@article{van,
author = {van, Eijk AM and Larsen, D and Kayentao, K and Koshy, G and Slaughter, D and Roper, C and Okell, L and Desai, M and Gutman, J and Khairallah, C and Rogerson, S and Sibley, C and Meshnick, S and Taylor, S and ter, Kuile F},
journal = {Lancet Infectious Diseases},
title = {Impact of Plasmodium falciparum Sulphadoxine-Pyrimethamine Resistance on the Effectiveness of Intermittent Preventive Therapy for Malaria in Pregnancy in Africa: A Systematic Review and Meta-Analysis},
url = {http://hdl.handle.net/10044/1/66473},
}

Download

TY  - JOUR
AB  - BackgroundPlasmodium falciparum resistance to sulphadoxine-pyrimethamine (SP) threatens the efficacy of intermittent preventive treatment (IPTp) for malaria in pregnancy in Africa. We conducted a meta-analysis to assess the impact of SP resistance on IPTp-SP effectiveness.MethodsWe searched databases (1990 to March-01-2018) for clinical studies (aggregated data) or surveys (individual-participant data) containing information on low birthweight (LBW, primary outcome) and malaria by IPTp-SP dose, and for studies reporting SP-resistance molecular markers. We performed random-effects meta-analysis (clinical studies) or multivariate log-binomial regression (surveys) to obtain summarized dose-response data (Relative-Risk-Reduction:RRR) and multivariate meta-regression to explore modifying effects of SP-resistance (dhps substitutions A437G, K540E, A581G). FindingsOf 1097 records, 57 studies were included in the aggregated-data meta-analysis (59,457 births). The RRR for LBW declined with increasing prevalence of Pfdhps-K540E (P-trend=0.0060) but not with Pfdhps-A437G (P-trend=0.35). The RRR in areas of high (Pfdhps-K540E >90%, n=11), moderate (Central/West Africa:Pfdhps-A437G≥90% or East/southern Africa:Pfdhps-K540E 30-90%, n=16) and low SP-resistances (n=30) were 7% (95% CI 0-13), 21% (14-29) and 27% (21-33) respectively (P-trend=0.0054, I2=69.5%). In the individual-participant analysis of 13 surveys (42,394 births), IPTp-SP was associated with reduced LBW in areas with Pfdhps-K540E>90% & Pfdhps-A581G<10% (RRR=10%, 7-12), but not those with Pfdhps-A581G>=10% (pooled Pfdhps-A581G prevalence:37%, range 29-46) (RRR=0.5%, -16-14, n=3). InterpretationThe effectiveness of IPTp-SP is reduced in areas with high SP-resistance, but IPTp-SP remains associated with reduced LBW in areas where Pfdhps-K540E prevalence exceeds 90%. IPTp-SP is not effective in areas with ≥37% prevalence of the highly-resistant sextuple Pfdhps-A581G-containing genotype.
AU  - van,Eijk AM
AU  - Larsen,D
AU  - Kayentao,K
AU  - Koshy,G
AU  - Slaughter,D
AU  - Roper,C
AU  - Okell,L
AU  - Desai,M
AU  - Gutman,J
AU  - Khairallah,C
AU  - Rogerson,S
AU  - Sibley,C
AU  - Meshnick,S
AU  - Taylor,S
AU  - ter,Kuile F
SN  - 1473-3099
TI  - Impact of Plasmodium falciparum Sulphadoxine-Pyrimethamine Resistance on the Effectiveness of Intermittent Preventive Therapy for Malaria in Pregnancy in Africa: A Systematic Review and Meta-Analysis
T2  - Lancet Infectious Diseases
UR  - http://hdl.handle.net/10044/1/66473
ER  - 

Download