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Malaria in Pregnancy Before and After the Implementation of a National IPTp Program in Gabon

Intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine–pyrimethamine has recently been adopted by many African countries to reduce maternal and neonatal morbidity and mortality associated with malaria in pregnancy. We assessed the impact of a newly established national IPTp program on maternal and neonatal health in Gabon. Data on prevalence of maternal Plasmodium falciparum infection, anemia, premature birth, and birth weight were collected in cross-sectional surveys in urban and rural regions of Gabon before and after the implementation of IPTp in a total of 1403 women and their offspring. After introduction of IPTp, the prevalence of maternal Plasmodium falciparum infection decreased dramatically (risk ratio 0.16, P < 0.001). Whereas only a modest effect on the rate of anemia in pregnant women was observed, there was a marked benefit on the prevalence of low birth weight and premature birth for women adhering to national recommendations. These effects were most pronounced in primi- and secundigravid women.

Received March 4, 2007. Accepted for publication May 15, 2007.

Acknowledgments: We are grateful for the fruitful collaboration with the midwives of the study centers. We further acknowledge the technical assistance of Nestor Obang and Oye Nsa Emmanuel at the Centre Hospitalier de Libreville. We are indebted to the administrative support of the Directeur Régional de Santé of the province of Moyen-Ogooué.

^* Address correspondence to Michael Ramharter, Department of Internal Medicine 1, Division of Infectious Diseases, Medical University of Vienna, Vienna, Austria. E-mail: michael.ramharter{at}meduniwien.ac.at

Contributors: M. Ramharter developed the study protocol, oversaw the implementation of the trial, and contributed to data analysis and drafting of the manuscript. K. Schuster, M. Bouyou-Akotet, A. A. Adegnika, K. Schmits, S. Nzenze Afène, I. Ndombi Onnas, G. Mom-bo-Ngoma, S. T. Agnandji, and J. Nemeth assisted in the implementation of the study, in data management and data analysis, and critical review of the manuscript. S. Issifou, M. Kombila, and P. G. Kremsner contributed to study design, monitoring of the study, data analysis, and drafting of the manuscript.

Authors’ addresses: Michael Ramharter, Katharina Schuster, Ayola A. Adegnika, Kristen Schmits, Ghyslain Mombo-Ngoma, Selidji T. Agnandji, Johannes Nemeth, Saadou Issifou, and Peter G. Kremsner, Medical Research Unit, Albert Schweitzer Hospital, Lambaréné, Gabon, Telephone: +241 581 099; Fax: +241 581 196. Michael Ramharter, Institut Pasteur, Université de la Méditerranée, Marseille, France. Telephone: +43 14 04 004 440 (M.R.), Fax: +43 14 04 004 418. Michael Ramharter, Katharina Schuster, Ayola A. Adegnika, Ghyslain Mombo-Ngoma, Selidji T. Agnandji, Johannes Nemeth, Saadou Issifou, and Peter G. Kremsner, Institute for Tropical Medicine, Department for Parasitology, University of Tübingen, Tübingen, Germany. Marielle K. Bouyou-Akotet, Solange Nzenze Afène, and Maryvonne Kombila, Département de Parasitologie, Mycologie, Médecine Tropicale, Université des Sciences de la Santé, Libreville, Gabon. Isabelle Ndombi Onnas, Département de Maternité, Centre Hospitalier de Libreville, Libreville, Gabon.