Effectiveness of Monthly Versus Two-Dose Regimen of Sulphadoxine-Pyrimethamine for Intermittent Preventive Treatment of Malaria in Pregnancy in Southeastern Nigeria: A Randomised Controlled Trial.

Background: There are reports of a high prevalence of maternal peripheral and placental malarial parasitaemia (MP) in southeastern Nigeria following the two-dose regimen of sulphadoxine-pyrimethamine (SP) for intermittent preventive treatment (IPT) of malaria in pregnancy.

Objective: To compare the effectiveness of monthly versus two-dose regimens of SP for IPT of malaria in pregnancy in Enugu, south-eastern Nigeria.

Methods: A randomized controlled trial involving antenatal clinic attendees at the University of Nigeria Teaching Hospital (UNTH), Ituku-Ozalla, Enugu, Nigeria. Pregnant women at gestational ages between 13 - 24 weeks were randomized into two groups; intervention group and control group to receive monthly dosing and a two-dose regimen of IPT-SP respectively. Peripheral and placental malaria parasitaemia (MP) and other outcome measures were compared between the two groups.

Results: Prevalence of placental parasitaemia ( 18% vs. 40.6%; RR: 0.44; 95% CI: 0.27 - 0.72; P < 0.001) and maternal peripheral parasitaemia (10.0% vs. 31.7%; RR: 0.32; 95% CI: 0.16 - 0.61; P < 0.001) were significantly lower in the intervention compared to the control group. Similarly, maternal anaemia (39.0% versus 57.4%, p<0.05), neonatal malaria parasitaemia (5.0% versus 16.8%, p < 0.05) and neonatal anaemia (10.0% versus 23.8%, < 0.05) were all significantly lower in the intervention than the control group. However, the incidence of low birth weight (LBW) did not differ between the two groups (P=1.0).

Conclusion: Monthly IPT-SP is more effective in preventing malaria in pregnancy than the standard two-dose regimen. We recommend the universal adoption of this regimen in all obstetric care units.