Intermittent sulphadoxine-pyrimethamine to prevent severe anaemia secondary to malaria in pregnancy: a randomised placebo-controlled trial

Lancet. 1999 Feb 20;353(9153):632-6. doi: 10.1016/s0140-6736(98)07318-8.

Abstract

Background: In areas of endemic transmission, malaria in pregnancy is associated with severe maternal anaemia and low-birthweight babies. We studied the efficacy of intermittent treatment doses of sulphadoxine-pyrimethamine in preventing malaria and severe anaemia in pregnancy in a double-blind placebo-controlled trial among primigravid women living in Kilifi District, Kenya.

Methods: Between January, 1996, and April, 1997, 1264 primigravid women were recruited when they attended for antenatal care, and randomly assigned sulphadoxine-pyrimethamine (640) or placebo (624). Women received one, two, or three doses of study medication depending on the duration of gestation at enrolment. Primary outcome measures were severe anaemia (haemoglobin <8 g/dL) and malaria parasitaemia, assessed at 34 weeks of gestation. Analyses were based on intention to treat among women who had study blood tests at 34 weeks.

Findings: 30 (5.3%) of 567 women in the sulphadoxine-pyrimethamine group and 199 (35.3%) of 564 in the placebo group had peripheral parasitaemia (protective efficacy 85% [95% CI 78-90], p<0.0001). 82 (14.5%) and 134 (23.7%) had severe anaemia (protective efficacy 39% [22-52], p<0.0001). Even women who booked late and received only one dose of sulphadoxine-pyrimethamine benefited significantly from the intervention. The effects were seen both in women who owned insecticide-treated bednets and in women who did not.

Interpretation: Intermittent presumptive treatment with sulphadoxine-pyrimethamine is an effective, practicable strategy to decrease the risk of severe anaemia in primigravidae living in malarious areas.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anemia / etiology
  • Anemia / prevention & control*
  • Antimalarials / administration & dosage
  • Antimalarials / therapeutic use*
  • Bedding and Linens
  • Double-Blind Method
  • Drug Administration Schedule
  • Drug Combinations
  • Endemic Diseases
  • Female
  • Hemoglobins / analysis
  • Humans
  • Insecticides
  • Kenya
  • Malaria, Falciparum / complications
  • Malaria, Falciparum / prevention & control*
  • Parasitemia / prevention & control
  • Parity
  • Placebos
  • Pregnancy
  • Pregnancy Complications, Parasitic / prevention & control*
  • Pyrimethamine / administration & dosage
  • Pyrimethamine / therapeutic use*
  • Sulfadoxine / administration & dosage
  • Sulfadoxine / therapeutic use*
  • Treatment Outcome

Substances

  • Antimalarials
  • Drug Combinations
  • Hemoglobins
  • Insecticides
  • Placebos
  • Sulfadoxine
  • Pyrimethamine