Intermittent sulphadoxine-pyrimethamine to prevent severe anaemia secondary to malaria in pregnancy: a randomised placebo-controlled trial

Background In areas of endemic transmission, malaria in pregnancy is associated with severe maternal anaemia and low-birthweight babies, We studied the efficacy of intermittent treatment doses of sulphadoxine-pyrimethamine In preventing malaria and severe anaemia in pregnancy in a double-blind placebo-controlled trial among primigravid women living in Kilifi District, Kenya. Methods Between January, 1996, and April, 1997, 1264 primigravid women were recruited when they attended: for antenatal care, and randomly assigned sulphadoxine-pyrimethamine (640) or placebo (624). Women received one, two, or three doses of study medication depending an the duration of gestation at enrolment. Primary outcome measures were severe anaemia (haemoglobin <8 g/dL) and malaria parasitaemia, assessed at 34 weeks of gestation. Analyses were based on intention to treat among women who had study blood tests at 34 weeks, Findings 30 (5.3%) of 567 women in the sulphadoxine- pyrimethamine group and 199 (35.3%) of 564 in the placebo group had peripheral parasitaemia (protecive efficacy 85% [95% CI 78-90], p < 0.0001). 82 (14.5%) and 134 (23.7%) had severe anaemia (protective efficacy 39% [22-52], p<0.0001). Even women who booked late and received only one dose of sulphadoxine-pyrimethamine benefited significantly from the intervention. The effects were, seen both in women who owned insecticide-treated bednets and in women who did not. Interpretation intermittent presumptive treatment with sulphadoxine-pyrimethamine is an effective, practicable strategy to decrease the risk of severe anaemia in primigravidae living in malarious areas.