IJE Advance Access published online on January 25, 2007
International Journal of Epidemiology, doi:10.1093/ije/dyl301
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Estimation of effectiveness of interventions for malaria control in pregnancy using the screening method
1 Child and Reproductive Health Group, Liverpool School of Tropical Medicine, Liverpool, UK.
2 Malaria Alert Centre, College of Medicine, Blantyre, Malawi.
3 Department of Biochemistry, College of Medicine, Blantyre, Malawi.
4 Kamuzu Central Hospital, Children's Clinical Centre of Excellence Lilongwe, Malawi.
5 Emma Kinderziekenhuis, Academic Medical Centre, University of Amsterdam, The Netherlands.
6 Department of Community Child Health, Royal Liverpool Children's Hospital NHS Trust, Alder Hey, Liverpool, UK.
* Corresponding author. Child and Reproductive Health Group, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK. E-mail: b.j.brabin{at}liv.ac.uk
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Abstract |
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Background The evaluation of the effectiveness of antimalarial drugs and bed net use in pregnant women is an important aspect of monitoring and surveillance of malaria control in pregnancy. In principle the screening method for assessing vaccine efficacy can be applied in non-vaccine settings for assessing interventions for malaria control in pregnancy.
Methods In this analysis field data on the proportion of placental malaria cases treated with two doses of sulphadoxine-pyrimethamine (SP) and the uptake of two doses of SP in the antenatal clinic was used in a case-coverage method to assess the protective effectiveness (PE) of intermittent preventive treatment with SP for malaria control in pregnancy. PE was assessed using placental malaria, low birthweight and maternal anaemia at delivery as outcome variables. The method was also applied to an evaluation of the protective effectiveness of self-reported use of impregnated bed nets (ITNs).
Results Effectiveness was highest for reduction of low birthweight in multigravidae (87.2%, 95% CI, 83.2–91.3%). PE was lower for placental malaria (61.6% primigravidae, 28.5% multigravidae), and maternal anaemia (Hb < 8.0 g/dl, 37.8% primigravidae, 29.6% multigravidae). Estimates for PE of self-reported use of ITNs gave values for all three outcome parameters that were much lower than for SP use. For women of all parties effectiveness estimates for reduction of low birthweight were 22% (95% CI, 17.7–26.4), prevention of placental malaria (all types) 7.1% (95% CI, 4.4–9.8), prevention of active placental infection 38.9% (95% CI, 27.4–50.4), and for maternal anaemia 8.8% (95% CI, 0–20.0).
Conclusions The case-coverage method could provide a useful and practical approach to routine monitoring and evaluation of drug interventions to control malaria in pregnancy and has potentially wide applications. Effectiveness estimates related to reported ITN use in pregnancy may be less reliable. The method should be further evaluated using currently available data sets.
Keywords Malaria, pregnancy, efficacy, antimalarials
Accepted 13 December 2006
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