Evaluation of the usefulness of intermittent preventive treatment of malaria in pregnancy with sulfadoxine-pyrimethamine in a context with increased resistance of Plasmodium falciparum in Kingasani Hospital, Kinshasa in the Democratic Republic of Congo

Kayiba, N.K.; Yobi, D.M.; Tchakounang, V.R.K.; Mvumbi, D.M.; Kabututu, P.Z.; Devleesschauwer, B.; Mukomena, E.S.; De Mol, Patrick; Hayette, Marie-Pierre; Mvumbi, G.L.; Rosas-Aguirre, A.; Lusamba, P.D.; Speybroeck, N.

doi:10.1016/j.meegid.2021.105009

Article (Scientific journals)

Evaluation of the usefulness of intermittent preventive treatment of malaria in pregnancy with sulfadoxine-pyrimethamine in a context with increased resistance of Plasmodium falciparum in Kingasani Hospital, Kinshasa in the Democratic Republic of Congo

Kayiba, N.K.; Yobi, D.M.; Tchakounang, V.R.K. et al.

2021 • In Infection, Genetics and Evolution: Journal of Molecular Epidemiology and Evolutionary Genetics of Infectious Diseases, 94

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https://hdl.handle.net/2268/295902

DOI
10.1016/j.meegid.2021.105009

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34284138

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Democratic Republic of Congo; Intermittent preventive treatment in pregnancy; Laboring woman; Malaria; Resistance; Sulfadoxine-Pyrimethamine; pyrimethamine plus sulfadoxine; antimalarial agent; fanasil, pyrimethamine drug combination; pyrimethamine; sulfadoxine; allogeneic stem cell transplantation; amenorrhea; anemia; Article; blood smear; controlled study; cross-sectional study; DNA extraction; dried blood spot testing; feasibility study; female; fetus death; fever; genotype; gestational age; hemoglobin blood level; human; low birth weight; major clinical study; malaria; malaria falciparum; microscopy; nested polymerase chain reaction; neutrophil count; newborn; outcome assessment; parasite clearance; Plasmodium falciparum; polymerase chain reaction restriction fragment length polymorphism; pregnancy; pregnancy diabetes mellitus; pregnancy outcome; prophylaxis; protein expression; questionnaire; real time polymerase chain reaction; restriction fragment length polymorphism; twin pregnancy; adolescent; adult; Democratic Republic Congo; drug combination; drug resistance; hospital; parasitology; pregnancy complication; young adult; Adolescent; Adult; Antimalarials; Democratic Republic of the Congo; Drug Combinations; Drug Resistance; Female; Hospitals; Humans; Malaria, Falciparum; Pregnancy; Pregnancy Complications; Pyrimethamine; Sulfadoxine; Young Adult

Abstract :

[en] Background: Increasing resistance of Plasmodium falciparum to sulfadoxine-pyrimethamine (SP) threatens its usefulness for intermittent preventive treatment in pregnancy (IPTp-SP). The prophylactic effects of IPTp-SP on maternal malaria and adverse pregnancy outcomes were evaluated in Kingasani Hospital, Kinshasa in the Democratic Republic of Congo (DRC). Methods: Laboring women (n = 844) and respective newborns were investigated. Blood samples collected from women were tested for malaria using rapid diagnostic test (RDT), blood smears examination, and real-time PCR. The hemoglobin level was measured by HemoCue© analyzer. A PCR-RFLP method was applied for detecting N51I, C59R, and S108N mutations on dhfr along with A437G and K540E mutations on dhps in P. falciparum positive samples. Logistic regression models assessed relationships between IPTp-SP uptake and pregnancy outcomes. Results: P. falciparum malaria was detected at delivery in 10.8% of women and was statistically associated with fever during the pregnancy (OR = 2.9 [1.5; 6.3]; p = 0.004) and maternal anemia (OR = 3.9 [2.4; 6.3]; p < 0.001). One out of five parasites was a quintuple mutant encoding dhfr mutations 51I, 59R, and 108 N along with dhps mutations 437G and 540E. The molecular profile of parasites (i.e., 32.6% of parasites carrying dhps K540E) was suitable with continued use of SP for IPTp. IPTp-SP uptake was not associated with reduced maternal malaria, fever reported in pregnancy, or fetal deaths (p > 0.05). Conversely, three or more doses of SP were associated with reduced maternal anemia at delivery (OR = 0.4 [0.2; 0.9]; p = 0.024), shortened gestation (OR = 0.4 [0.2; 0.8]; p = 0.009), and low-birth weights (OR = 0.2 [0.1; 0.5]; p < 0.001). Conclusion: IPTp-SP was not associated with reduced maternal malaria in our study, but evidence was found of a prophylactic effect against adverse pregnancy outcomes. To counteract further loss of clinical effects of IPTp-SP in the study population, alternative strategies able to improve its anti-malarial efficacy such as combination of SP with partner molecules should be implemented. © 2021

Disciplines :

Laboratory medicine & medical technology

Author, co-author :

Kayiba, N.K.; Research Institute of Health and Society, Catholic University of Louvain, Brussels, 1200, Belgium, School of Public Health, Faculty of Medicine, University of Kinshasa, Kinshasa XI, 127, Democratic Republic Congo, Department of Public Health, Faculty of Medicine, University of Mbujimayi, 225 Mbujimayi, Democratic Republic Congo

Yobi, D.M.; Department of Basic Sciences, Faculty of Medicine, University of Kinshasa, Kinshasa XI, 127, Democratic Republic Congo

Tchakounang, V.R.K.; Laboratory of Clinical Microbiology, Center for Interdisciplinary Research on Medicines (CIRM), University of Liège, Liège, 4000, Belgium

Mvumbi, D.M.; Department of Basic Sciences, Faculty of Medicine, University of Kinshasa, Kinshasa XI, 127, Democratic Republic Congo, Department of Quality of Laboratories, Sciensano, Brussels, 1050, Belgium

Kabututu, P.Z.; Department of Basic Sciences, Faculty of Medicine, University of Kinshasa, Kinshasa XI, 127, Democratic Republic Congo

Devleesschauwer, B.; Department of Epidemiology and Public Health, Sciensano, Brussels, 1050, Belgium, Department of Veterinary Public Health and Food Safety, Ghent University, Merelbeke, B-9820, Belgium

Mukomena, E.S.; National Malaria Control Program, National Ministry of Public Health, Democratic Republic Congo, Department of Public Health, Faculty of Medicine, University of Lubumbashi, Lubumbashi, 1825, Democratic Republic Congo

De Mol, Patrick ; Université de Liège - ULiège > Département des sciences biomédicales et précliniques

Hayette, Marie-Pierre ; Centre Hospitalier Universitaire de Liège - CHU > > Service de microbiologie clinique

Mvumbi, G.L.; Department of Basic Sciences, Faculty of Medicine, University of Kinshasa, Kinshasa XI, 127, Democratic Republic Congo

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Language :

English

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Publication date :

2021

Journal title :

Infection, Genetics and Evolution: Journal of Molecular Epidemiology and Evolutionary Genetics of Infectious Diseases

ISSN :

1567-1348

eISSN :

1567-7257

Publisher :

Elsevier B.V.

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Peer reviewed :

Peer reviewed

Funding text :

This work was supported by the Belgian Cooperation Agency through the Académie de Recherche et d'Enseignement Supérieur (ARES) .

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