A new approach to the treatment of malaria in pregnant women in West Africa

Treating women with the drug amodiaquine, either alone or in combination with sulphadoxine-pyrimethamine (SP), was found to almost completely eliminate the malaria parasite and to cause no serious side-effects in the women being treated.

The study, carried out among pregnant women who attended antenatal clinics at a district hospital in Ghana, is published in today's Lancet. The research team was based jointly at St Theresa's Hospital, Nkoranza, Ghana and at LSHTM.

Malaria parasites are becoming increasingly resistant to choloroquine and sulphadoxine-pyrimethamine (SP) across Africa and there is a need to find new drugs which are safe and well tolerated. Most countries in Africa are adopting artesunate-based combination therapy (ACT) as the preferred first line treatment but there is insufficient information as to its safety of ACT during pregnancy. There are concerns that ACT might have a deleterious effect on the developing embryo, particularly when given during the first trimester of pregnancy.

The extent of drug resistance is not as high in west Africa as it is in east Africa, so the authors sought to determine whether amodiaquine, which is effective in some areas with chloroquine resistance, given alone or in combination with SP might be an effective and safe treatment to use until the safety of ACT treatment in pregnancy has been be established.

They screened pregnant women with a gestational age of 16 weeks or more for the malaria parasite and those who tested positive (900 women) were enrolled, and randomly treated with four different regimens. Parasitological failure by day 28 was 14%, 11%, 3% and 0% in the women assigned choloroquine, SP, amodiaquine, and amodiaquine plus SP respectively.

Professor Brian Greenwood, Clinician and Epidemiologist at LSHTM, and one of the study's authors, comments: 'Malaria in pregnancy poses a threat to both the mother and the foetus. Previous studies had already found amodiaquine alone or in combination with SP to be an effective treatment of malaria in children in west Africa, but our research confirms that this is also true for pregnant women. No serious side-effects were noted and the treatment was well tolerated by the majority of women who took part in the trial'.