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PARASITOLOGIC ASSESSMENT OF TWO-DOSE AND MONTHLY IPTp -SP IN LAGOS, NIGERIA

PARASITOLOGIC ASSESSMENT OF TWO-DOSE AND MONTHLY IPTp -SP IN LAGOS, NIGERIA. Agomo CO 1,2 , Oyibo WA 2 and Odukoya-Maije F 3 1. Malaria Research Laboratory, Dept of Biochemistry, Nigerian Institute of Medical Research, Lagos, Nigeria.

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PARASITOLOGIC ASSESSMENT OF TWO-DOSE AND MONTHLY IPTp -SP IN LAGOS, NIGERIA

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  1. PARASITOLOGIC ASSESSMENT OF TWO-DOSE AND MONTHLY IPTp-SP IN LAGOS, NIGERIA Agomo CO1,2, Oyibo WA2and Odukoya-Maije F3 1. Malaria Research Laboratory, Deptof Biochemistry, Nigerian Institute of Medical Research, Lagos, Nigeria. 2. TDRL, Dept. of Medical Microbiology and Parasitology, Collegeof Medicine, University of Lagos, Nigeria 3. Department of Obstetrics and Gynaecology, Ajeromi General Hospital, Ajegunle, Lagos, Nigeria.

  2. Introduction • Annually, 30.3 million women get pregnant in Africa (Dellicouret al., 2010) • Susceptibility to malaria in pregnancy: • immunosuppression • absence of specific immunity(Hviid and Salanti, 2007) • 11% of maternal death due to Malaria in Nigeria (FMOH, 2005) • Consequences: maternal anaemia, LBW, FGR, premature delivery, abortion and stillbirth (Rogerson and Boeuf, 2007) • SP is recommended for IPTp(FMOH, 2005) • IPTp-SP – administration of ≥2 therapeutic doses of SP (1500/75mg) at defined intervals

  3. Introduction contd… • SP inhibits DHFR and DHPS in folate pathway (Sibley et al., 2001) • Low rate of fatal reaction to SP (Fornaet al., 2006) • SP failure rate of 24.4% (day 14) in SW Nigeria in children (FMOH, 2005) • Rationale: • Resistance to SP – need for continuous monitoring • Concerns on adequacy of 2-dose IPTp-SP in high transmission areas (Filler et al., 2006) • Few studies on adequacy of 2-dose IPTp-SP in Africa but none in Nigeria • Objective: • to assess equivalence of standard 2-dose IPTp-SP to experimental monthly IPTp-SP dose

  4. Methods • Ethical approval: NIMR-IRB and College of Medicine, University of Lagos • Study sites: Ajeromi General Hospital, Ajegunle, and St. Kizito PHC, Lekki, Lagos • Study period: March 2007 to February 2008 • Two arms: 2-dose (Arm A) and monthly IPTp-SP dose (Arm B) • Minimum Sample size: 60 per study Arm • Inclusion: 2nd Trimester; • Exclusion: multiple pregnancy, severe anaemia • SP administration – D.O.T • Monthly monitoring of parasitaemia • Birth outcome – live birth, birth weight

  5. RESULTS Table 1: Baseline Characteristics Of Participants Character Arm A (n=122) Arm B (n=137) Mean Age±SD (years) 26.5 ±4.2 27.9 ±4.9 Gravidity Primigravidae 47 (38.6%) 56 (40.9%) Secundigravidae 33 (27.0%) 35 (25.5%) Multigravidae 42 (34.4%) 46 (33.6%) Mean PCV(%) 32.3±3.7% 32.4±3.7% Anaemia(PCV <33%) 29 (23.8%) 29 (21.2%)

  6. Month 1: P=0.636 Month 2: P = 0.466

  7. Table 2: Monthly monitoring of malaria parasitaemia in the two study arms

  8. TABLE 3: Comparison of pregnancy outcome in the two study arms * Fisher Exact Test

  9. Table 4: Comparison of live births with age and gravidity

  10. Conclusion • IPTp-SP provided effective protection against MIP irrespective of gravidity and maternal age • Monthly IPTp-SP was not superior to the standard 2-dose regimen in Lagos Recommendation • Future research to include monitoring of specific mutations in dhfr and dhps genes of P. falciparum isolates from pregnant women

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