Authors: Mary Muchekeza, Admore Chadambuka, M Tishmanga, Anderson Chimusoro, Nortion Gombe, Gerald Shambira, Kufakwanguzvarova W Pomerai.
Introduction: Intermittent preventive treatment (IPT) for malaria in pregnancy has been implemented in Zimbabwe since 2004 but no pragmatic studies on its effectiveness have been done. This study investigated the operational effectiveness of IPT in Gokwe North, a malaria endemic district in Zimbabwe with IPT coverage of 43.8% for at least one dose of IPT.
Methods: A prospective cohort study was conducted in 2011. Pregnant women were recruited as they attended ANC at 34 weeks gestation and classified into whether they had received IPT or not. They were followed up until they delivered where different pregnancy outcomes (prematurity, low birth weight deliveries, still birth deliveries, maternal anaemia) were assessed for women in different IPT exposure groups.
Results: Three hundred women were recruited into the study. The prevalence of low birth weight and severe maternal anaemia was 35% and 25.3% respectively. No placental malaria was detected by microscopy on all 300 placental blood films. In multivariate analysis, IPT was protective for low birth weight deliveries (adjusted RR 0.31 (95%CI 0.17-0.56) and for developing severe maternal anaemia (adjusted RR 0.39 (95% CI 0.22- 0.67). A mean increase in birth weight of 229grams was observed for women who had received 1 dose compared to those who had not received any dose of IPT. IPT was also found to be protective for premature deliveries (adjusted RR 0.29 (95% CI 0.17-0.49) and for still birth deliveries (adjusted RR 0.42 (95% CI 0.16- 1.07).
Discussion: This study demonstrated that IPT with SP is effective in reducing LBW, prematurity, still births and severe maternal anaemia. It is therefore necessary to increase coverage, access and compliance to SP in Gokwe North district. A recommendation from this study to use community based IPT distributors as a way to improve IPT coverage was taken up for serious consideration by the National Malaria Control Programme. The results of this study are also to be presented at the National Malaria Conference in October 2011 so as to assist in ensuring the deployment of effective, well evaluated, documented and evidence based malaria prevention strategies in Zimbabwe.
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