Effectiveness of intermittent screening and treatment for the control of malaria in pregnancy: a cluster randomised trial in India
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 adve...
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BMJ Publishing Group
2019-07-01
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| Series: | BMJ Global Health |
| Online Access: | https://gh.bmj.com/content/4/4/e001399.full |
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| author | Irene Kuepfer Neelima Mishra Jane Bruce Vinit Mishra Anupkumar R Anvikar Sanghamitra Satpathi Prativa Behera Atis Muehlenbachs Jayne Webster Feiko terKuile Brian Greenwood Neena Valecha Daniel Chandramohan |
| author_facet | Irene Kuepfer Neelima Mishra Jane Bruce Vinit Mishra Anupkumar R Anvikar Sanghamitra Satpathi Prativa Behera Atis Muehlenbachs Jayne Webster Feiko terKuile Brian Greenwood Neena Valecha Daniel Chandramohan |
| author_sort | Irene Kuepfer |
| collection | DOAJ |
| 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. |
| format | Article |
| id | doaj-art-c2c124cd805e4759828e0e9570ae7554 |
| institution | OA Journals |
| issn | 2059-7908 |
| language | English |
| publishDate | 2019-07-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Global Health |
| spelling | doaj-art-c2c124cd805e4759828e0e9570ae75542025-08-20T01:56:38ZengBMJ Publishing GroupBMJ Global Health2059-79082019-07-014410.1136/bmjgh-2019-001399Effectiveness of intermittent screening and treatment for the control of malaria in pregnancy: a cluster randomised trial in IndiaIrene Kuepfer0Neelima Mishra1Jane Bruce2Vinit Mishra3Anupkumar R Anvikar4Sanghamitra Satpathi5Prativa Behera6Atis Muehlenbachs7Jayne Webster8Feiko terKuile9Brian Greenwood10Neena Valecha11Daniel Chandramohan12Department of Disease Control, London School of Hygiene & Tropical Medicine Faculty of Infectious and Tropical Diseases, London, UKNational Institute of Malaria Research, New Delhi, IndiaDepartment of Disease Control, London School of Hygiene & Tropical Medicine Faculty of Infectious and Tropical Diseases, London, UKNational Institute of Malaria Research, New Delhi, India1 ICMR- National Institute of Malaria Research (NIMR), New Delhi, IndiaDepartment of Pathology, Ispat General Hospital, Rourkela, IndiaDepartment of Pathology, Ispat General Hospital, Rourkela, IndiaOffice of Infectious Diseases, National Foundation for the Centers for Disease Control and Prevention Inc, Atlanta, Georgia, USADepartment of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UKDepartment of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UKFaculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UKNational Institute of Malaria Research, New Delhi, IndiaDisease Control, London School of Hygiene & Tropical Medicine Faculty of Infectious and Tropical Diseases, London, UKBackground 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.https://gh.bmj.com/content/4/4/e001399.full |
| spellingShingle | Irene Kuepfer Neelima Mishra Jane Bruce Vinit Mishra Anupkumar R Anvikar Sanghamitra Satpathi Prativa Behera Atis Muehlenbachs Jayne Webster Feiko terKuile Brian Greenwood Neena Valecha Daniel Chandramohan Effectiveness of intermittent screening and treatment for the control of malaria in pregnancy: a cluster randomised trial in India BMJ Global Health |
| title | Effectiveness of intermittent screening and treatment for the control of malaria in pregnancy: a cluster randomised trial in India |
| title_full | Effectiveness of intermittent screening and treatment for the control of malaria in pregnancy: a cluster randomised trial in India |
| title_fullStr | Effectiveness of intermittent screening and treatment for the control of malaria in pregnancy: a cluster randomised trial in India |
| title_full_unstemmed | Effectiveness of intermittent screening and treatment for the control of malaria in pregnancy: a cluster randomised trial in India |
| title_short | Effectiveness of intermittent screening and treatment for the control of malaria in pregnancy: a cluster randomised trial in India |
| title_sort | effectiveness of intermittent screening and treatment for the control of malaria in pregnancy a cluster randomised trial in india |
| url | https://gh.bmj.com/content/4/4/e001399.full |
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