Abstract:
BACKGROUND:Trials of intermittent preventive treatment (IPTp) of malaria in pregnant women that compared dihydroartemisinin-piperaquine with the standard of care, sulfadoxine-pyrimethamine, showed dihydroartemisinin-piperaquine was superior at preventing malaria infection, but not at improving birthweight. We aimed to assess whether sulfadoxine-pyrimethamine shows greater non-malarial benefits for birth outcomes than does dihydroartemisinin-piperaquine, and whether dihydroartemisinin-piperaquine shows greater antimalarial benefits for birth outcomes than does sulfadoxine-pyrimethamine. METHODS:We defined treatment as random assignment to sulfadoxine-pyrimethamine or dihydroartemisinin-piperaquine before pooling individual participant-level data from 1617 HIV-uninfected pregnant women in Kenya (one trial; n=806) and Uganda (two trials; n=811). We quantified the relative effect of treatment on birthweight (primary outcome) attributed to preventing placental malaria infection (mediator). We estimated antimalarial (indirect) and non-malarial (direct) effects of IPTp on birth outcomes using causal mediation analyses, accounting for confounders. We used two-stage individual participant data meta-analyses to calculate pooled-effect sizes. FINDINGS:Overall, birthweight was higher among neonates of women randomly assigned to sulfadoxine-pyrimethamine compared with women assigned to dihydroartemisinin-piperaquine (mean difference 69 g, 95% CI 26 to 112), despite placental malaria infection being lower in the dihydroartemisinin-piperaquine group (relative risk [RR] 0·64, 95% CI 0·39 to 1·04). Mediation analyses showed sulfadoxine-pyrimethamine conferred a greater non-malarial effect than did dihydroartemisinin-piperaquine (mean difference 87 g, 95% CI 43 to 131), whereas dihydroartemisinin-piperaquine conferred a slightly larger antimalarial effect than did sulfadoxine-pyrimethamine (8 g, -9 to 26), although more frequent dosing increased the antimalarial effect (31 g, 3 to 60). INTERPRETATION:IPTp with sulfadoxine-pyrimethamine appears to have potent non-malarial effects on birthweight. Further research is needed to evaluate monthly dihydroartemisinin-piperaquine with sulfadoxine-pyrimethamine (or another compound with non-malarial effects) to achieve greater protection against malarial and non-malarial causes of low birthweight. FUNDING:Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bill & Melinda Gates Foundation, and Worldwide Antimalarial Resistance Network.
journal_name
Lancet Glob Healthjournal_title
The Lancet. Global healthauthors
Roh ME,Kuile FOT,Rerolle F,Glymour MM,Shiboski S,Gosling R,Gutman J,Kakuru A,Desai M,Kajubi R,L'Ianziva A,Kamya MR,Dorsey G,Chico RMdoi
10.1016/S2214-109X(20)30119-4subject
Has Abstractpub_date
2020-07-01 00:00:00pages
e942-e953issue
7issn
2214-109Xpii
S2214-109X(20)30119-4journal_volume
8pub_type
杂志文章,随机对照试验abstract:BACKGROUND:To contribute to the WHO initiative, VISION 2020: The Right to Sight, an assessment of global vision impairment in 2020 and temporal change is needed. We aimed to extensively update estimates of global vision loss burden, presenting estimates for 2020, temporal change over three decades between 1990-2020, an...
journal_title:The Lancet. Global health
pub_type: 杂志文章
doi:10.1016/S2214-109X(20)30425-3
更新日期:2021-02-01 00:00:00
abstract:BACKGROUND:Low birthweight (LBW) of less than 2500 g is an important marker of maternal and fetal health, predicting mortality, stunting, and adult-onset chronic conditions. Global nutrition targets set at the World Health Assembly in 2012 include an ambitious 30% reduction in LBW prevalence between 2012 and 2025. Esti...
journal_title:The Lancet. Global health
pub_type: 杂志文章
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abstract:BACKGROUND:The need for multiple clinical visits remains a barrier to women accessing safe legal medical abortion services. Alternatives to routine clinic follow-up visits have not been assessed in rural low-resource settings. We compared the effectiveness of standard clinic follow-up versus home assessment of outcome ...
journal_title:The Lancet. Global health
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1016/S2214-109X(15)00150-3
更新日期:2015-09-01 00:00:00
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journal_title:The Lancet. Global health
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pub_type: 杂志文章
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更新日期:2016-11-01 00:00:00
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pub_type: 杂志文章
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更新日期:2018-12-01 00:00:00
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pub_type: 杂志文章
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更新日期:2017-08-01 00:00:00
abstract:BACKGROUND:Timely access to emergency care can substantially reduce mortality. International benchmarks for access to emergency hospital care have been established to guide ambitions for universal health care by 2030. However, no Pan-African database of where hospitals are located exists; therefore, we aimed to complet...
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更新日期:2018-03-01 00:00:00
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pub_type: 杂志文章
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journal_title:The Lancet. Global health
pub_type: 杂志文章
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更新日期:2014-08-01 00:00:00
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pub_type: 杂志文章
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更新日期:2017-03-01 00:00:00
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更新日期:2021-01-11 00:00:00
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pub_type: 评论,杂志文章
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更新日期:2014-03-01 00:00:00
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pub_type: 杂志文章,随机对照试验
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pub_type: 杂志文章
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更新日期:2016-09-01 00:00:00
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更新日期:2014-09-01 00:00:00
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