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IPTp

Changes in the frequencies of Plasmodium falciparum dhps and dhfr drug-resistant mutations in children from Western Kenya from 2005 to 2018: the rise of Pfdhps S436H

October 22, 2020 - 15:45 -- Open Access
Author(s): 
M. Andreína Pacheco, Kristan A. Schneider, Qiuying Cheng, Elly O. Munde, Caroline Ndege, Clinton Onyango, Evans Raballah, Samuel B. Anyona, Collins Ouma, Douglas J. Perkins and Ananias A. Escalante
Reference: 
Malaria Journal 2020 19:378, 22 October 2020

Sulfadoxine-pyrimethamine (SP) is the only anti-malarial drug formulation approved for intermittent preventive treatment in pregnancy (IPTp). However, mutations in the Plasmodium falciparum dhfr (Pfdhfr) and dhps (Pfdhps) genes confer resistance to pyrimethamine and sulfadoxine, respectively. Here, the frequencies of SP resistance-associated mutations from 2005 to 2018 were compared in samples from Kenyan children with malaria residing in a holoendemic transmission region.

NOT Open Access | Associations between malaria preventive regimens and Plasmodium falciparum drug resistance mediating polymorphisms in Ugandan pregnant women

October 7, 2020 - 15:35 -- NOT Open Access
Author(s): 
Nayebare P, Asua V, Conrad MD, Kajubi R, Kakuru A, Nankabirwa JI, Muhanguzi D, Dorsey G, Kamya MR, Nsobya S, Rosenthal PJ
Reference: 
Antimicrob Agents Chemother. 2020 Oct 5:AAC.01047-20

Intermittent preventive treatment in pregnancy (IPTp) with monthly sulfadoxine-pyrimethamine (SP) is recommended for malaria-endemic parts of Africa, but efficacy is compromised by resistance and, in recent trials, dihydroartemisinin-piperaquine (DP) has shown better antimalarial protective efficacy. We utilized blood samples from a recent trial to evaluate selection by IPTp with DP or SP of Plasmodium falciparum genetic polymorphisms that alter susceptibility to these drugs.

Sub-optimal Intermittent Preventive Treatment in pregnancy (IPTp) is associated with an increased risk of submicroscopic P. falciparum infection in pregnant women: a prospective cohort study in Benin

September 10, 2020 - 08:51 -- Open Access
Author(s): 
Hounkonnou CPA, Ndam NT, Fievet N, Accrombessi M, Yovo E, Mama A, Sossou D, Vianou B, Massougbodji A, Briand V, Cot M, Cottrell G
Reference: 
Clin Infect Dis. 2020 Sep 9:ciaa1355

Harmful maternal and neonatal health outcomes result from malaria in pregnancy, the prevention of which primarily relies on intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP). WHO recommends IPTp-SP in sub-Saharan Africa, but implementation is highly heterogeneous and often sub-optimal in terms of the number of doses and their timing. In this study, we assessed the impact of this heterogeneity on malaria in pregnancy, mainly with respect to submicroscopic Plasmodium falciparum infections.

Impact of Health Systems on the Implementation of Intermittent Preventive Treatment for Malaria in Pregnancy in Sub-Saharan Africa: A Narrative Synthesis

August 27, 2020 - 08:07 -- Open Access
Author(s): 
Olaleye AO, Walker O
Reference: 
Trop Med Infect Dis. 2020 Aug 22;5(3):E134

Malaria in pregnancy is a public health challenge with serious negative maternal and newborn consequences. Intermittent preventive treatment (IPTp) with sulphadoxine-pyrimethamine is recommended for the control of malaria during pregnancy within endemic areas, but coverage for the recommended ≥3 doses IPTp regimen has remained suboptimal. We searched PubMed, Cochrane library, and HINARI database from 1 January 2010 to 23 May 2020, for studies investigating the effect of the health system on IPTp implementation.

Impact of intermittent preventive treatment of malaria in pregnancy with dihydroartemisinin-piperaquine versus sulfadoxine-pyrimethamine on the incidence of malaria in infancy: a randomized controlled trial

August 11, 2020 - 07:39 -- Open Access
Author(s): 
Kakuru A, Jagannathan P, Dorsey G, et al.
Reference: 
BMC Med. 2020 Aug 10;18(1):207

Intermittent preventive treatment of malaria during pregnancy (IPTp) with dihydroartemisinin-piperaquine (DP) significantly reduces the burden of malaria during pregnancy compared to sulfadoxine-pyrimethamine (SP), the current standard of care, but its impact on the incidence of malaria during infancy is unknown.

A cluster randomized trial of delivery of intermittent preventive treatment of malaria in pregnancy at the community level in Burkina Faso

August 10, 2020 - 14:54 -- Open Access
Author(s): 
Julie R. Gutman, Daniel K. Stephens, Justin Tiendrebeogo, Ousmane Badolo, Mathurin Dodo, Danielle Burke, John Williamson, Kristen Vibbert, Susan J. Youll, Yacouba Savadogo and William R. Brieger
Reference: 
Malaria Journal 2020 19:282, 5 August 2020

Malaria in pregnancy is responsible for 8–14% of low birth weight and 20% of stillbirths in sub-Saharan Africa. To prevent these adverse consequences, the World Health Organization recommends intermittent preventive treatment of pregnant women (IPTp) with sulfadoxine–pyrimethamine be administered at each ANC visit starting as early as possible in the second trimester. Global IPTp coverage in targeted countries remains unacceptably low. Community delivery of IPTp was explored as a means to improve coverage.

NOT Open Access | Interactions Between Antenatal Sulfadoxine-Pyrimethamine, Drug-Resistant Plasmodium falciparum Parasites, and Delivery Outcomes in Malawi

July 27, 2020 - 12:29 -- NOT Open Access
Author(s): 
Taylor SM, Levitt B, Freedman B, Madanitsa M, Thwai KL, Kalilani-Phiri L, Khairallah C, Mwapasa V, Ter Kuile FO, Meshnick SR
Reference: 
J Infect Dis. 2020 Jul 23; 222(4):661-669

Sulfadoxine-pyrimethamine (SP) is used as intermittent preventive therapy in pregnancy (IPTp) for malaria in sub-Saharan Africa. The resistance marker dhps A581G has been associated with reduced IPTp-SP efficacy and enhanced morbidity in SP recipients.

Occurrence of septuple and elevated Pfdhfr-Pfdhps quintuple mutations in a general population threatens the use of sulfadoxine-pyrimethamine for malaria prevention during pregnancy in eastern-coast of Tanzania

July 26, 2020 - 13:34 -- Open Access
Author(s): 
Bwire GM, Mikomangwa WP, Kilonzi M
Reference: 
BMC Infect Dis. 2020 Jul 22;20(1):530

Plasmodium falciparum dihydrofolate reductase (Pfdhfr) and dihydropteroate synthetase (Pfdhps) mutations compromise the effectiveness of sulfadoxine-pyrimethamine (SP) for treatment of uncomplicated malaria, and are likely to impair the efficiency of intermittent preventive treatment during pregnancy (IPTp). This study was conducted to determine the level of Pfdhfr-Pfdhps mutations, a decade since SP was limited for IPTp use in pregnant women in Tanzania.

Defining the combined benefit of intermittent preventive malaria treatment in pregnancy

July 8, 2020 - 15:27 -- Open Access
Author(s): 
Salman S, Davis TME, Moore B
Reference: 
Lancet Glob Health. 2020 Jul;8(7):e871-e872

WHO  has  included  intermittent  preventive  treatment  in  pregnancy  (IPTp)  with  sulfadoxine-pyrimethamine  as  an  important  malaria  intervention  since  2012.1  Although  other candidate therapies remain under investigation and despite  waning  sulfadoxine-pyrimethamine  antimalarial  efficacy  due  to  increasing  parasite  resistance,  IPTp  with  sulfadoxine-pyrimethamine  remains  a  key  component  of   the   management   of   pregnant   women   in   malaria-endemic areas. In areas of high-grade parasite resistance, the   use   of   IPTp   with   sulfadoxine-pyrimethamine   is   associated with improved birth weight, suggesting that there are benefits of beyond antimalarial efficacy.

Overall, anti-malarial, and non-malarial effect of intermittent preventive treatment during pregnancy with sulfadoxine-pyrimethamine on birthweight: a mediation analysis

July 8, 2020 - 15:25 -- Open Access
Author(s): 
Roh ME, Kuile FOT, Rerolle F, Glymour MM, Shiboski S, Gosling R, Gutman J, Kakuru A, Desai M, Kajubi R, L'Ianziva A, Kamya MR, Dorsey G, Chico RM
Reference: 
Lancet Glob Health. 2020 Jul;8(7):e942-e953

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.

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