Intermittent screening and treatment with artemisinin-combination therapy versus intermittent preventive treatment with sulphadoxine-pyrimethamine for malaria in pregnancy: a systematic review and individual participant data meta-analysis of randomised clinical trials.
Malaria
artemisinin combination therapy
intermittent preventive treatment
intermittent screening
pregnancy
sulphadoxine-pyrimethamine
Journal
EClinicalMedicine
ISSN: 2589-5370
Titre abrégé: EClinicalMedicine
Pays: England
ID NLM: 101733727
Informations de publication
Date de publication:
Nov 2021
Nov 2021
Historique:
received:
12
07
2021
revised:
16
09
2021
accepted:
30
09
2021
entrez:
8
11
2021
pubmed:
9
11
2021
medline:
9
11
2021
Statut:
epublish
Résumé
In sub-Saharan Africa, the efficacy of intermittent preventive therapy in pregnancy with sulphadoxine-pyrimethamine (IPTp-SP) for malaria in pregnancy is threatened by parasite resistance. We conducted an individual-participant data (IPD) meta-analysis to assess the efficacy of intermittent screening with malaria rapid diagnostic tests (RDTs) and treatment of RDT-positive women with artemisinin-based combination therapy (ISTp-ACT) compared to IPTp-SP, and understand the importance of subpatent infections. We searched MEDLINE and the Malaria-in-Pregnancy Library on May 6, 2021 for trials comparing ISTp-ACT and IPTp-SP. Generalised linear regression was used to compare adverse pregnancy outcomes (composite of small-for-gestational-age, low birthweight (LBW), or preterm delivery) and peripheral or placental Five trials conducted between 2007 and 2014 contributed (10,821 pregnancies), two from high SP-resistance areas where ISTp-ACT was not superior to IPTp-SP and may result in more subpatent infections than the existing IPTp-SP policy. Subpatent infections were associated with increased LBW and preterm delivery. More sensitive diagnostic tests are needed to detect and treat low-grade infections. Centers for Disease Control and Prevention and Worldwide Antimalarial Resistance Network.
Sections du résumé
BACKGROUND
BACKGROUND
In sub-Saharan Africa, the efficacy of intermittent preventive therapy in pregnancy with sulphadoxine-pyrimethamine (IPTp-SP) for malaria in pregnancy is threatened by parasite resistance. We conducted an individual-participant data (IPD) meta-analysis to assess the efficacy of intermittent screening with malaria rapid diagnostic tests (RDTs) and treatment of RDT-positive women with artemisinin-based combination therapy (ISTp-ACT) compared to IPTp-SP, and understand the importance of subpatent infections.
METHODS
METHODS
We searched MEDLINE and the Malaria-in-Pregnancy Library on May 6, 2021 for trials comparing ISTp-ACT and IPTp-SP. Generalised linear regression was used to compare adverse pregnancy outcomes (composite of small-for-gestational-age, low birthweight (LBW), or preterm delivery) and peripheral or placental
FINDINGS
RESULTS
Five trials conducted between 2007 and 2014 contributed (10,821 pregnancies), two from high SP-resistance areas where
INTERPRETATION
CONCLUSIONS
ISTp-ACT was not superior to IPTp-SP and may result in more subpatent infections than the existing IPTp-SP policy. Subpatent infections were associated with increased LBW and preterm delivery. More sensitive diagnostic tests are needed to detect and treat low-grade infections.
FUNDING
BACKGROUND
Centers for Disease Control and Prevention and Worldwide Antimalarial Resistance Network.
Identifiants
pubmed: 34746720
doi: 10.1016/j.eclinm.2021.101160
pii: S2589-5370(21)00440-5
pmc: PMC8556518
doi:
Types de publication
Journal Article
Langues
eng
Pagination
101160Subventions
Organisme : Medical Research Council
ID : MC_PC_MR/P006914/1
Pays : United Kingdom
Organisme : Medical Research Council
ID : MR/R010161/1
Pays : United Kingdom
Déclaration de conflit d'intérêts
All authors declare no competing interests.
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