sites in Malawi with high SP resistance. The intervention consisted of three or four scheduled visits in the second and third trimester, 4 to 6 wk apart. Women in the IPTp-SP arm received SP at each visit. Women in the intermittent screening and treatment in pregnancy with DP (ISTp-DP) arm were screened for malaria at every visit and treated with DP if RDT-positive. The primary outcomes were adverse live birth outcome (composite of small for gestational age, low birthweight [<2,500 g], or preterm birth [<37 wk]) in paucigravidae (first or second pregnancy) and maternal or placental plasmodium infection at delivery in multigravidae (third pregnancy or higher). Analysis was by intention to treat. Between 21 July 2011 and 18 March 2013, 1,873 women were recruited (1,155 paucigravidae and 718 multigravidae). The prevalence of adverse live birth outcome was similar in the ISTp-DP (29.9%) and IPTp-SP (28.8%) arms (risk difference = 1.08% [95% CI -3.25% to 5.41%]; all women: relative risk [RR] = 1.04 [95% CI 0.90-1.20], p = 0.625; paucigravidae: RR = 1.10 [95% CI 0.92-1.31], p = 0.282; multigravidae: RR = 0.92 [95% CI 0.71-1.20], p = 0.543). The prevalence of malaria at delivery was higher in the ISTp-DP arm (48.7% versus 40.8%; risk difference = 7.85%, [95% CI 3.07%-12.63%]; all women: RR = 1.19 [95% CI 1.07-1.33], p = 0.007; paucigravidae: RR = 1.16 [95% CI 1.04-1.31], p = 0.011; multigravidae: RR = 1.29 [95% CI 1.02-1.63], p = 0.037). Fetal loss was more common with ISTp-DP (2.6% versus 1.3%; RR = 2.06 [95% CI 1.01-4.21], p = 0.046) and highest among non-DP-recipients (3.1%) in the ISTp-DP arm. Limitations included the open-label design. CONCLUSIONS Scheduled screening for malaria parasites with the current generation of RDTs three to four times during pregnancy as part of focused antenatal care was not superior to IPTp-SP in this area with high malaria transmission and high SP resistance and was associated with higher fetal loss and more malaria at delivery. TRIAL REGISTRATION Pan African Clinical Trials Registry PACTR201103000280319; ISRCTN Registry ISRCTN69800930.
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Affiliation(s)
- Mwayiwawo Madanitsa
- College of Medicine, University of Malawi, Blantyre, Malawi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Linda Kalilani
- College of Medicine, University of Malawi, Blantyre, Malawi
| | - Victor Mwapasa
- College of Medicine, University of Malawi, Blantyre, Malawi
| | - Anna M. van Eijk
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Carole Khairallah
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Doreen Ali
- National Malaria Control Programme, Ministry of Health, Lilongwe, Malawi
| | - Cheryl Pace
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - James Smedley
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Kyaw-Lay Thwai
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Brandt Levitt
- Department of Molecular Genetics and Microbiology, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Duolao Wang
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Arthur Kang’ombe
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Brian Faragher
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Steve M. Taylor
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Steve Meshnick
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Feiko O. ter Kuile
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- * E-mail:
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32
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Desai M, Gutman J, L'lanziva A, Otieno K, Juma E, Kariuki S, Ouma P, Were V, Laserson K, Katana A, Williamson J, ter Kuile FO. Intermittent screening and treatment or intermittent preventive treatment with dihydroartemisinin-piperaquine versus intermittent preventive treatment with sulfadoxine-pyrimethamine for the control of malaria during pregnancy in western Kenya: an open-label, three-group, randomised controlled superiority trial. Lancet 2015; 386:2507-19. [PMID: 26429700 PMCID: PMC4718402 DOI: 10.1016/s0140-6736(15)00310-4] [Citation(s) in RCA: 147] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Every year, more than 32 million pregnancies in sub-Saharan Africa are at risk of malaria infection and its adverse consequences. The effectiveness of the intermittent preventive treatment with sulfadoxine-pyrimethamine strategy recommended by WHO is threatened by high levels of parasite resistance. We aimed to assess the efficacy and safety of two alternative strategies: intermittent screening with malaria rapid diagnostic tests and treatment of women who test positive with dihydroartemisinin-piperaquine, and intermittent preventive treatment with dihydroartemisinin-piperaquine. METHODS We did this open-label, three-group, randomised controlled superiority trial at four sites in western Kenya with high malaria transmission and sulfadoxine-pyrimethamine resistance. HIV-negative pregnant women between 16 and 32 weeks' gestation were randomly assigned (1:1:1), via computer-generated permuted-block randomisation (block sizes of three, six, and nine), to receive intermittent screening and treatment with dihydroartemisinin-piperaquine, intermittent preventive treatment with dihydroartemisinin-piperaquine, or intermittent preventive treatment with sulfadoxine-pyrimethamine. Study participants, study clinic nurses, and the study coordinator were aware of treatment allocation, but allocation was concealed from study investigators, delivery unit nurses, and laboratory staff. The primary outcome was malaria infection at delivery, defined as a composite of peripheral or placental parasitaemia detected by placental histology, microscopy, or rapid diagnostic test. The primary analysis was by modified intention to treat. This study is registered with ClinicalTrials.gov, number NCT01669941. FINDINGS Between Aug 21, 2012, and June 19, 2014, we randomly assigned 1546 women to receive intermittent screening and treatment with dihydroartemisinin-piperaquine (n=515), intermittent preventive treatment with dihydroartemisinin-piperaquine (n=516), or intermittent preventive treatment with sulfadoxine-pyrimethamine (n=515); 1368 (88%) women comprised the intention-to-treat population for the primary endpoint. Prevalence of malaria infection at delivery was lower in the intermittent preventive treatment with dihydroartemisinin-piperaquine group than in the intermittent preventive treatment with sulfadoxine-pyrimethamine group (15 [3%] of 457 women vs 47 [10%] of 459 women; relative risk 0·32, 95% CI 0·18-0·56; p<0·0001), but not in the intermittent screening and treatment with dihydroartemisinin-piperaquine group (57 [13%] of 452 women; 1·23, 0·86-1·77; p=0·26). Compared with intermittent preventive treatment with sulfadoxine-pyrimethamine, intermittent preventive treatment with dihydroartemisinin-piperaquine was associated with a lower incidence of malaria infection during pregnancy (192·0 vs 54·4 events per 100 person-years; incidence rate ratio [IRR] 0·28, 95% CI 0·22-0·36; p<0·0001) and clinical malaria during pregnancy (37·9 vs 6·1 events; 0·16, 0·08-0·33; p<0·0001), whereas intermittent screening and treatment with dihydroartemisinin-piperaquine was associated with a higher incidence of malaria infection (232·0 events; 1·21, 1·03-1·41; p=0·0177) and clinical malaria (53·4 events; 1·41, 1·00-1·98; p=0·0475). We recorded 303 maternal and infant serious adverse events, which were least frequent in the intermittent preventive treatment with dihydroartemisinin-piperaquine group. INTERPRETATION At current levels of rapid diagnostic test sensitivity, intermittent screening and treatment is not a suitable alternative to intermittent preventive treatment with sulfadoxine-pyrimethamine in the context of high sulfadoxine-pyrimethamine resistance and malaria transmission. However, dihydroartemisinin-piperaquine is a promising alternative drug to replace sulfadoxine-pyrimethamine for intermittent preventive treatment. Future studies should investigate the efficacy, safety, operational feasibility, and cost-effectiveness of intermittent preventive treatment with dihydroartemisinin-piperaquine. FUNDING The Malaria in Pregnancy Consortium, which is funded through a grant from the Bill & Melinda Gates Foundation to the Liverpool School of Tropical Medicine.
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Affiliation(s)
- Meghna Desai
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA; Centers for Disease Control and Prevention (CDC), Kisumu, Kenya.
| | - Julie Gutman
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Anne L'lanziva
- Centers for Disease Control and Prevention (CDC), Kisumu, Kenya
| | - Kephas Otieno
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - Elizabeth Juma
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - Simon Kariuki
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - Peter Ouma
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - Vincent Were
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - Kayla Laserson
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - John Williamson
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Desai M, Gutman J, Taylor SM, Wiegand RE, Khairallah C, Kayentao K, Ouma P, Coulibaly SO, Kalilani L, Mace KE, Arinaitwe E, Mathanga DP, Doumbo O, Otieno K, Edgar D, Chaluluka E, Kamuliwo M, Ades V, Skarbinski J, Shi YP, Magnussen P, Meshnick S, Ter Kuile FO. Impact of Sulfadoxine-Pyrimethamine Resistance on Effectiveness of Intermittent Preventive Therapy for Malaria in Pregnancy at Clearing Infections and Preventing Low Birth Weight. Clin Infect Dis 2015; 62:323-333. [PMID: 26486699 DOI: 10.1093/cid/civ881] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 10/03/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Owing to increasing sulfadoxine-pyrimethamine (SP) resistance in sub-Saharan Africa, monitoring the effectiveness of intermittent preventive therapy in pregnancy (IPTp) with SP is crucial. METHODS Between 2009 and 2013, both the efficacy of IPTp-SP at clearing existing peripheral malaria infections and the effectiveness of IPTp-SP at reducing low birth weight (LBW) were assessed among human immunodeficiency virus-uninfected participants in 8 sites in 6 countries. Sites were classified as high, medium, or low resistance after measuring parasite mutations conferring SP resistance. An individual-level prospective pooled analysis was conducted. RESULTS Among 1222 parasitemic pregnant women, overall polymerase chain reaction-uncorrected and -corrected failure rates by day 42 were 21.3% and 10.0%, respectively (39.7% and 21.1% in high-resistance areas; 4.9% and 1.1% in low-resistance areas). Median time to recurrence decreased with increasing prevalence of Pfdhps-K540E. Among 6099 women at delivery, IPTp-SP was associated with a 22% reduction in the risk of LBW (prevalence ratio [PR], 0.78; 95% confidence interval [CI], .69-.88; P < .001). This association was not modified by insecticide-treated net use or gravidity, and remained significant in areas with high SP resistance (PR, 0.81; 95% CI, .67-.97; P = .02). CONCLUSIONS The efficacy of SP to clear peripheral parasites and prevent new infections during pregnancy is compromised in areas with >90% prevalence of Pfdhps-K540E. Nevertheless, in these high-resistance areas, IPTp-SP use remains associated with increases in birth weight and maternal hemoglobin. The effectiveness of IPTp in eastern and southern Africa is threatened by further increases in SP resistance and reinforces the need to evaluate alternative drugs and strategies for the control of malaria in pregnancy.
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Affiliation(s)
- Meghna Desai
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia.,Malaria Branch, Center for Global Health Research, Kenya Medical Research Institute, Kisumu
| | - Julie Gutman
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Steve M Taylor
- Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina.,Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill
| | - Ryan E Wiegand
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Carole Khairallah
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, United Kingdom
| | - Kassoum Kayentao
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, United Kingdom.,Malaria Research and Training Center, University of Sciences, Technics and Technologies of Bamako, Mali
| | - Peter Ouma
- Malaria Branch, Center for Global Health Research, Kenya Medical Research Institute, Kisumu
| | | | | | - Kimberly E Mace
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Ogobara Doumbo
- Malaria Research and Training Center, University of Sciences, Technics and Technologies of Bamako, Mali
| | - Kephas Otieno
- Malaria Branch, Center for Global Health Research, Kenya Medical Research Institute, Kisumu
| | | | | | | | - Veronica Ades
- New York University Langone Medical Center, New York
| | - Jacek Skarbinski
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ya Ping Shi
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Pascal Magnussen
- Centre for Medical Parasitology, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Steve Meshnick
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill
| | - Feiko O Ter Kuile
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, United Kingdom
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Activity of antimicrobial drugs against bacterial pathogens under mild hypothermic conditions. Am J Emerg Med 2015; 33:1445-8. [PMID: 26231525 DOI: 10.1016/j.ajem.2015.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 07/03/2015] [Accepted: 07/03/2015] [Indexed: 11/23/2022] Open
Abstract
BACKROUND Infections are a common problem in cardiac arrest survivors. Antimicrobial drugs are often administered in routine care during treatment of patients with mild therapeutic hypothermia (MTH). Because there is to date no evidence for the pharmacodynamics of antimicrobial drugs under MTH conditions, we investigated the in vitro activity of common antimicrobials against clinically relevant bacterial pathogens. MATERIAL AND METHODS Activities of antimicrobial drugs against clinically relevant bacterial pathogens were assessed in vitro by disk diffusion and broth microdilution assays at normothermic (37°C) and hypothermic (32°C) conditions. RESULTS Seventy-three bacterial isolates were tested in disk diffusion and 15 in broth microdilution assays. Mean differences in zone diameters and minimal inhibitory concentration ratios were 0.6 mm (95% confidence interval, 0.3-0.9 mm) and 0.98 (95% confidence interval, 0.95-1.02), respectively, meeting predefined criteria for equivalence of in vitro antimicrobial activity. CONCLUSIONS The presented data provide reassuring evidence that the intrinsic activity of antimicrobials seems to be unaltered in MTH. However, further studies evaluating the pharmacokinetics including target site concentrations of the respective drugs and in vivo pharmacodynamics are necessary to complement our understanding of the appropriate use of antimicrobials in MTH.
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Capan-Melser M, Mombo Ngoma G, Akerey-Diop D, Basra A, Würbel H, Groger M, Mackanga JR, Zoleko-Manego R, Schipulle U, Schwing J, Lötsch F, Rehman K, Matsiegui PB, Agnandji ST, Adegnika AA, Bélard S, González R, Kremsner PG, Menendez C, Ramharter M. Evaluation of intermittent preventive treatment of malaria against group B Streptococcus colonization in pregnant women: a nested analysis of a randomized controlled clinical trial of sulfadoxine/pyrimethamine versus mefloquine. J Antimicrob Chemother 2015; 70:1898-902. [PMID: 25722300 DOI: 10.1093/jac/dkv041] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 01/31/2015] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Streptococcus agalactiae constitutes an important cause of neonatal infections in sub-Saharan Africa. Sulfadoxine/pyrimethamine-the current intermittent preventive treatment of malaria in pregnancy (IPTp)-has proven in vitro activity against group B Streptococcus (GBS). Because of specific drug resistance to sulfadoxine/pyrimethamine, mefloquine-an antimalarial without in vitro activity against GBS-was evaluated as a potential alternative. This study assessed the potential of sulfadoxine/pyrimethamine-IPTp to reduce the prevalence of GBS colonization in pregnant women in Gabon when compared with the inactive control mefloquine-IPTp. METHODS Pregnant women participating in a randomized controlled clinical trial evaluating mefloquine-IPTp versus sulfadoxine/pyrimethamine-IPTp were invited to participate and recto-vaginal swabs were collected at delivery for detection of GBS colonization. Prevalence of recto-vaginal GBS colonization was compared between IPTp regimens and risk factor and birth outcome analyses were computed. RESULTS Among 549 participants, 106 were positive for GBS colonization at delivery (19%; 95% CI = 16%-23%). Prevalence of maternal GBS colonization showed no significant difference between the two IPTp regimens (mefloquine-IPTp: 67 of 366 women = 18%; 95% CI = 14%-22%; sulfadoxine/pyrimethamine-IPTp: 39 of 183 women = 21%; 95% CI = 15%-27%). Risk factor analysis for GBS colonization demonstrated a significant association with illiteracy (adjusted OR = 2.03; 95% CI = 1.25-3.30). GBS colonization had no impact on birth outcome, anaemia at delivery, gestational age and birth weight. CONCLUSIONS Sulfadoxine/pyrimethamine did not reduce colonization rates when used as the IPTp drug during pregnancy. Illiteracy was associated with GBS colonization.
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Affiliation(s)
- Mesküre Capan-Melser
- Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
| | - Ghyslain Mombo Ngoma
- Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany Département de Parasitologie, Université des Sciences de la Santé, Libreville, Gabon
| | - Daisy Akerey-Diop
- Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany
| | - Arti Basra
- Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany
| | - Heike Würbel
- Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany
| | - Mirjam Groger
- Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
| | - Jean R Mackanga
- Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany
| | - Rella Zoleko-Manego
- Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany Ngounie Medical Research Centre, Fougamou, Gabon
| | - Ulla Schipulle
- Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany
| | - Julia Schwing
- Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany
| | - Felix Lötsch
- Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
| | - Khalid Rehman
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
| | | | - Selidji T Agnandji
- Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany
| | - Ayôla A Adegnika
- Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany
| | - Sabine Bélard
- Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany Department of Pediatric Pneumology and Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Raquel González
- Barcelona Centre for International Health Research (CRESIB, Hospital Clínic-Universitat de Barcelona), IS Global, Barcelona, Spain
| | - Peter G Kremsner
- Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany
| | - Clara Menendez
- Barcelona Centre for International Health Research (CRESIB, Hospital Clínic-Universitat de Barcelona), IS Global, Barcelona, Spain
| | - Michael Ramharter
- Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
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Schaumburg F, Alabi AS, Mombo-Ngoma G, Kaba H, Zoleko RM, Diop DA, Mackanga JR, Basra A, Gonzalez R, Menendez C, Grobusch MP, Kremsner PG, Köck R, Peters G, Ramharter M, Becker K. Transmission of Staphylococcus aureus between mothers and infants in an African setting. Clin Microbiol Infect 2013; 20:O390-6. [PMID: 24118578 DOI: 10.1111/1469-0691.12417] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 08/28/2013] [Accepted: 09/26/2013] [Indexed: 11/28/2022]
Abstract
Staphylococcus aureus colonization is a risk factor for invasive disease. There is a need to understand S. aureus colonization in infancy as the burden of S. aureus infections in infants is high. We aimed to investigate the transmission of S. aureus between mothers and their newborns during the first year after delivery in an African setting. In a longitudinal cohort study, colonization of Gabonese mother-infant pairs was assessed at delivery and after 1, 9 and 12 months. Swabs were taken from mothers (nares, mammillae) and infants (nares and throat). Isolates were characterized and risk factors for colonization were assessed using a standardized questionnaire. We recruited 311 mothers and 318 infants including seven sets of twins. Maternal and infant colonization rates declined synchronously following a peak after 1 month at 40% (mothers) and 42% (infants). Maternal colonization was a risk factor for S. aureus carriage in infants. Based on spa typing, direct mother-to-infant transmission was evident in 5.6%. Of all methicillin-resistant isolates (n = 9), 44.4% were related to the USA300 clone; 56.7% (n = 261) of all S. aureus carried Panton-Valentine leukocidin encoding genes. Direct mother-to-infant transmission was rare and cannot explain the increase of carriage in infants within the first month. A transmission from external sources is likely and challenges the S. aureus infection control in newborns and infants in an African setting. The detection of USA300-related MRSA fuels the concern about the spread of this clone in Central Africa.
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Affiliation(s)
- F Schaumburg
- Institute of Medical Microbiology, University Hospital Münster, Münster, Germany; Centre de Recherches Médicales de Lambaréné, Albert Schweitzer Hospital, Lambaréné, Gabon
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Basra A, Mombo-Ngoma G, Melser MC, Diop DA, Würbel H, Mackanga JR, Fürstenau M, Zoleko RM, Adegnika AA, Gonzalez R, Menendez C, Kremsner PG, Ramharter M. Efficacy of mefloquine intermittent preventive treatment in pregnancy against Schistosoma haematobium infection in Gabon: a nested randomized controlled assessor-blinded clinical trial. Clin Infect Dis 2012; 56:e68-75. [PMID: 23175561 DOI: 10.1093/cid/cis976] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Urogenital schistosomiasis is a major public health problem in sub-Saharan Africa, and routine programs for screening and treatment of pregnant women are not established. Mefloquine-currently evaluated as a potential alternative to sulfadoxine-pyrimethamine as intermittent preventive treatment against malaria in pregnancy (IPTp)-is known to exhibit activity against Schistosoma haematobium. In this study we evaluated the efficacy of mefloquine IPTp against S. haematobium infection in pregnant women. METHODS Pregnant women with S. haematobium infection presenting at 2 antenatal health care centers in rural Gabon were invited to participate in this nested randomized controlled, assessor-blinded clinical trial comparing sulfadoxine-pyrimethamine with mefloquine IPTp. Study drugs were administered twice during pregnancy with a 1- month interval after completion of the first trimester. RESULTS Sixty-five pregnant women were included in this study. Schistosoma haematobium egg excretion rates showed a median reduction of 98% (interquartile range [IQR], 70%-100%) in the mefloquine group compared to an increase of 20% (IQR, -186% to 75%) in the comparator group. More than 80% of patients showed at least 50% reduction of egg excretion and overall cure rate was 47% (IQR, 36%-70%) 6 weeks after the second administration of mefloquine IPTp. CONCLUSION When used as IPTp for the prevention of malaria, mefloquine shows promising activity against concomitant S. haematobium infection leading to an important reduction of egg excretion in pregnant women. Provided that further studies confirm these findings, the use of mefloquine may transform future IPTp programs into a 2-pronged intervention addressing 2 of the most virulent parasitic infections in pregnant women in sub-Saharan Africa. CLINICAL TRIALS REGISTRATION NCT01132248; ATMR2010020001429343.
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Affiliation(s)
- Arti Basra
- Centre de Recherches Médicales de Lambaréné, Université des Sciences de la Santé, Libreville, Gabon
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Capan M, Mombo-Ngoma G, Akerey-Diop D, Basra A, Würbel H, Lendamba W, Auer-Hackenberg L, Mackanga R, Melser J, Belard S, Ramharter M. Epidemiology and management of group B streptococcal colonization during pregnancy in Africa. Wien Klin Wochenschr 2012; 124 Suppl 3:14-6. [DOI: 10.1007/s00508-012-0239-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Accepted: 08/06/2012] [Indexed: 10/27/2022]
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An efficient, solvent-free microwave-assisted synthesis and antimicrobial screening of 1,6-dihydropyrimidine analogues. Med Chem Res 2012. [DOI: 10.1007/s00044-012-9980-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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