Parasite clearance following treatment with sulphadoxine-pyrimethamine for intermittent preventive treatment in Burkina-Faso and Mali: 42-day in vivo follow-up study

Sheick O. Coulibaly; Kassoum Kayentao; Steve Taylor; Etienne A. Guirou; Carole Khairallah; Nouhoun Guindo; Moussa Djimde; Richard Bationo; Alamissa Soulama; Edgar Dabira; Binta Barry; Moussa Niangaly; Hammadoun Diakite; Sidiki Konate; Mohamed Keita; Boubacar Traore; Steve R. Meshnick; Pascal Magnussen; Ogobara K. Doumbo; Feiko Ter Kuile

doi:10.1186/1475-2875-13-41

Parasite clearance following treatment with sulphadoxine-pyrimethamine for intermittent preventive treatment in Burkina-Faso and Mali: 42-day in vivo follow-up study

Sheick O. Coulibaly, Kassoum Kayentao, Steve Taylor, Etienne A. Guirou, Carole Khairallah, Nouhoun Guindo, Moussa Djimde, Richard Bationo, Alamissa Soulama, Edgar Dabira, Binta Barry, Moussa Niangaly, Hammadoun Diakite, Sidiki Konate, Mohamed Keita, Boubacar Traore, Steve R. Meshnick, Pascal Magnussen, Ogobara K. Doumbo, Feiko Ter Kuile

Clinical Sciences

Research output: Contribution to journal › Article › peer-review

20 Citations (Scopus)

Abstract

Background

Intermittent Preventive Treatment in pregnancy (IPTp) with sulphadoxine-pyrimethamine (SP) is widely used for the control of malaria in pregnancy in Africa. The emergence of resistance to SP is a concern requiring monitoring the effectiveness of SP for IPTp.

Methods

This was an in-vivo efficacy study to determine the parasitological treatment response and the duration of post-treatment prophylaxis among asymptomatic pregnant women receiving SP as part of IPTp in Mali and Burkina-Faso. The primary outcome was the PCR-unadjusted % of patients with parasites recurrence by day 42 defined as a positive diagnostic test by malaria smear at any visit between days 4 and 42. Treatment failure was based on the standard World Health Organization criteria. The therapeutic response was estimated using the Kaplan-Meier curve.

Results

A total of 580 women were enrolled in Mali (N=268) and Burkina-Faso (N=312) and followed weekly for 42 days. Among these, 94.3% completed the follow-up. The PCR-unadjusted cumulative risk of recurrence by day 42 was 4.9% overall, and 3.2% and 6.5% in Mali and Burkina Faso respectively (Hazard Ratio [HR] =2.14, 95%, CI [0.93-4.90]; P=0.070), and higher among the primi– and secundigravida (6.4%) than multigravida (2.2%, HR=3.01 [1.04-8.69]; P=0.042). The PCR-adjusted failure risk was 1.1% overall (Mali 0.8%, Burkina-Faso 1.4%). The frequencies (95% CI) of the dhfr double and triple mutant and dhps 437 and 540 alleles mutant genotype at enrolment were 24.2% (23.7-25.0), 4.7% (4.4-5.0), and 21.4% (20.8-22.0) and 0.37% (0.29-0.44) in Mali, and 7.1% (6.5-7.7), 44.9% (43.8-46.0) and 75.3% (74.5-76.2) and 0% in Burkina-Faso, respectively. There were no dhfr 164L or dhps 581G mutations.

Conclusion

SP remains effective at clearing existing infections when provided as IPTp to asymptomatic pregnant women in Mali and Burkina. Continued monitoring of IPTp-SP effectiveness, including of the impact on birth parameters in this region is essential.

Original language	English
Article number	41
Pages (from-to)	:41
Journal	Malaria Journal
Volume	13
Issue number	1
DOIs	https://doi.org/10.1186/1475-2875-13-41
Publication status	Published - 31 Jan 2014

Keywords

Burkina-Faso
Intermittent
Malaria
Mali
Pregnancy
Resistance
Sulphadoxine-pyrimethamine

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1186/1475-2875-13-41Licence: CC BY-NC

1475-2875-13-41Final published version, 1.47 MBLicence: CC BY-NC

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Coulibaly, S. O., Kayentao, K., Taylor, S., Guirou, E. A., Khairallah, C., Guindo, N., Djimde, M., Bationo, R., Soulama, A., Dabira, E., Barry, B., Niangaly, M., Diakite, H., Konate, S., Keita, M., Traore, B., Meshnick, S. R., Magnussen, P., Doumbo, O. K., & Ter Kuile, F. (2014). Parasite clearance following treatment with sulphadoxine-pyrimethamine for intermittent preventive treatment in Burkina-Faso and Mali: 42-day in vivo follow-up study. Malaria Journal, 13(1), :41. Article 41. https://doi.org/10.1186/1475-2875-13-41

@article{d4cd1afbba874e009a84f46ea35c08fa,

title = "Parasite clearance following treatment with sulphadoxine-pyrimethamine for intermittent preventive treatment in Burkina-Faso and Mali: 42-day in vivo follow-up study",

abstract = "BackgroundIntermittent Preventive Treatment in pregnancy (IPTp) with sulphadoxine-pyrimethamine (SP) is widely used for the control of malaria in pregnancy in Africa. The emergence of resistance to SP is a concern requiring monitoring the effectiveness of SP for IPTp.MethodsThis was an in-vivo efficacy study to determine the parasitological treatment response and the duration of post-treatment prophylaxis among asymptomatic pregnant women receiving SP as part of IPTp in Mali and Burkina-Faso. The primary outcome was the PCR-unadjusted \% of patients with parasites recurrence by day 42 defined as a positive diagnostic test by malaria smear at any visit between days 4 and 42. Treatment failure was based on the standard World Health Organization criteria. The therapeutic response was estimated using the Kaplan-Meier curve.ResultsA total of 580 women were enrolled in Mali (N=268) and Burkina-Faso (N=312) and followed weekly for 42 days. Among these, 94.3\% completed the follow-up. The PCR-unadjusted cumulative risk of recurrence by day 42 was 4.9\% overall, and 3.2\% and 6.5\% in Mali and Burkina Faso respectively (Hazard Ratio [HR] =2.14, 95\%, CI [0.93-4.90]; P=0.070), and higher among the primi– and secundigravida (6.4\%) than multigravida (2.2\%, HR=3.01 [1.04-8.69]; P=0.042). The PCR-adjusted failure risk was 1.1\% overall (Mali 0.8\%, Burkina-Faso 1.4\%). The frequencies (95\% CI) of the dhfr double and triple mutant and dhps 437 and 540 alleles mutant genotype at enrolment were 24.2\% (23.7-25.0), 4.7\% (4.4-5.0), and 21.4\% (20.8-22.0) and 0.37\% (0.29-0.44) in Mali, and 7.1\% (6.5-7.7), 44.9\% (43.8-46.0) and 75.3\% (74.5-76.2) and 0\% in Burkina-Faso, respectively. There were no dhfr 164L or dhps 581G mutations.ConclusionSP remains effective at clearing existing infections when provided as IPTp to asymptomatic pregnant women in Mali and Burkina. Continued monitoring of IPTp-SP effectiveness, including of the impact on birth parameters in this region is essential.",

keywords = "Burkina-Faso, Intermittent, Malaria, Mali, Pregnancy, Resistance, Sulphadoxine-pyrimethamine",

author = "Coulibaly, \{Sheick O.\} and Kassoum Kayentao and Steve Taylor and Guirou, \{Etienne A.\} and Carole Khairallah and Nouhoun Guindo and Moussa Djimde and Richard Bationo and Alamissa Soulama and Edgar Dabira and Binta Barry and Moussa Niangaly and Hammadoun Diakite and Sidiki Konate and Mohamed Keita and Boubacar Traore and Meshnick, \{Steve R.\} and Pascal Magnussen and Doumbo, \{Ogobara K.\} and \{Ter Kuile\}, Feiko",

year = "2014",

month = jan,

day = "31",

doi = "10.1186/1475-2875-13-41",

language = "English",

volume = "13",

pages = ":41",

journal = "Malaria Journal",

issn = "1475-2875",

publisher = "BioMed Central Ltd",

number = "1",

}

Coulibaly, SO, Kayentao, K, Taylor, S, Guirou, EA, Khairallah, C, Guindo, N, Djimde, M, Bationo, R, Soulama, A, Dabira, E, Barry, B, Niangaly, M, Diakite, H, Konate, S, Keita, M, Traore, B, Meshnick, SR, Magnussen, P, Doumbo, OK & Ter Kuile, F 2014, 'Parasite clearance following treatment with sulphadoxine-pyrimethamine for intermittent preventive treatment in Burkina-Faso and Mali: 42-day in vivo follow-up study', Malaria Journal, vol. 13, no. 1, 41, pp. :41. https://doi.org/10.1186/1475-2875-13-41

TY - JOUR

T1 - Parasite clearance following treatment with sulphadoxine-pyrimethamine for intermittent preventive treatment in Burkina-Faso and Mali: 42-day in vivo follow-up study

AU - Coulibaly, Sheick O.

AU - Kayentao, Kassoum

AU - Taylor, Steve

AU - Guirou, Etienne A.

AU - Khairallah, Carole

AU - Guindo, Nouhoun

AU - Djimde, Moussa

AU - Bationo, Richard

AU - Soulama, Alamissa

AU - Dabira, Edgar

AU - Barry, Binta

AU - Niangaly, Moussa

AU - Diakite, Hammadoun

AU - Konate, Sidiki

AU - Keita, Mohamed

AU - Traore, Boubacar

AU - Meshnick, Steve R.

AU - Magnussen, Pascal

AU - Doumbo, Ogobara K.

AU - Ter Kuile, Feiko

PY - 2014/1/31

Y1 - 2014/1/31

N2 - BackgroundIntermittent Preventive Treatment in pregnancy (IPTp) with sulphadoxine-pyrimethamine (SP) is widely used for the control of malaria in pregnancy in Africa. The emergence of resistance to SP is a concern requiring monitoring the effectiveness of SP for IPTp.MethodsThis was an in-vivo efficacy study to determine the parasitological treatment response and the duration of post-treatment prophylaxis among asymptomatic pregnant women receiving SP as part of IPTp in Mali and Burkina-Faso. The primary outcome was the PCR-unadjusted % of patients with parasites recurrence by day 42 defined as a positive diagnostic test by malaria smear at any visit between days 4 and 42. Treatment failure was based on the standard World Health Organization criteria. The therapeutic response was estimated using the Kaplan-Meier curve.ResultsA total of 580 women were enrolled in Mali (N=268) and Burkina-Faso (N=312) and followed weekly for 42 days. Among these, 94.3% completed the follow-up. The PCR-unadjusted cumulative risk of recurrence by day 42 was 4.9% overall, and 3.2% and 6.5% in Mali and Burkina Faso respectively (Hazard Ratio [HR] =2.14, 95%, CI [0.93-4.90]; P=0.070), and higher among the primi– and secundigravida (6.4%) than multigravida (2.2%, HR=3.01 [1.04-8.69]; P=0.042). The PCR-adjusted failure risk was 1.1% overall (Mali 0.8%, Burkina-Faso 1.4%). The frequencies (95% CI) of the dhfr double and triple mutant and dhps 437 and 540 alleles mutant genotype at enrolment were 24.2% (23.7-25.0), 4.7% (4.4-5.0), and 21.4% (20.8-22.0) and 0.37% (0.29-0.44) in Mali, and 7.1% (6.5-7.7), 44.9% (43.8-46.0) and 75.3% (74.5-76.2) and 0% in Burkina-Faso, respectively. There were no dhfr 164L or dhps 581G mutations.ConclusionSP remains effective at clearing existing infections when provided as IPTp to asymptomatic pregnant women in Mali and Burkina. Continued monitoring of IPTp-SP effectiveness, including of the impact on birth parameters in this region is essential.

AB - BackgroundIntermittent Preventive Treatment in pregnancy (IPTp) with sulphadoxine-pyrimethamine (SP) is widely used for the control of malaria in pregnancy in Africa. The emergence of resistance to SP is a concern requiring monitoring the effectiveness of SP for IPTp.MethodsThis was an in-vivo efficacy study to determine the parasitological treatment response and the duration of post-treatment prophylaxis among asymptomatic pregnant women receiving SP as part of IPTp in Mali and Burkina-Faso. The primary outcome was the PCR-unadjusted % of patients with parasites recurrence by day 42 defined as a positive diagnostic test by malaria smear at any visit between days 4 and 42. Treatment failure was based on the standard World Health Organization criteria. The therapeutic response was estimated using the Kaplan-Meier curve.ResultsA total of 580 women were enrolled in Mali (N=268) and Burkina-Faso (N=312) and followed weekly for 42 days. Among these, 94.3% completed the follow-up. The PCR-unadjusted cumulative risk of recurrence by day 42 was 4.9% overall, and 3.2% and 6.5% in Mali and Burkina Faso respectively (Hazard Ratio [HR] =2.14, 95%, CI [0.93-4.90]; P=0.070), and higher among the primi– and secundigravida (6.4%) than multigravida (2.2%, HR=3.01 [1.04-8.69]; P=0.042). The PCR-adjusted failure risk was 1.1% overall (Mali 0.8%, Burkina-Faso 1.4%). The frequencies (95% CI) of the dhfr double and triple mutant and dhps 437 and 540 alleles mutant genotype at enrolment were 24.2% (23.7-25.0), 4.7% (4.4-5.0), and 21.4% (20.8-22.0) and 0.37% (0.29-0.44) in Mali, and 7.1% (6.5-7.7), 44.9% (43.8-46.0) and 75.3% (74.5-76.2) and 0% in Burkina-Faso, respectively. There were no dhfr 164L or dhps 581G mutations.ConclusionSP remains effective at clearing existing infections when provided as IPTp to asymptomatic pregnant women in Mali and Burkina. Continued monitoring of IPTp-SP effectiveness, including of the impact on birth parameters in this region is essential.

KW - Burkina-Faso

KW - Intermittent

KW - Malaria

KW - Mali

KW - Pregnancy

KW - Resistance

KW - Sulphadoxine-pyrimethamine

U2 - 10.1186/1475-2875-13-41

DO - 10.1186/1475-2875-13-41

M3 - Article

SN - 1475-2875

VL - 13

SP - :41

JO - Malaria Journal

JF - Malaria Journal

IS - 1

M1 - 41

ER -

Parasite clearance following treatment with sulphadoxine-pyrimethamine for intermittent preventive treatment in Burkina-Faso and Mali: 42-day in vivo follow-up study

Abstract

Keywords

UN SDGs

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