Volume 8, Issue 1, January 2020, Page: 4-11
Use of Intermittent Preventive Therapy for Malaria During Pregnancy and Development of Febrile Illness Among Infants in Nigeria
Ngozi Anayochukwu-Ugwu, Nigeria Field Epidemiology and Laboratory Training Programme (NFELTP), Abuja, Nigeria;Department of Medical Laboratory, Federal Neuropsychiatric Hospital, Enugu, Nigeria
Innocent Anayochukwu Ugwu, Department of Obstetrics & Gynaecology, College of Medicine, Enugu State University of Science & Technology (ESUT) and ESUT Teaching Hospital, Parklane, Enugu, Nigeria
Received: Nov. 19, 2019;       Accepted: Dec. 17, 2019;       Published: Jan. 6, 2020
DOI: 10.11648/j.jgo.20200801.12      View  59      Downloads  49
In most African countries, a good number of pregnant women make multiple antenatal visits providing a major opportunity for the prevention of malaria (associated with febrile illness) in infants through the use of intermittent preventive treatment in pregnancy (IPTp). This study assessed the association between maternal use of IPTp with sulphadoxine and pyrimethamine (SP) and the development of febrile illness in infants. This was a secondary data analysis of the 2013 Nigeria Demographic Health Survey (NDHS) data. Mother-child pairs where the mother was aged 15-49 years and the child was less than one year at the time of the survey were included. Variables such as the use of IPTp-SP and development of febrile illness as well as the socio-demographic and other control variable were analyzed. Chi-square testing and logistic regression were used to determine the association between the use of IPTp-SP and the development of febrile illness. Statistical analysis was done using SPSS version 21 and Statistical significance was set at P<0.05. A total of 6,212 mother-child pairs were analyzed. Chi-square test showed that there was a significant association between the use of IPTp-SP and report of fever in infants. A higher proportion of mothers that used IPTp-SP (15.8%) reported fever in their infants compared with those whose mother did not receive IPTp-SP (11.6%) (P<0.001). Logistic regression showed that mothers that used IPTp-SP were about one and half times more likely to report fever in their infants, before adjustment for confounding variables (OR = 1.46, 95% CI: 1.24 – 1.71, p<0.001). Following adjustment, there was a weaker (though still significant) association between IPTp-SP use and fever in the infants (OR = 1.26, 95% CI: 1.04 – 1.52, p = 0.019). This study found a significant association between the use of IPTp-SP and mothers' report of febrile illness among infants in the two weeks before the survey. This requires further evidence to confirm but highlights the complex relationship between maternal drug exposure and long term susceptibility to illness in offspring.
Intermittent Preventive Therapy, Sulphadoxine-pyrimethamine, Pregnancy, Febrile Illness, Malaria
To cite this article
Ngozi Anayochukwu-Ugwu, Innocent Anayochukwu Ugwu, Use of Intermittent Preventive Therapy for Malaria During Pregnancy and Development of Febrile Illness Among Infants in Nigeria, Journal of Gynecology and Obstetrics. Vol. 8, No. 1, 2020, pp. 4-11. doi: 10.11648/j.jgo.20200801.12
Copyright © 2020 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Desai, M. I., Kuile, F. O, Nosten, F., McGready, R., Asamoa, K. Brabin, B. et al., (2007). Epidemiology and burden of malaria in pregnancy. Lancet of Infectious Disease. 7 (2), pp. 93–104.
World Health Organization (2015) 'Malaria in pregnant women' [Online] Available at http://www.who.int/malaria/areas/high_risk_groups/pregnancy/en/ (Accessed 6 April 2015).
Dellicour, S. Andrew J. T., Carlos A. G., Robert W. S., Feiko O., et al., (2010). Quantifying the Number of Pregnancies at Risk of Malaria in 2007: A Demographic Study. PLoS Med, 7 (1) e1000221. https://doi.org/10.1371/journal.pmed.1000221.
Lawn, E. J., Blencowe, H2, Waiswa P3, Amouzou A4, Mathers C5, Hogan D5et al.,(2016). Stillbirths: rates, risk factors, and acceleration towards 2030. The Lancet, 387 No 10018, pp. 587–603.
Robalo et al, (n. d) ‘Opportunities for Africa’s newborns' [Online] Available at http://www.who.int/pmnch/media/publications/oanfullreport.pdf (Accessed 27 September 2015).
Mulamba, M. and Mash, B., (2010). Evaluation of malaria prevention strategies during pregnancy in Ndola, Zambia. African Journal of Primary Health Care & Family Medicine, 2 (1): pp. 1-5.
World Health Organization, (2015). ‘Intermittent preventive treatment in pregnancy (IPTp)’ [Online] Available at http://www.who.int/malaria/areas/preventive_therapies/pregnancy. (Accessed 10 April 2016).
Menendez, C., Bardajı, A., Sigauque, B., Sanz, S., Aponte, J. J., Mabunda, S., et al. (2010). Malaria Prevention with IPTp during Pregnancy Reduces Neonatal Mortality. PLoS ONE, 5 (2), 1–6. doi: 10.1371.
National Population Commission (NPC) [Nigeria] and ICF International. (2014). Nigeria Demographic and Health Survey 2013. Abuja, Nigeria, and Rockville, Maryland, USA: NPC and ICF International.
Ntirushwa, D. (2010). A Strategic Framework for Malaria Prevention and Control during Pregnancy in the Africa Region. [Online] Available at https://www.gfmer.ch/SRH-Course-2010/assignments/pdf/Malaria-pregnancy-Ntirushwa-2010.pdf (Accessed 31 November 2019).
Nigeria Malaria Fact Sheet, (2011).Malaria in Nigeria [Online] Available at: http://photos.state.gov/libraries/nigeria/231771/Public/December-MalariaFactSheet2.pdf (Accessed 27 September 2015).
National Population Commission (NPC) [Nigeria] and ICF Macro. (2009). Nigeria Demographic and Health Survey 2008. Abuja, Nigeria: National Population Commission and ICF Macro.
Central Intelligence Agency, (2015). Central Intelligence Agency (CIA). [Online] Available at: http://www.theodora.com/wfbcurrent/nigeria/nigeria_people.html (Accessed 9 April 2016).
Graham, J. W. (2009) ‘Missing data analysis: making it work in the real world’ Annu. Rev. Psychol. 60: pp. 549–576 [Online] Available at http://www.annualreviews.org.ezproxy.liv.ac.uk/doi/pdf/10.1146/annurev.psych.58.110405.085530 (Accessed 22 September 2015).
DHS Programme, (n. d) Sapling Weights. http://www.dhsprogram.com/data/Data-Quality-and-Use.cfm#CP_JUMP_5188 (Accessed 10 April 2016).
World Health Organization (2016) 'Malaria and disease burden' [Online] Available at http://www.who.int/mediacentre/factsheets/fs094/en/. (Accessed 30 September 2016).
Harrington, W., Morrison R, Fried M, D. P. (2013). Intermittent Preventive Treatment in Pregnant Women Is Associated with Increased Risk of Severe Malaria in Their Offspring. PLoS ONE, 8 (2).
Harrington, W. et al., (2009). Competitive facilitation of drug-resistant Plasmodium falciparum malaria parasites in pregnant women who receive preventive treatment Proc Natl Acad Sci U SA., 106, pp. 9027–9032.
Harrington, W. et al., (2011). “Intermittent Treatment to Prevent Pregnancy Malaria Does Not Confer Benefit in an Area of Widespread Drug Resistance”. Clinical Infectious Diseases. 53 (3), pp. 224–230.
Mutabingwa, T. K. I., Bolla, M. C, Li J. L., Domingo, G. J., Li X., Fried M, et al., (2005). Maternal malaria and gravidity interact to modify infant susceptibility to malaria. PLoS Med, 2: e407.
Le Hesran, J. M., Michel Cot, Personne, P., Fievet, N., Dubois, B., Beyeme, M. et al (1997). Maternal placental infection with Plasmodium falciparum and malaria morbidity during the first 2 years of life. American Journal of Epidemiology, Volume 146, (10) pp. 826–831.
Schwarz, N. G., Adegnika, A. A., Breitling, L. P., Gabor, J., Agnandji, S. T and Newman, R. D. (2008). Placental malaria increases malaria risk in the first 30 months of life. Clin Infect Dis, 47, pp. 1017–1025.
Serra-Casas, E., Menéndez, C., Bardají, A., Quintó, A., Dobaño, C., Sigauque, B. et al. (2010). The effect of intermittent preventive treatment during pregnancy on malarial antibodies depends on HIV status and is not associated with poor delivery outcomes. Journal of Infectious Diseases, 201 (1) pp 123-131.
Aitken, E. H., Mbewe, B., Luntamo, M., Kulmala, T., Beeson, J. G and Ashorn, P (2012). Antibody to P. falciparum in pregnancy varies with intermittent preventive treatment regime and bed net use. PLoS ONE 7 (1): e29874. https://doi.org/10.1371/journal.pone.0029874.
Vincent Staszewski, V, Reece, S. E., O'Donnell, A. O and Cunningham, E. J. A. (2012). Drug treatment of malaria infections can reduce levels of protection transferred to offspring via maternal immunity. Proc Biol Sci, 279 (1737) pp. 2487–2496.
le Cessie, S., Verhoeff, F., Mengistie, G., Kazembe, P., Broadhead, R and BrabinLe, B. (2002). Changes in haemoglobin levels in infants in Malawi: effect of low birth weight and fetal anaemia. Arch Dis Child Fetal Neonatal Ed. 86 (3) pp 182-187.
Kalanda, B., Verhoeff. F., le Cessie, S and Brabin J. Low birth weight and fetal anaemia as risk factors for infant morbidity in rural Malawi. Malawi Med J. 2009 Jun; 21 (2): 69-74.
Desai, M., Gutman, J., Taylor, S. M., Wiegand, R. E., Khairallah, C., Kayentao et al, (2016). 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. Feb 1; 62 (3): 323-333. doi: 10.1093/cid/civ881.
Moya-Alvarez, V. Abellana, R. and Cot, M. (2014). Pregnancy-associated malaria and malaria in infants: an old problem with present consequences. Malaria Journal. 13, Article number: 271. [Online] Available at: https://malariajournal.biomedcentral.com/articles/10.1186/1475-2875-13-271 Accessed 6 November 2019.
Tagbor, H., Bruce, J., Agbo, M., Greenwood, B. and Chandramohan, D (2010). Intermittent screening and treatment versus intermittent preventive treatment of malaria in pregnancy: a randomized controlled non-inferiority trial. PLoS ONE, 5: e14425. [Online Available at https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0014425 Accessed 6 November 2019.
Browse journals by subject