Research

Implementation of intermittent preventive treatment in pregnancy with sulphadoxine/pyrimethamine (IPTp-SP) at a district health centre in rural Senegal

Piero L Olliaro¹ , Henriette Delenne² , Moustafa Cisse³ , Malick Badiane³ , Alberto Olliaro⁴ , Michel Vaillant⁵ and Philippe Brasseur⁶

¹UNICEF/UNDP/WB/WHO Special Programme for Research and Training in Tropical Diseases (TDR), 20 avenue Appia, CH-1211 Geneva 27, Switzerland

²Dispensaire Saint Joseph, Mlomp, District d'Oussouye, Sénégal

³District Médical d'Oussouye, Sénégal

⁴UNIGE, Université de Genève, Switzerland

⁵Unité d'Epidémiologie Clinique et de Santé Publique, Centre d'Etudes en Santé, CRP-Santé, Luxembourg

⁶Institut de Recherche pour le Développement (IRD), Dakar, Sénégal

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Malaria Journal 2008, 7:234doi:10.1186/1475-2875-7-234

Published:	7 November 2008

Abstract

Background

Intermittent preventive treatment with sulphadoxine-pyrimethamine (SP) is recommended for reducing the risk of malaria in pregnancy and its consequences on mothers and babies (IPTp-SP). Indicators of implementation and effects of IPTp-SP were collected in a rural clinic in Southern Senegal.

Methods

Women seen routinely at the antenatal clinic (ANC) of a rural dispensary during 2000–2007. Deployment of IPTp-SP started in January 2004. Inspection of antenatal and outpatient clinic registries of the corresponding period.

Results

Between 1^st January 2000 and 30^th April 2007, 1,781 women of all gravitidities and parities attended the ANC with 965 deliveries (606 and 398 respectively since 1^st January 2004, when IPTp-SP was started.) 69% of women were seen ≥ 3 times; 95% received at least one dose and 70% two doses of SP (from 61% in 2004 to 86% in 2007). The first visit, first and second dose of SP occurred at a median week 20, 22 and 31. The probability of receiving two doses was > 80% with ≥ 3 antenatal visits and a first dose of SP by week 20.

The prevalence of maternal malaria was low and similar pre- (0.7%) and during IPTp (0.8%). Effects on of low birth weight (LBW, < 2.5 kg) were non-statistically significant. The prevalence of LBW was 10.8% pre- and 7.7% during IPTp deployment (29% risk reduction, p = 0.12).

Unfavourable pregnancy outcomes numbered 72 (7.5% of pregnancies with known outcome), including 30 abortions and 42 later deaths (late foetal deaths, stillbirth, peri-natal) of which 13 with one or more malformations (1.35% of all recorded deliveries).

Conclusion

The implementation of IPTp-SP was high. Early attendance to ANC favours completion of IPTp-SP. The record keeping system in place is amenable to data extraction and linkage. A model was developed that predicts optimal compliance to two SP doses, and could be tested in other settings. Maternal malaria was infrequent and unaffected by IPTp-SP. The risk of LBW was lower during IPT implementation but the difference was non-significant and could have other explanations.