In this issue of the journal, Maiga et al report on a randomized clinical trial performed in Mali, which shows the superiority of 3 over 2 doses of IPTp SP for the prevention of placenta malaria and associated low birth weight infants.
This study evaluates the effectiveness of IPTp-SP among pregnant women attending the antenatal clinic at Korle-Bu Teaching Hospital in Accra, Ghana.
This was a cross-sectional, descriptive study of only well pregnant women recruited consecutively at the time of booking for antenatal care.
Malaria in pregnancy can lead to serious maternal and fetal morbidity and mortality. Access to the most effective antimalarials in pregnancy is essential.
The intermittent preventive treatment of malaria in pregnancy (IPTp) with sulphadoxine-pyrimethamine (SP) has been a key component of the focused antenatal care package for nearly a decade, reducing the burden of low birthweight attributable to malaria in sub-Saharan Africa.
Self-reported malaria was extremely common in this population and adherence to treatment guidelines for the management of malaria in pregnancy was poor.
The data suggest that multiplicity of var2csa-type genes enables P. falciparum parasites to persist for a longer period of time during placental infections, probably because of their greater capacity for antigenic variation and evasion of variant-specific immune responses.
Recommendations for interventions to control malaria in pregnancy are often based on studies using birthweight as the primary endpoint.
IPT-SP decreases the rate of placental malaria parasitaemia and has a strong dose effect.
Local cultivation and preparation of A. annua are feasible where growing conditions are appropriate.