Effectiveness of intermittent screening and treatment for the control of malaria in pregnancy: a cluster randomised trial in India.
India
intermittent screening and treatment
malaria
pregnancy
prevention and control
Journal
BMJ global health
ISSN: 2059-7908
Titre abrégé: BMJ Glob Health
Pays: England
ID NLM: 101685275
Informations de publication
Date de publication:
2019
2019
Historique:
received:
14
01
2019
revised:
16
05
2019
accepted:
25
05
2019
entrez:
14
8
2019
pubmed:
14
8
2019
medline:
14
8
2019
Statut:
epublish
Résumé
The control of malaria in pregnancy (MiP) in India relies on testing women who present with symptoms or signs suggestive of malaria. We hypothesised that intermittent screening and treatment for malaria at each antenatal care visit (ISTp) would improve on this approach and reduce the adverse effects of MiP. A cluster randomised controlled trial comparing ISTp versus passive case detection (PCD) was conducted in Jharkhand state. Pregnant women of all parities with a gestational age of 18-28 weeks were enrolled. Women in the ISTp group were screened with a rapid diagnostic test (RDT) for malaria at each antenatal clinic visit and those in the PCD group were screened only if they had symptoms or signs suggestive of malaria. All RDT positive women were treated with artesunate/sulfadoxine-pyrimethamine. The primary endpoint was placental malaria, determined by placental histology, and the key secondary endpoints were birth weight, gestational age, vital status of the newborn baby and maternal anaemia. Between April 2012 and September 2015, 6868 women were enrolled; 3300 in 46 ISTp clusters and 3568 in 41 PCD clusters. In the ISTp arm, 4.9% of women were tested malaria positive and 0.6% in the PCD arm. There was no difference in the prevalence of placental malaria in the ISTp (87/1454, 6.0%) and PCD (65/1560, 4.2%) groups (6.0% vs 4.2%; OR 1.34, 95% CI 0.78 to 2.29, p=0.29) or in any of the secondary endpoints. ISTp detected more infections than PCD, but monthly ISTp with the current generation of RDT is unlikely to reduce placental malaria or impact on pregnancy outcomes. ISTp trials with more sensitive point-of-care diagnostic tests are needed.
Sections du résumé
BACKGROUND
BACKGROUND
The control of malaria in pregnancy (MiP) in India relies on testing women who present with symptoms or signs suggestive of malaria. We hypothesised that intermittent screening and treatment for malaria at each antenatal care visit (ISTp) would improve on this approach and reduce the adverse effects of MiP.
METHODS
METHODS
A cluster randomised controlled trial comparing ISTp versus passive case detection (PCD) was conducted in Jharkhand state. Pregnant women of all parities with a gestational age of 18-28 weeks were enrolled. Women in the ISTp group were screened with a rapid diagnostic test (RDT) for malaria at each antenatal clinic visit and those in the PCD group were screened only if they had symptoms or signs suggestive of malaria. All RDT positive women were treated with artesunate/sulfadoxine-pyrimethamine. The primary endpoint was placental malaria, determined by placental histology, and the key secondary endpoints were birth weight, gestational age, vital status of the newborn baby and maternal anaemia.
RESULTS
RESULTS
Between April 2012 and September 2015, 6868 women were enrolled; 3300 in 46 ISTp clusters and 3568 in 41 PCD clusters. In the ISTp arm, 4.9% of women were tested malaria positive and 0.6% in the PCD arm. There was no difference in the prevalence of placental malaria in the ISTp (87/1454, 6.0%) and PCD (65/1560, 4.2%) groups (6.0% vs 4.2%; OR 1.34, 95% CI 0.78 to 2.29, p=0.29) or in any of the secondary endpoints.
CONCLUSION
CONCLUSIONS
ISTp detected more infections than PCD, but monthly ISTp with the current generation of RDT is unlikely to reduce placental malaria or impact on pregnancy outcomes. ISTp trials with more sensitive point-of-care diagnostic tests are needed.
Identifiants
pubmed: 31406586
doi: 10.1136/bmjgh-2019-001399
pii: bmjgh-2019-001399
pmc: PMC6666812
doi:
Types de publication
Journal Article
Langues
eng
Pagination
e001399Déclaration de conflit d'intérêts
Competing interests: None declared.
Références
Lancet Infect Dis. 2007 Feb;7(2):93-104
pubmed: 17251080
Malar J. 2009 Feb 12;8:24
pubmed: 19210797
Malar J. 2009 Sep 03;8:210
pubmed: 19728882
PLoS Med. 2010 Jan 26;7(1):e1000221
pubmed: 20126256
PLoS One. 2010 Dec 28;5(12):e14425
pubmed: 21203389
Health Policy. 2011 Dec;103(2-3):283-9
pubmed: 21782268
Malar J. 2011 Oct 28;10:321
pubmed: 22035448
Am J Trop Med Hyg. 2012 Aug;87(2):251-6
pubmed: 22859362
Glob Health Action. 2012 Sep 03;5:1-8
pubmed: 22944365
Mediterr J Hematol Infect Dis. 2013;5(1):e2013010
pubmed: 23350023
Trop Med Int Health. 2015 Dec;20(12):1621-33
pubmed: 26325263
Lancet. 2015 Dec 19;386(10012):2507-19
pubmed: 26429700
Clin Infect Dis. 2016 Apr 1;62(7):837-844
pubmed: 26721833
Malar J. 2017 Sep 22;16(1):385
pubmed: 28938906
Health Policy Plan. 2017 Dec 1;32(suppl_5):v4-v12
pubmed: 28973503
PLoS Med. 2018 Jan 10;15(1):e1002486
pubmed: 29320495
Lancet Infect Dis. 2018 Apr;18(4):e119-e132
pubmed: 29395997
Malar J. 2018 Jul 4;17(1):246
pubmed: 29973212
PLoS One. 2018 Aug 2;13(8):e0201769
pubmed: 30071004
Lancet Infect Dis. 2019 Jul 25;:null
pubmed: 31353217
Histopathology. 1993 Mar;22(3):211-8
pubmed: 8495954