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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Effectiveness of intermittent screening and treatment for the control of malaria in pregnancy: A cluster randomised trial in India
BMJ Global Health, Volume 4, No. 4, Year 2019
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Description
Background The control of malaria in pregnancy (MiP) in India relies on testing women who present with symptoms or signs suggestive of malaria. We hypothesised that intermittent screening and treatment for malaria at each antenatal care visit (ISTp) would improve on this approach and reduce the adverse effects of MiP. Methods A cluster randomised controlled trial comparing ISTp versus passive case detection (PCD) was conducted in Jharkhand state. Pregnant women of all parities with a gestational age of 18-28 weeks were enrolled. Women in the ISTp group were screened with a rapid diagnostic test (RDT) for malaria at each antenatal clinic visit and those in the PCD group were screened only if they had symptoms or signs suggestive of malaria. All RDT positive women were treated with artesunate/sulfadoxine-pyrimethamine. The primary endpoint was placental malaria, determined by placental histology, and the key secondary endpoints were birth weight, gestational age, vital status of the newborn baby and maternal anaemia. Results Between April 2012 and September 2015, 6868 women were enrolled; 3300 in 46 ISTp clusters and 3568 in 41 PCD clusters. In the ISTp arm, 4.9% of women were tested malaria positive and 0.6% in the PCD arm. There was no difference in the prevalence of placental malaria in the ISTp (87/1454, 6.0%) and PCD (65/1560, 4.2%) groups (6.0% vs 4.2%; OR 1.34, 95% CI 0.78 to 2.29, p=0.29) or in any of the secondary endpoints. Conclusion ISTp detected more infections than PCD, but monthly ISTp with the current generation of RDT is unlikely to reduce placental malaria or impact on pregnancy outcomes. ISTp trials with more sensitive point-of-care diagnostic tests are needed. © 2019 Author(s) (or their employer(s)). Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Authors & Co-Authors
Kuepfer, Irene
United Kingdom, London
London School of Hygiene & Tropical Medicine
Mishra, Neelima N.
India, New Delhi
National Institute of Malaria Research India
Bruce, Jane C.
United Kingdom, London
London School of Hygiene & Tropical Medicine
Anvikar, Anupkumar R.
India, New Delhi
National Institute of Malaria Research India
Satpathy, Sanghamitra K.
India, Rourkela
Ispat General Hospital
Behera, Prativa Kumari
India, Rourkela
Ispat General Hospital
Muehlenbachs, Atis
United States, Atlanta
Centers for Disease Control and Prevention
Webster, Jayne
United Kingdom, London
London School of Hygiene & Tropical Medicine
TerKuile, Feiko O.
United Kingdom, Liverpool
Liverpool School of Tropical Medicine
Greenwood, Brian M.
United Kingdom, London
London School of Hygiene & Tropical Medicine
Valecha, Neena
India, New Delhi
National Institute of Malaria Research India
Chandramohan, Daniel
United Kingdom, London
London School of Hygiene & Tropical Medicine
Statistics
Citations: 9
Authors: 12
Affiliations: 5
Identifiers
Doi:
10.1136/bmjgh-2019-001399
ISSN:
20597908
Research Areas
Health System And Policy
Infectious Diseases
Maternal And Child Health
Sexual And Reproductive Health
Study Design
Randomised Control Trial
Cross Sectional Study
Participants Gender
Female