Sustained clinical benefit of malaria chemoprevention with sulfadoxine-pyrimethamine (SP) in pregnant women in a region with high SP resistance markers
Glória Matambisso, Nanna Brokhattingen, Sónia Maculuve, Pau Cisteró, Henriques Mbeve, Anna Escoda, Gizela Bambo, Boaventura Cuna, Cardoso Melembe, Nelo Ndimande, Kevin K. A. Tetteh, Chris Drakeley, Benoît Gamain, Chetan E. Chitnis, Virander S. Chauhan, Llorenç Quintó, Eusébio Macete, Alfredo Mayor
Abstract
ObjectiveThe effectiveness of intermittent preventive treatment of malaria in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) is threatened by increasing SP resistance in Africa. We assessed the level of SP-resistance markers, and the clinical and parasitological effectiveness of IPTp-SP in southern Mozambique.MethodsP. falciparum infection, antimalarial antibodies and dhfr/dhps SP-resistance mutants were detected by quantitative polymerase chain reaction (qPCR), suspension array technology and targeted deep sequencing, respectively, among 4016 HIV negative women in Maputo province (2016-2019). Univariate and multivariate regression models were used to assess the association between taking the recommended three or more IPTp-SP doses (IPTp3+) and parasitological and clinical outcomes.Results84.3% (3385/4016) women received three or more IPTp-SP doses. The prevalence of quintuple mutants at first ANC visit was 94.2%. IPTp3+ was associated with a higher clearance rate of qPCR-detected infections from first ANC visit to delivery (adjusted odds ratio [aOR]=5.9, 95%CI: 1.5-33.3; p=0.012), lower seroprevalence at delivery of antibodies against the pregnancy-specific antigen VAR2CSADBL34 (aOR=0.72, 95%CI: 0.54-0.95; p=0.022), and lower prevalence of low birth weight deliveries (aOR: 0.61, 95% CI: 0.41-0.90; p=0.013).ConclusionA sustained parasitological effect of IPTp-SP contributes to the clinical effectiveness of IPTp3+ in areas with high prevalence of SP resistance markers.