@article{fdi:010084577,
  title = {{I}ntermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine and parasite resistance : cross-sectional surveys from antenatal care visit and delivery in rural {G}hana},
  author = {{M}ama, {A}. and {A}hiabor, {C}. and {T}ornyigah, {B}. and {F}rempong, {N}. {A}. and {K}usi, {K}. {A}. and {A}du, {B}. and {C}ourtin, {D}avid and {H}ouze, {S}. and {D}eloron, {P}hilippe and {O}fori, {M}. {F}. and {A}nang, {A}. {K}. and {A}riey, {F}. and {T}uikue {N}dam, {N}icaise},
  editor = {},
  language = {{ENG}},
  abstract = {{B}ackground {D}espite decades of prevention efforts, the burden of malaria in pregnancy ({M}i{P}) remains a great public health concern. {S}ulfadoxine-pyrimethamine ({SP}), used as intermittent preventive treatment in pregnancy ({IPT}p-{SP}) is an important component of the malaria prevention strategy implemented in {A}frica. {H}owever, {IPT}p-{SP} is under constant threat from parasite resistance, thus requires regular evaluation to inform decision-making bodies. {M}ethods {I}n two malaria endemic communities in the {V}olta region ({A}didome and {B}attor), a cross-sectional hospital-based study was conducted in pregnant women recruited at their first antenatal care ({ANC}) visit and at delivery. {B}asic clinical and demographic information were documented and their antenatal records were reviewed to confirm {IPT}p-{SP} adherence. {P}eripheral and placental blood were assayed for the presence of {P}lasmodium falciparum parasites by quantitative polymerase chain reaction (q{PCR}). {O}ne hundred and twenty (120) positive samples were genotyped for mutations associated with {SP} resistance. {R}esults {A}t first {ANC} visit, {P}. falciparum prevalence was 28.8% in {A}didome and 18.2% in {B}attor. {A}t delivery, this decreased to 14.2% and 8.2%, respectively. {A}t delivery, 66.2% of the women had taken at least the recommended 3 or more doses of {IPT}p-{SP} and there was no difference between the two communities. {T}aking at least 3 {IPT}p-{SP} doses was associated with an average birth weight increase of more than 360 g at both study sites compared to women who did not take treatment (p = 0.003). {T}he {P}fdhfr/{P}fdhps quintuple mutant {IRNI}-{A}/{FGKAA} was the most prevalent (46.7%) haplotype found and the nonsynonymous {P}fdhps mutation at codon {A}581{G} was higher at delivery among post-{SP} treatment isolates (40.6%) compared to those of first {ANC} (10.22%). {T}here was also an increase in the {A}581{G} mutation in isolates from women who took 3 or more {IPT}p-{SP}. {C}onclusions {T}his study confirms a positive impact following the implementation of the new {IPT}p-{SP} policy in {G}hana in increasing the birth weight of newborns. {H}owever, the selection pressure exerted by the recommended 3 or more doses of {IPT}p-{SP} results in the emergence of parasites carrying the non-synonymous mutation on codon {A}581{G}. {T}his constant selective pressure calls into question the time remaining for the clinical utility of {IPT}p-{SP} treatment during pregnancy in {A}frica.},
  keywords = {{M}alaria ; {P}regnancy ; {P}lasmodium falciparum ; {G}hana ; {IPT}p-{SP} ; {SP} resistance ; {GHANA}},
  booktitle = {},
  journal = {{M}alaria {J}ournal},
  volume = {21},
  numero = {1},
  pages = {107 [9 p.]},
  year = {2022},
  DOI = {10.1186/s12936-022-04124-7},
  URL = {https://www.documentation.ird.fr/hor/fdi:010084577},
}