Nana O. Wilson*, Fatou K. Ceesay, Samuel A. Obed, Andrew A. Adjei, Richard K. Gyasi, Patricia Rodney, Yassa Ndjakani, Winston A. Anderson, Naomi W. Lucchi and Jonathan K. Stiles
Abstract.
The effectiveness of intermittent preventive treatment during pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) against malaria and anemia is unclear because of the spread of SP-resistant Plasmodium falciparum. This study evaluates the effectiveness of IPTp-SP among pregnant women attending the antenatal clinic at Korle-Bu Teaching Hospital in Accra, Ghana. A cross-sectional study comparing malaria and anemia prevalence among pregnant women using IPTp-SP with non-IPTp-SP users was conducted during June–August 2009. A total of 363 pregnant women (202 of IPTp users and 161 non-IPTp users) were recruited. A total of 15.3% of IPTp users had malaria compared with 44.7% of non-IPTp users (P < 0.001). A total of 58.4% of non-IPTp users were anemic compared with 22.8% of IPTp users (P < 0.001). When we controlled for other variables, the difference in the prevalence of malaria (odds ratio = 0.18, 95% confidence interval = 0.08–0.37) and anemia (odds ratio = 0.20, 95% confidence interval = 0.12–0.34) remained significant. The recommended IPTp-SP regimen is useful in preventing malaria and anemia among pregnant women in Ghana.
http://www.ajtmh.org/content/85/1/12.abstract
Showing posts with label sulfadoxine-pyrimethamine. Show all posts
Showing posts with label sulfadoxine-pyrimethamine. Show all posts
Sunday, 10 July 2011
Wednesday, 22 December 2010
MALARIA: Antimalarial drug resistance of Plasmodium falciparum in India
Naman K Shah, Gajender P S Dhillon, Adtiya P Dash, Usha Arora, Steven R Meshnick, Neena Valecha
After the launch of the National Malaria Control Programme in 1953, the number of malaria cases reported in India fell to an all-time low of 0·1 million in 1965. However, the initial success could not be maintained and a resurgence of malaria began in the late 1960s. Resistance of Plasmodium falciparum to chloroquine was fi rst reported in 1973 and increases in antimalarial resistance, along with rapid urbanisation and labour migration, complicated the challenge that India’s large geographical area and population size already pose for malaria control. Although several institutions have done drug-resistance monitoring in India, a complete analysis of countrywide data across institutions does not exist. We did a systematic review of P falciparum malaria drug-effi cacy studies in India to summarise drug-resistance data and describe changes over the past 30 years to inform future policy. Continued use of chloroquine for treatment of P falciparum malaria in India will likely be ineff ective. Resistance to sulfa–pyrimethamine should be closely monitored to protect the eff ectiveness of treatment with artesunate plus sulfadoxine–pyrimethamine, which is the new fi rst-line treatment for P falciparum malaria.
Shah2010antmalarial resisteance in India.pdf
After the launch of the National Malaria Control Programme in 1953, the number of malaria cases reported in India fell to an all-time low of 0·1 million in 1965. However, the initial success could not be maintained and a resurgence of malaria began in the late 1960s. Resistance of Plasmodium falciparum to chloroquine was fi rst reported in 1973 and increases in antimalarial resistance, along with rapid urbanisation and labour migration, complicated the challenge that India’s large geographical area and population size already pose for malaria control. Although several institutions have done drug-resistance monitoring in India, a complete analysis of countrywide data across institutions does not exist. We did a systematic review of P falciparum malaria drug-effi cacy studies in India to summarise drug-resistance data and describe changes over the past 30 years to inform future policy. Continued use of chloroquine for treatment of P falciparum malaria in India will likely be ineff ective. Resistance to sulfa–pyrimethamine should be closely monitored to protect the eff ectiveness of treatment with artesunate plus sulfadoxine–pyrimethamine, which is the new fi rst-line treatment for P falciparum malaria.
Shah2010antmalarial resisteance in India.pdf
Wednesday, 15 December 2010
MALARIA: Malaria in Pregnancy & Procurement Supply Management
Bill Brieger : 14 Dec 2010
Michelle Wallon from Jhpiego’s Zambia office discusses the challenges of maintaining stocks of sulphadoxine-pyrimethamine (SP) for use in Intermittent Preventive Treatment for pregnant women (IPTp) that arose during recent Roll Back Malaria meetings in Livingstone and Lusaka:
The effects of malaria in pregnancy are many and the interventions, simple. Intermittent Preventive Treatment (IPTp), insecticide-treated bed nets, and timely case management can reduce effects including maternal anemia, low birth weight, and maternal and fetal mortality. Yet, when speaking to clinicians and public health experts across Africa about prevention and control of malaria in pregnancy (MIP), there is a common theme – stock-outs of SP, the drug used for IPTp, commonly inhibit the effectiveness of MIP interventions.
IPTp is relatively straight-forward and SP, is an inexpensive drug. Furthermore, at the time that the IPTp recommendations were adopted via the Abuja Declaration in 2000, many countries were still procuring SP as the first-line treatment for the general population (For example, Nigeria did not officially switch to ACTs as firstline malaria drugs until 2005).
SP supplies were abundant when it was still recommended as treatment. What then is the problem now?
Although SP stock-outs are formally documented in only a few African countries, including Zambia, Tanzania, and Malawi, the problem can be inferred by most of the recent Demographic and Health Survey and Malaria Indicator Survey reports (e.g. Liberia, Nigeria, Uganda, Senegal) showing low coverage of the recommended two doses of IPTp. MIP experts readily and repeatedly identify a handful of culprits for the SP stock-out phenomenon.
One set of problems surrounds continued and irrational use of SP for treatment in RDT-negative cases in the general population that siphon off SP supplies from MIP services. These stem from …
Provider mistrust of RDTs coupled with policies that ACTs be provided only after positive diagnosis via RDT or microscopy
Real or perceived high incidences of malaria
Strong correlation in the community between fever and malaria with high expectations for malaria treatment
Weak clinical skills in the appropriate diagnosis and management of fever
Lack of skilled providers and high client loads
Inaccurate SP quantification based on population rather than consumption data and/or quantification failing to account for irrational use also create stock problems. Weak logistics systems with bottlenecks between central-level drug stores and receiving facilities result in stock-outs of both SP and ACTs.
These problems are not new and neither are the solutions. MIP has a potential advantage in that it falls under both reproductive health and national malaria control programs, and yet the persistence of SP stock-outs indicates that this is often used less as an opportunity for collaboration than as an excuse to pass the buck.
As the public health community moves towards more integrated programming, we must seize the opportunity to bridge the programmatic gap.
http://www.malariafreefuture.org/blog/?p=1116
Michelle Wallon from Jhpiego’s Zambia office discusses the challenges of maintaining stocks of sulphadoxine-pyrimethamine (SP) for use in Intermittent Preventive Treatment for pregnant women (IPTp) that arose during recent Roll Back Malaria meetings in Livingstone and Lusaka:
The effects of malaria in pregnancy are many and the interventions, simple. Intermittent Preventive Treatment (IPTp), insecticide-treated bed nets, and timely case management can reduce effects including maternal anemia, low birth weight, and maternal and fetal mortality. Yet, when speaking to clinicians and public health experts across Africa about prevention and control of malaria in pregnancy (MIP), there is a common theme – stock-outs of SP, the drug used for IPTp, commonly inhibit the effectiveness of MIP interventions.
IPTp is relatively straight-forward and SP, is an inexpensive drug. Furthermore, at the time that the IPTp recommendations were adopted via the Abuja Declaration in 2000, many countries were still procuring SP as the first-line treatment for the general population (For example, Nigeria did not officially switch to ACTs as firstline malaria drugs until 2005).
SP supplies were abundant when it was still recommended as treatment. What then is the problem now?
Although SP stock-outs are formally documented in only a few African countries, including Zambia, Tanzania, and Malawi, the problem can be inferred by most of the recent Demographic and Health Survey and Malaria Indicator Survey reports (e.g. Liberia, Nigeria, Uganda, Senegal) showing low coverage of the recommended two doses of IPTp. MIP experts readily and repeatedly identify a handful of culprits for the SP stock-out phenomenon.
One set of problems surrounds continued and irrational use of SP for treatment in RDT-negative cases in the general population that siphon off SP supplies from MIP services. These stem from …
Provider mistrust of RDTs coupled with policies that ACTs be provided only after positive diagnosis via RDT or microscopy
Real or perceived high incidences of malaria
Strong correlation in the community between fever and malaria with high expectations for malaria treatment
Weak clinical skills in the appropriate diagnosis and management of fever
Lack of skilled providers and high client loads
Inaccurate SP quantification based on population rather than consumption data and/or quantification failing to account for irrational use also create stock problems. Weak logistics systems with bottlenecks between central-level drug stores and receiving facilities result in stock-outs of both SP and ACTs.
These problems are not new and neither are the solutions. MIP has a potential advantage in that it falls under both reproductive health and national malaria control programs, and yet the persistence of SP stock-outs indicates that this is often used less as an opportunity for collaboration than as an excuse to pass the buck.
As the public health community moves towards more integrated programming, we must seize the opportunity to bridge the programmatic gap.
http://www.malariafreefuture.org/blog/?p=1116
Sunday, 14 November 2010
MALARIA: Chloroquine is again an efficacious treatment for malaria,
Laufer MK, Thesing PC, Eddington ND, Masonga R, Dzinjalamala FK, Takala SL, Taylor TE, Plowe CV.
BACKGROUND: In 1993, Malawi became the first country in Africa to replace chloroquine with the combination of sulfadoxine and pyrimethamine for the treatment of malaria. At that time, the clinical efficacy of chloroquine was less than 50%. The molecular marker of chloroquine-resistant falciparum malaria subsequently declined in prevalence and was undetectable by 2001, suggesting that chloroquine might once again be effective in Malawi.
METHODS: We conducted a randomized clinical trial involving 210 children with uncomplicated Plasmodium falciparum malaria in Blantyre, Malawi. The children were treated with either chloroquine or sulfadoxine\#8211;pyrimethamine and followed for 28 days to assess the antimalarial efficacy of the drug.
RESULTS: In analyses conducted according to the study protocol, treatment failure occurred in 1 of 80 participants assigned to chloroquine, as compared with 71 of 87 participants assigned to sulfadoxine\#8211;pyrimethamine. The cumulative efficacy of chloroquine was 99% (95% confidence interval [CI], 93 to 100), and the efficacy of sulfadoxine\#8211;pyrimethamine was 21% (95% CI, 13 to 30). Among children treated with chloroquine, the mean time to parasite clearance was 2.6 days (95% CI, 2.5 to 2.8) and the mean time to the resolution of fever was 10.3 hours (95% CI, 8.1 to 12.6). No unexpected adverse events related to the study drugs occurred.
CONCLUSIONS: Chloroquine is again an efficacious treatment for malaria, 12 years after it was withdrawn from use in Malawi. (ClinicalTrials.gov number, NCT00125489 [ClinicalTrials.gov].).
N Engl J Med. 2006 Nov 9;355(19):1959-66.
http://www.ncbi.nlm.nih.gov/pubmed/17093247
BACKGROUND: In 1993, Malawi became the first country in Africa to replace chloroquine with the combination of sulfadoxine and pyrimethamine for the treatment of malaria. At that time, the clinical efficacy of chloroquine was less than 50%. The molecular marker of chloroquine-resistant falciparum malaria subsequently declined in prevalence and was undetectable by 2001, suggesting that chloroquine might once again be effective in Malawi.
METHODS: We conducted a randomized clinical trial involving 210 children with uncomplicated Plasmodium falciparum malaria in Blantyre, Malawi. The children were treated with either chloroquine or sulfadoxine\#8211;pyrimethamine and followed for 28 days to assess the antimalarial efficacy of the drug.
RESULTS: In analyses conducted according to the study protocol, treatment failure occurred in 1 of 80 participants assigned to chloroquine, as compared with 71 of 87 participants assigned to sulfadoxine\#8211;pyrimethamine. The cumulative efficacy of chloroquine was 99% (95% confidence interval [CI], 93 to 100), and the efficacy of sulfadoxine\#8211;pyrimethamine was 21% (95% CI, 13 to 30). Among children treated with chloroquine, the mean time to parasite clearance was 2.6 days (95% CI, 2.5 to 2.8) and the mean time to the resolution of fever was 10.3 hours (95% CI, 8.1 to 12.6). No unexpected adverse events related to the study drugs occurred.
CONCLUSIONS: Chloroquine is again an efficacious treatment for malaria, 12 years after it was withdrawn from use in Malawi. (ClinicalTrials.gov number, NCT00125489 [ClinicalTrials.gov].).
N Engl J Med. 2006 Nov 9;355(19):1959-66.
http://www.ncbi.nlm.nih.gov/pubmed/17093247
Wednesday, 15 September 2010
MALARIA: The rise and fall of the antimalarial Lapdap: a lesson in pharmacogenetics
13 September 2010
The Lancet, Volume 376, Issue 9742, 28 August 2010-3 September 2010, Pages 739-741Prof Lucio Luzzatto MD
The spread of chloroquine-resistant Plasmodium falciparum in Africa has been a strong stimulus to the development of new antimalarial drugs. Although artemisinin and related compounds have been promising therapies since the 1980s, their low availability and high cost have greatly delayed large-scale use. In the meantime, a logical alternative was to experiment with existing agents, and there was added pressure to do so because of the increasing frequency of resistance to sulfadoxine-pyrimethamine (Fansidar, Roche, Basel, Switzerland), which was the main alternative to chloroquine. Therefore, in the late 1990s, a combination of chlorproguanil (Lapudrine) and dapsone—both low-cost drugs—known as Lapdap (GlaxoSmithKline, London, UK) was introduced. Chlorproguanil, which is similar to proguanil, is a very effective antimalarial, and dapsone, which is chemically related to the sulphonamides, is very effective for treatment of leprosy. Chlorproguanil and dapsone both interfere with folate metabolism but at different biosynthetic stages, thus their combined use was in line with the classic tenet of antimicrobial therapy, which aims to prevent development of resistant organisms.
http://www.malarianexus.com/articles/read/81/the-rise-and-fall-of-the-antimalarial-lapdap-a-lesson-in-pharmacogenetics/
The Lancet, Volume 376, Issue 9742, 28 August 2010-3 September 2010, Pages 739-741Prof Lucio Luzzatto MD
The spread of chloroquine-resistant Plasmodium falciparum in Africa has been a strong stimulus to the development of new antimalarial drugs. Although artemisinin and related compounds have been promising therapies since the 1980s, their low availability and high cost have greatly delayed large-scale use. In the meantime, a logical alternative was to experiment with existing agents, and there was added pressure to do so because of the increasing frequency of resistance to sulfadoxine-pyrimethamine (Fansidar, Roche, Basel, Switzerland), which was the main alternative to chloroquine. Therefore, in the late 1990s, a combination of chlorproguanil (Lapudrine) and dapsone—both low-cost drugs—known as Lapdap (GlaxoSmithKline, London, UK) was introduced. Chlorproguanil, which is similar to proguanil, is a very effective antimalarial, and dapsone, which is chemically related to the sulphonamides, is very effective for treatment of leprosy. Chlorproguanil and dapsone both interfere with folate metabolism but at different biosynthetic stages, thus their combined use was in line with the classic tenet of antimicrobial therapy, which aims to prevent development of resistant organisms.
http://www.malarianexus.com/articles/read/81/the-rise-and-fall-of-the-antimalarial-lapdap-a-lesson-in-pharmacogenetics/
Thursday, 12 August 2010
MALARIA: Epidemiology of drug-resistant malaria
Since the first reports of chloroquine-resistant falciparum malaria in southeast Asia and South America almost half a century ago, drug-resistant malaria has posed a major problem in malaria control. By the late 1980s, resistance to sulfadoxine-pyrimethamine and to mefloquine was also prevalent on the Thai-Cambodian and Thai-Myanmar (Thai-Burmese) borders, rendering them established multidrug-resistant (MDR) areas. Chloroquine resistance spread across Africa during the 1980s, and severe resistance is especially found in east Africa. As a result, more than ten African countries have switched their first-line drug to sulfadoxine- pyrimethamine. Of great concern is the fact that the efficacy of this drug in Africa is progressively deteriorating, especially in foci in east Africa, which are classified as emerging MDR areas. Urgent efforts are needed to lengthen the lifespan of sulfadoxine-pyrimethamine and to identify effective, affordable, alternative antimalarial regimens. Molecular markers for antimalarial resistance have been identified, including pfcrt polymorphisms associated with chloroquine resistance and dhtr and drips CIhPS polymorphisms associated with sulfadoxine-pyrimethamine resistance. Polymorphisms in pfmdr1 may also be associated with resistance to chloroquine, mefloquine, quinine, and artemisinin. Use of such genetic information for the early detection of resistance foci and future monitoring of drug-resistant malaria is a potentially useful epidemiological tool, in conjunction with the conventional in-vivo and in-vitro drug-sensitivity assessments. This review describes the various features of drug resistance in Plasmodium falciparum, including its determinants, current status in diverse geographical areas, molecular markers, and their implications.
http://www.scopus.com/record/display.url?eid=2-s2.0-0036242351&origin=inward&txGid=570t1pj4m6HLiuI3ulhvnph%3a2
http://www.scopus.com/record/display.url?eid=2-s2.0-0036242351&origin=inward&txGid=570t1pj4m6HLiuI3ulhvnph%3a2
Saturday, 10 July 2010
MALARIA: Preventive treatment in pregnancy
Demographics and health practices of 2,232 pregnant women in rural northeastern Ghana and characteristics of their 2,279 newborns were analyzed to determine benefits associated with intermittent preventive treatment (IPTp), antenatal care, and/or bed net use during pregnancy. More than half reported bed net use, 90% reported at least two antenatal care visits, and > 82% took at least one IPTp dose of sulfadoxine-pyrimethamine. Most used a bed net and IPTp (45%) or IPTp alone (38%). Low birth weight (<>
Am. J. Trop. Med. Hyg., 83(1), 2010, pp. 79–89
Am. J. Trop. Med. Hyg., 83(1), 2010, pp. 79–89
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