Evaluation of maternal practices, efficacy, and cost-effectiveness of alternative antimalarial regimens for use in pregnancy: chloroquine and sulfadoxine-pyrimethamine
| Autor: | Lester Chitsulo, Peter N. Kazembe, Richard W. Steketee, L. J. Schultz, Alan Macheso, Jack J. Wirima |
|---|---|
| Rok vydání: | 1996 |
| Předmět: |
Health Knowledge
Attitudes Practice Malawi Pediatrics medicine.medical_specialty Sulfadoxine Cost effectiveness Cost-Benefit Analysis medicine.medical_treatment Population Prenatal care Antimalarials Pregnancy Virology parasitic diseases medicine Humans Malaria Falciparum education education.field_of_study Obstetrics business.industry Chloroquine medicine.disease Sulfadoxine/pyrimethamine Regimen Pyrimethamine Treatment Outcome Infectious Diseases Pregnancy Complications Parasitic Drug Therapy Combination Female Parasitology business Malaria medicine.drug |
| Zdroj: | The American Journal of Tropical Medicine and Hygiene. 55:87-94 |
| ISSN: | 1476-1645 0002-9637 |
| Popis: | In Malawi the National Malaria Control Committee called for investigations to identify alternative antimalarial regimens for use during pregnancy since prevention of placental malaria could greatly reduce the incidence of low birth weight (LBW). The investigations were a survey of knowledge attitudes and practices revolving around malaria and maternal practices (e.g. use of prenatal care services and malaria treatment and prevention during pregnancy) of 842 women who had completed a pregnancy within the last 5 years (March-May 1992) an antimalarial efficacy study of 159 women in their first or second pregnancy in Mangochi District (March-October 1992) and a cost-effectiveness analysis of 3 regimens administered beginning during 16-32 weeks gestation and continuing throughout the pregnancy. The 3 regimens examined included chloroquine throughout the pregnancy (CQ/CQ) initial dose of sulfadoxine-pyrimethamine followed by CG (SP/CG) and SP/SP. 87% of the pregnant women received prenatal care at least 2 times suggesting that an antimalarial intervention could reach most women during pregnancy. The placental malaria parasitemia rate for SP/SP was significantly lower than that for CQ/CQ and SP/CQ (9% vs. 32% and 26% respectively; p = 0.006). The SP/SP regimen was also much more cost effective in preventing infant deaths than the other regimens (US $75 vs. $542 for CQ/CQ and $481 for SP/CQ). In fact it remained most cost-effective when its cost was increased 3-fold and the efficacy was reduced to a level that 18% of the women on SP/SP had placental malaria at delivery. These findings suggest that the current CQ/CQ regimen that is popular in many countries with CQ-resistant Plasmodium falciparum is neither an effective nor inexpensive intervention to prevent LBW. Based on the findings the Ministry of Health has changed the national malaria control policy to recommend SP/SP regimen for pregnant women. This change has been implemented nationwide. |
| Databáze: | OpenAIRE |
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