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MALARIA PREVENTION DURING PREGNANCY: ASSESSING THE DISEASE BURDEN ONE YEAR AFTER IMPLEMENTING A PROGRAM OF INTERMITTENT PREVENTIVE TREATMENT IN KOUPÉLA DISTRICT, BURKINA FASO

The World Health Organization recommends that pregnant women in malaria-endemic areas receive 2 doses of intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp/SP) in the second and third trimesters of pregnancy to prevent maternal anemia, placental parasitemia, and low birth weight (LBW). In 2001, a program evaluation in Koupéla District, Burkina Faso demonstrated that despite widespread use of chloroquine chemoprophylaxis, the burden of malaria during pregnancy remained high. In 2003, the Burkina Faso Ministry of Health piloted a program of IPTp/SP (three doses) and accelerated distribution of insecticide-treated nets (ITN) to pregnant women in Koupéla District. In 2004, a follow-up program evaluation was conducted. Coverage with 1 doses of IPTp/SP was high among women attending antenatal clinics (ANCs) (96.2%) and delivery units (DUs) (93.5%); ITN ownership was moderately high (ANC = 53.9%, DU = 61.6%). In multivariate analysis, 1 dose of IPTp/SP was associated with a significant reduction in the prevalence of peripheral parasitemia at ANCs (risk ratio [RR] = 0.49, P = 0.008), 2 doses of IPTp/SP were associated with a reduction in the prevalence of placental parasitemia (RR = 0.56, P = 0.02), and three doses of IPTp/SP were associated with a reduced risk of LBW (RR = 0.51, P = 0.04). The proportions of women at ANCs with peripheral parasitemia and anemia were significantly lower in 2004 than in 2001 (RR = 0.53, P = 0.001 and RR = 0.78, P = 0.003, respectively). The proportions of women at DUs with peripheral and placental parasitemia were also significantly lower in 2004 than in 2001 (RR = 0.66, P < 0.0001 and RR = 0.71, P = 0.0002, respectively). These data suggest that a package of IPTp/SP and ITNs is effective in reducing the burden of malaria during pregnancy in Burkina Faso.

Received December 6, 2005. Accepted for publication March 26, 2006.

Acknowledgments: We thank JHPIEGO, including Jéremie Zoungrana, Cecile Somda, Sidibé Samba, Aimee Dickerson, and Rebecca Dineen, and Dr. Xavier Pitriopa (Director of the Centre National de Recherche et de Formation sur le Paludisme) for program assistance, Amidou Ouédraogo (Centre National de Recherche et de Formation sur le Paludisme) for data management, Dr. Sara Crawford (Centers for Disease Control and Prevention) for assistance with data analysis, and members of the team in Burkina Faso and all women and their newborns who participated in this assessment.

Financial support: This assessment was supported by the United States Agency for International Development through the Malaria Action Coalition, the Centers for Disease Control and Prevention, and JHPIEGO Corporation.

Disclaimer: Use of trade names is for identification only and does not imply endorsement by the Public Health Service or by the U.S. Department of Health and Human Service.

Disclosure: None of the authors had any conflicts of interest.

^* Address correspondence to Robert D. Newman, Malaria Branch, Centers for Disease Control and Prevention, 4770 Buford Highway NE, MS F-22, Atlanta, GA 30341. E-mail: rnewman{at}cdc.gov

Authors’ addresses: Sodiomon B. Sirima, Amadou Konaté, Edith C. Bougouma, Amidou Diarra, and Alphonse Ouédraogo, Centre National de Recherche et de Formation sur le Paludisme, Ministère de la Santé, 01 BP 2208, Ouagadougou, Burkina Faso, Telephone: 226-32-46-95, Fax: 226-31-04-77. Annett H. Cotte, Kwame Asamoa, Monica E. Parise, and Robert D. Newman, Malaria Branch, Centers for Disease Control and Prevention, 4770 Buford Highway NE, MS F-22, Atlanta, GA 30341, Telephone: 770-488-7755, Fax: 770-488-4206. Allisyn C. Moran, Maternal and Neonatal Health, JHPIEGO Corporation, 1615 Thames Street, Suite 100, Baltimore, MD 21231, Telephone: 410-537-1891, Fax: 410-537-1479.

Reprint requests: Robert D. Newman, Malaria Branch, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Mailstop F-22, Atlanta, GA 30341, Telephone: 770-488-7755, Fax: 770-488-4206, E-mail ren5{at}cdc.gov.

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