COMPARISON OF THE EFFECTIVENESS OF SULPHADOXINEPYRIMETHAMINE WITH PROGUANIL AS MALARIA CHEMOPROPHYLAXIS IN PREGNANT WOMEN IN PORT HARCOURT, SOUTH-SOUTH NIGERIA.

Abstract

BACKGROUND: Malaria, especially in tropical Africa, is one of the leading
causes of maternal and perinatal morbidity and mortality. Various drugs have
been used in the past for malaria prophylaxis in pregnancy without much
success. Intermittent preventive treatment with sulphadoxine-pyrimethamine
(SP) has been proven efficacious in reducing the burden of malaria in
pregnancy. There is need to compare its effectiveness with that of proguanil in
order to have a possible alternative drug to be used in our environment.
OBJECTIVE: To compare the effectiveness of sulphadoxine – pyrimethamine
and proguanil as malaria chemoprophylaxis in pregnancy.
METHODOLOGY: Pregnant women attending antenatal clinic at the
University of Port Harcourt Teaching Hospital were randomly selected at
booking and monitored till delivery. Blood samples were taken to confirm the
presence of malaria parasites as well as anaemia. Intermittent preventive
treatment for malaria using sulphadoxine (500mg) and pyrimethamine (25mg)
combination was given to one group of participants while the other group
received daily proguanil (100mg) as prophylaxis. Mothers were screened at
delivery to determine the presence or absence of malaria parasitaemia and
anaemia.
RESULTS: The prevalence of maternal malaria parasitaemia in this study was
29.9% at booking and 12.5% at delivery. This was statistically significant (P
value = 0.00000007). The prevalence at delivery in women given
chemoprophylaxis with SP and proguanil was 10.6% and 14.4% respectively,
with no statistical significance (P = 0.429). Maternal anaemia was present in
62.6% and 19.6% of all clients at booking and delivery respectively and this
was significant (P=0.0001). The prevalence of maternal anaemia at delivery in
women given SP compared to proguanil was 19.0% and 18.7%, with no
statistical significance (P = 0.931). There was no statistical difference in the
incidence of preterm delivery (P = 0.262), cord blood parasitaemia (P = 0.385),
low birth weight (P = 0.175) and birth asphyxia (P = 0.367) between the two
study groups.
CONCLUSION: Proguanil is a good alternative drug for malaria
chemoprophylaxis especially where there is resistance to SP.

COMPARISON OF THE EFFECTIVENESS OF SULPHADOXINEPYRIMETHAMINE WITH PROGUANIL AS MALARIA CHEMOPROPHYLAXIS IN PREGNANT WOMEN IN PORT HARCOURT, SOUTH-SOUTH NIGERIA.