Evaluation of the Effectiveness of Sulphadoxine Pyrimethamine as Intermittent Preventive Treatment For Malaria In Pregnancy In Selected Health Facilities In Sekondi-Takoradi, Ghana

Abstract

Malaria in pregnancy still remains a huge public health problem in most parts of Africa and Asia-Pacific. The use of Sulphadoxine-Pyrimethamine as intermittent preventive treatment for malaria in pregnancy (SP -IPTp) in endemic regions of the world has reduced the burden of malaria in pregnancy and minimized the consequences of malaria to both mother and the foetus. However, there have been reports of wide-spread mutations, especially in eastern and some parts of southern Africa, in the dhfr and dhps genes, which confer to the Plasmodium parasite, resistance to pyrimethamine and sulphadoxine respectively. This, coupled with the general preponderance of substandard anti-malaria drugs on the African market, threatens the success of SP-IPTp. The aim of this study was to evaluate the effectiveness of sulphadoxine and pyrimethamine as IPTp in three selected health facilities in Sekondi-Takoradi metropolis of the western region of Ghana. SP was found to be efficacious in clearing parasitaemia amongst parasitaemic yet asymptomatic pregnant women in the face of high prevalence (71.4%) of dhfi" triple mutations Nl08, 151 and R59. The quintuple mutation, known to confirm high-grade resistance to the parasites was found in only two (2) isolates in nonpregnant attendants at the general outpatient department. There was no association between number of SP doses taken, the use of insecticide treated nets (ITNs) and maternal anaemia. Higher doses of SP, ITN usage, but not parity, reduced the risk of both placental parasitaemia and low birth weight. The SP tablets in used were found to be of good quality having a USP of 95.3% and 92.8% and dissolution of95.2% and 83.03% for sulphadoxine and pyrimethamine respectively. This study therefore found the SP tablets in use as IPTp to be of good quality and effective in the face of high prevalence of dhfr triple mutations.