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Effectiveness of intermittent screening and treatment for the control of malaria in pregnancy: a cluster randomised trial in India.

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Kuepfer, Irene, Mishra, Neelima, Bruce, Jane, Mishra, Vinit, Anvikar, Anupkumar R, Satpathi, Sanghamitra, Behera, Prativa, Muehlenbachs, Atis, Webster, Jayne, terKuile, Feiko ORCID: https://orcid.org/0000-0003-3663-5617, Greenwood, Brian, Valecha, Neena and Chandramohan, Daniel (2019) 'Effectiveness of intermittent screening and treatment for the control of malaria in pregnancy: a cluster randomised trial in India.'. BMJ Global Health, Vol 4, e001399.

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Abstract

Background
The control of malaria in pregnancy (MiP) in India relies on testing women who present with symptoms or signs suggestive of malaria. We hypothesised that intermittent screening and treatment for malaria at each antenatal care visit (ISTp) would improve on this approach and reduce the adverse effects of MiP.
Methods
A cluster randomised controlled trial comparing ISTp versus passive case detection (PCD) was conducted in Jharkhand state. Pregnant women of all parities with a gestational age of 18-28 weeks were enrolled. Women in the ISTp group were screened with a rapid diagnostic test (RDT) for malaria at each antenatal clinic visit and those in the PCD group were screened only if they had symptoms or signs suggestive of malaria. All RDT positive women were treated with artesunate/sulfadoxine-pyrimethamine. The primary endpoint was placental malaria, determined by placental histology, and the key secondary endpoints were birth weight, gestational age, vital status of the newborn baby and maternal anaemia.
Results
Between April 2012 and September 2015, 6868 women were enrolled; 3300 in 46 ISTp clusters and 3568 in 41 PCD clusters. In the ISTp arm, 4.9% of women were tested malaria positive and 0.6% in the PCD arm. There was no difference in the prevalence of placental malaria in the ISTp (87/1454, 6.0%) and PCD (65/1560, 4.2%) groups (6.0% vs 4.2%; OR 1.34, 95% CI 0.78 to 2.29, p=0.29) or in any of the secondary endpoints.
Conclusion
ISTp detected more infections than PCD, but monthly ISTp with the current generation of RDT is unlikely to reduce placental malaria or impact on pregnancy outcomes. ISTp trials with more sensitive point-of-care diagnostic tests are needed.

Item Type: Article
Subjects: WA Public Health > Health Problems of Special Population Groups > WA 310 Maternal welfare
WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WC Communicable Diseases > Tropical and Parasitic Diseases > WC 750 Malaria
WQ Obstetrics > Pregnancy > WQ 200 General works
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI): https://doi.org/10.1136/bmjgh-2019-001399
Depositing User: Tracy Seddon
Date Deposited: 21 Aug 2019 09:15
Last Modified: 21 Aug 2019 09:15
URI: https://archive.lstmed.ac.uk/id/eprint/11459

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