Malaria chemoprophylaxis, birth weight and child survival

Abstract

Study of the effects of malaria chemoprophylaxis given during pregnancy on birthweight and investigation of the influence of birthweight on child survival suggest that, in a rural area of The Gambia, chemoprophylaxis given during pregnancy might reduce infant mortality by about one-fifth in the children of primigravidae but by less than 5% in the children of multigravidae. In malaria endemic areas, primigravidae should be protected against malaria not only for their own sake but also for that of their infants.

PIP: Over 3 years, researchers randomly assigned more than 1775 pregnant women (many in their 3rd trimester of pregnancy) from 41 villages near Farafenni, The Gambia, to receive either Maloprim (malaria chemoprophylaxis of pyrimethamine and dapsone) or a placebo to determine Maloprim's effects on birth weight and child survival. All births occurred at home. Field workers went to each home as soon as possible after delivery to weigh the newborns. The relative risks for neonatal and infant mortality were 23 for infants weighing less than 2000 gms and 12 for those who weighed at least 2500 gms. While they were 2.1 and 0.8, respectively, for infants weighing between 2000 and 2500 gms. 33.3% of low birth weight infants of primigravidae died compared with 19% of those of multigravidae. Taking Maloprim during pregnancy reduced infant mortality by 18% for infants of primigravidae and only 4% for infants of multigravidae. It reduced neonatal deaths by 42% for infants of primigravidae and by just 6% for infants of multigravidae. These results suggested that health workers should distribute antimalarial medicine to all primigravidae. Chemoprophylaxis along with other malaria control efforts, such as insecticide impregnated bed nets or a malaria vaccine, would protect mothers and their infants.