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LSTM study leads WHO to update its malaria prevention policy
Smiling pregnant womanAn estimated 32 million women who become pregnant each year can benefit from preventive therapy
Liverpool – A study led by Liverpool School of Tropical Medicine (LSTM) has been a critical element in helping the World Health Organization (WHO) to update its policy recommendation on intermittent preventive treatment for the prevention of malaria in pregnant women (IPTp) who live in malaria-endemic regions of sub-Saharan Africa. Study results show that when these pregnant women receive three or more doses of preventive therapy instead of the standard two-dose regimen the birth weight of their newborns will be higher.
Results of the study have been published by the Journal of the American Medical Association (JAMA) on 13 February 2013.1
‘Malaria in pregnancy can have devastating consequences for both mother and baby’, said Dr. Kassoum Kayentao, the lead author of the study based in Bamako, Mali. ‘The updated recommendation of the malaria prevention policy from WHO is very good news as it will greatly benefit pregnant women throughout Africa. The new regimen significantly reduces the risk of malaria and malaria-associated severe anaemia in the mother and the risk of low birth weight in the newborn. By increasing a baby’s birth weight, their chances of survival are improved and will lead to better health in their first year of life.’
The study consisted of a meta-analysis of seven randomised controlled trials amongst pregnant women in Africa. Each of these trials compared the standard two-dose regimen with regimens providing the drug more frequently. Combining the outcomes from these seven trials, four of which were published as recently as 2010, results in greater statistical power than provided by the trial outcomes individually. It provides definitive evidence of the benefit on birth weight when providing three or more doses of anti-malaria drugs throughout the pregnancy instead of two doses.
The study shows that by providing the drug sulphadoxine-pyrimethamine (SP) more frequently during pregnancy, a period in a woman’s life when she and her baby are particularly vulnerable to harmful effects of malaria, the period of protection is greatly enhanced and the risk of malaria re-infection in women is reduced.
‘The outcomes of the study were remarkably consistent across Africa, despite differences in malaria transmission, study designs and different degrees of resistance to the drug SP’, said Prof. Feiko ter Kuile and senior author of the LSTM-led study. ‘We were pleasantly surprised by the consistency and magnitude of the beneficial effect that can be achieved by providing these additional doses during the last 10 weeks of pregnancy, which is a critical period for foetal growth’, Prof. Ter Kuile added.
The study comes at a critical time of increasing parasite resistance to SP, leading to questions from malaria-endemic countries regarding the continued effectiveness of IPTp. The findings of the study were presented to the Malaria Policy Advisory Committee of the WHO in September 2012, contributing to an updated policy recommendation on intermittent preventive treatment of malaria in pregnancy (IPTp), which is now being communicated to African Member States of the WHO.
‘This updated policy will benefit pregnant women in the 36 malaria endemic countries in sub-Saharan Africa which have adopted IPTp with SP as national policy,’ said Dr. Robert Newman, Director of the WHO Global Malaria Programme.
Dr. Newman added that the WHO was hopeful that the updated malaria prevention policy could also contribute to increased uptake and quality of antenatal care services in Africa. The adapted protocol is now more closely aligned to WHO’s Focussed Antenatal Care (FANC) schedule, ensuring that intermittent preventive treatment with SP can be given to pregnant women during each scheduled ANC visit, improving both maternal and neonatal outcomes.
For further information, please contact:
Ms Jenny Hill,
Programme Manager, Malaria in Pregnancy Consortium
Liverpool School of Tropical Medicine
Office: +44 (0)151 705 3216
Mr Diderik van Halsema
Director of Communications
Liverpool School of Tropical Medicine
Office: +44 (0)151 705 3104
Mobile: +44 (0)7960 867337
Notes to Editors:
The Malaria in Pregnancy Consortium consists of 41 partner institutions in 29 countries around the world, joined in the fight against malaria in pregnancy and committed to improving its control and treatment in Africa, Asia and Latin America. The Consortium, led by Liverpool School of Tropical Medicine, was established with an initial grant of $30 million from the Bill & Melinda Gates Foundation and is also supported by the European Union. The five-year programme will directly benefit the 50 million women globally who face exposure to malaria whilst pregnant every year.
For further information please visit www.mip-consortium.org
Liverpool School of Tropical Medicine (LSTM) has been engaged in the fight against infectious, debilitating and disabling diseases for more than a hundred years and continues that tradition today with a research portfolio in excess of £200 million and a teaching programme attracting students from over 50 countries.
For further information please visit www.lstmliverpool.ac.uk