The effectiveness of intermittent preventive therapy with sulphadoxine and pyrimethamine on the risk of low birthweight in West Africa: a systematic review and metal-analysis

Abstract

Background: Intermittent preventive therapy with Sulphadoxine-Pyrimethamine, used in the prevention of malaria in pregnancy is the standard used in over 37 countries in Sub-Saharan Africa. With an increasing burden of malaria in pregnancy as well as the increased potential for P. falciparum resistance and inadequate dosage regimentation, there may be a reason to believe IPTP-SP may no longer be effective for the prevention of malaria in pregnancy, in endemic regions of the continent specifically in West Africa.

Methods: A stepwise, systematic and extensive literature of online databases was performed based on predefined search terms. The Malaria in pregnancy library, PubMed, and Google Scholar were searched for randomized control trials conducted within the years of 2000 to 2017, which compared Intermittent preventive therapy with Sulphadoxine and Pyrimethamine with other prophylactic drug interventions, in the West African sub-region was done. Eligible studies included randomized control trials of published or unpublished original research studies.

Results: Of 60 studies, 10 trials with 15,936 pregnancies were included in the final meta-analysis. Pregnant women in the Intermittent preventive therapy with Sulphadoxine and Pyrimethamine groups showed no significant difference in risks of having low birthweight infants from groups that used other interventions (RR = 0.94; 95% CI [0.78 – 1.13], I2=77) showing that IPTP-SP use did not inherently reduce the risk of pregnant women having low birth weight babies. The outcome of low birthweight at term in the IPTP-SP groups was 930 events out of a total population of 7131. Other outcomes showed the same consistency.

Conclusion: Among pregnant women in West Africa Intermittent Preventive Therapy with two or more doses of Sulphadoxine and Pyrimethamine did not inherently reduce the risk of adverse birth outcomes from malaria in pregnancy. The main objective of this analysis was to evaluate the effectiveness of two or more dose of IPTP-SP in preventing adverse birth outcomes, in the context of public health, the evidence shows that this effectiveness is not upheld in a malaria endemic region. Keywords Malaria in Pregnancy, Low Birthweight, Adverse birth outcomes, IPTP-SP, West Africa