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Sponsors and Collaborators: |
Institute of Tropical Medicine, Belgium University of Ouagadougou, Burkina Faso National Laboratory of Public Health,Burkina Faso Liverpool School of Tropical Medicine Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA) |
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Information provided by: | Institute of Tropical Medicine, Belgium |
ClinicalTrials.gov Identifier: | NCT00730366 |
Malaria in pregnancy contributes substantially to maternal anaemia and low birth weight: effective malaria control in pregnancy could avoid about 10,000 maternal and up to 200,000 infant deaths every year. Intermittent preventive treatment with the drug sulfadoxine-pyrimethamine (IPTp-SP), administered at least twice during routine antenatal clinics, is recommended by the World Health Organization for areas of moderate to high malaria transmission, including Sub-Saharan Africa.
Studies carried out in Kenya and Malawi before 2004 had showed that two doses of IPTp-SP significantly reduce maternal anaemia, placental malaria parasitaemia and low birth weight. However, in countries where this strategy had been introduced as part of national policy, the coverage of the target population has varied widely, with estimates of 33-93% for uptake of one dose and 24-68% for two doses, and no country had reached the goal of 80% of pregnant women receiving at least 2 doses of IPTp. New approaches designed to improve IPTp coverage were therefore urgently needed.
This study was therefore set up in 2002, in order to evaluate the additional effect of a targeted promotional campaign on antenatal clinics utilization and on coverage and uptake of Intermittent preventive treatment with sulfadoxine-pyrimethamine in a rural health district in Burkina Faso; and to investigate the effectiveness of intermittent preventive treatment with the sulfadoxine-pyrimethamine compared with weekly chloroquine, in order to provide additional evidence to the Burkinabé Ministry of Health for an impending policy change.
Condition | Intervention | Phase |
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Malaria in Pregnancy |
Drug: sulfadoxine-pyrimethamine Drug: Chloroquine |
Phase III |
Study Type: | Interventional |
Study Design: | Prevention, Randomized, Open Label, Active Control, Parallel Assignment, Efficacy Study |
Official Title: | New Approaches to Improve Coverage and Compliance of Antimalarial Treatment for Pregnant Women in Rural Africa. |
Enrollment: | 2766 |
Study Start Date: | March 2004 |
Study Completion Date: | December 2006 |
Primary Completion Date: | October 2006 (Final data collection date for primary outcome measure) |
Arms | Assigned Interventions |
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1: Experimental
Experimental: IPTp-SP + promotion: Active Comparator
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Drug: sulfadoxine-pyrimethamine
Sulfadoxine-pyrimethamine given as intermittent therapy, at the dosage of 1500/75 mg per administration (3 tablets), Twice during pregnancy
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2: Experimental
IPTp-SP alone (without promotion)
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Drug: sulfadoxine-pyrimethamine
Sulfadoxine-pyrimethamine given as intermittent therapy, at the dosage of 1500/75 mg per administration (3 tablets), Twice during pregnancy
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3: Active Comparator
Weekly CQ prophylaxis
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Drug: Chloroquine
Chloroquine tablets 100 mg. First administration of 1500 mg given over three days, followed by weekly doses of 300 mg/week
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Each year, about 50 million women living in malaria endemic regions become pregnant, more than half in sub-Saharan Africa. In areas of relatively stable transmission, where acquired immunity to Plasmodium falciparum limits infection and prevents severe disease in adults, women in their first and second pregnancy are the most vulnerable subjects, due to a higher risk of severe anaemia and a low birth weight (LBW) outcome, a leading cause of child mortality and poor growth and development.
Malaria in pregnancy and its adverse consequences can be prevented with suppressive antimalarial treatment or chemoprophylaxis. Weekly chloroquine (CQ) had been the basis for prevention for many years, but its application became limited over time, partly because of difficulties in coverage and compliance throughout pregnancy and partly because of increased parasite resistance to CQ in endemic areas. A new strategy for prevention based on insecticide-treated bed nets (ITNs) and use of intermittent preventive treatment in pregnancy (IPTp) was thus formulated, with IPTp being based on the administration of treatment doses of sulfadoxine-pyrimethamine (1500/75 mg; SP) to all pregnant women at pre-defined intervals and regardless of malaria infection. WHO elaborated new recommendations, based on the administration of SP two or three times at scheduled antenatal visits at least one month apart from the second trimester onwards. Evidence of the efficacy of IPTp with SP for preventing malaria infection and improving birth weight was reported from East Africa and West Africa.
However, the IPTp strategy assumes that most pregnant women attend antenatal clinics (ANC) at least twice during their pregnancy and at a time when SP can be administered under direct observation. Unfortunately, it appeared soon that late attendance to ANC and weak health services limit the effectiveness of this strategy; coverage with two or more SP doses varied widely (24-68%) and was well behind the goal of 80% proposed by the Roll Back Malaria Partnership. New approaches to increase IPTp coverage were urgently needed.
This study, conceived in 2002 and carried out between 2004 and 2006, had therefore two different components: on one side, it investigated whether promoting regular and early antenatal attendance of pregnant women through community based health education would increase coverage and uptake of IPTp; on the other side, it investigated the effectiveness of IPTp-SP compared with weekly CQ, in order to provide additional evidence to the Burkinabé Ministry of Health for an impending policy change.
Genders Eligible for Study: | Female |
Accepts Healthy Volunteers: | No |
Inclusion Criteria:
Exclusion Criteria:
- Refuse to give informed consent
Burkina Faso | |
District Sanitaire | |
Boromo, Burkina Faso |
Study Director: | Sheick Coulibaly Oumar Coulibaly, MD PhD | Directeur de la Biologie Médicale du Laboratoire National de Santé Publique |
Study Chair: | Umberto D'Alessandro, MD | Institute of Tropical Medicine |
Responsible Party: | Institute of Tropical Medicine, Antwerp, Belgium ( Prof. Umberto D'Alessandro ) |
Study ID Numbers: | DELIMAL |
Study First Received: | August 5, 2008 |
Last Updated: | August 7, 2008 |
ClinicalTrials.gov Identifier: | NCT00730366 |
Health Authority: | Burkina Faso: Ministry of Health |
Malaria Pregnancy Intermittent Preventive Treatment |
Folic Acid Pyrimethamine Protozoan Infections Sulfadoxine-pyrimethamine Chloroquine diphosphate |
Chloroquine Parasitic Diseases Malaria Sulfadoxine |
Anti-Inflammatory Agents Anti-Infective Agents Antiprotozoal Agents Molecular Mechanisms of Pharmacological Action Physiological Effects of Drugs Renal Agents Antimalarials Antiparasitic Agents Sensory System Agents Therapeutic Uses Anti-Inflammatory Agents, Non-Steroidal Analgesics Amebicides |
Antinematodal Agents Coccidiosis Filaricides Anthelmintics Enzyme Inhibitors Anti-Infective Agents, Urinary Folic Acid Antagonists Pharmacologic Actions Analgesics, Non-Narcotic Peripheral Nervous System Agents Antirheumatic Agents Central Nervous System Agents |