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dc.contributor.authorRukhsana Ahmeden_US
dc.contributor.authorJeanne R. Poespoprodjoen_US
dc.contributor.authorDin Syafruddinen_US
dc.contributor.authorCarole Khairallahen_US
dc.contributor.authorCheryl Paceen_US
dc.contributor.authorTheda Lukitoen_US
dc.contributor.authorSylvia S. Maratinaen_US
dc.contributor.authorPuji B.S. Asihen_US
dc.contributor.authorMaria A. Santana-Moralesen_US
dc.contributor.authorEmily R. Adamsen_US
dc.contributor.authorVera T. Unwinen_US
dc.contributor.authorChristopher T. Williamsen_US
dc.contributor.authorTao Chenen_US
dc.contributor.authorJames Smedleyen_US
dc.contributor.authorDuolao Wangen_US
dc.contributor.authorBrian Faragheren_US
dc.contributor.authorRichard N. Priceen_US
dc.contributor.authorFeiko O. ter Kuileen_US
dc.contributor.otherEijkman Institute for Molecular Biologyen_US
dc.contributor.otherUniversitas Gadjah Madaen_US
dc.contributor.otherMenzies School of Health Researchen_US
dc.contributor.otherLiverpool School of Tropical Medicineen_US
dc.contributor.otherMahidol Universityen_US
dc.contributor.otherNuffield Department of Clinical Medicineen_US
dc.contributor.otherUniversidad de la Lagunaen_US
dc.contributor.otherPapuan Health and Community Development Foundationen_US
dc.contributor.otherMimika District Health Authorityen_US
dc.identifier.citationThe Lancet Infectious Diseases. Vol.19, No.9 (2019), 973-987en_US
dc.description.abstract© 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Background: Plasmodium falciparum and Plasmodium vivax infections are important causes of adverse pregnancy outcomes in the Asia-Pacific region. We hypothesised that monthly intermittent preventive treatment (IPT) or intermittent screening and treatment (IST) with dihydroartemisinin–piperaquine is more effective in reducing malaria in pregnancy than the existing single screening and treatment (SST) strategy, which is used to screen women for malaria infections at the first antenatal visit followed by passive case detection, with management of febrile cases. Methods: We did an open-label, three-arm, cluster-randomised, superiority trial in Sumba (low malaria transmission site) and Papua (moderate malaria transmission site), Indonesia. Eligible participants were 16–30 weeks pregnant. Clusters (antenatal clinics with at least ten new pregnancies per year matched by location, size, and malaria risk) were randomly assigned (1:1:1) via computer-generated lists to IPT, IST, or SST clusters. In IPT clusters, participants received the fixed-dose combination of dihydroartemisinin-piperaquine (4 and 18 mg/kg per day). In IST clusters, participants were screened with malaria rapid diagnostic tests once a month, whereas, in SST clusters, they were screened at enrolment only. In all groups, participants with fever were tested for malaria. Any participant who tested positive received dihydroartemisinin–piperaquine regardless of symptoms. The primary outcome was malaria infection in the mother at delivery. Laboratory staff were unaware of group allocation. Analyses included all randomly assigned participants contributing outcome data and were adjusted for clustering at the clinic level. This trial is complete and is registered with ISRCTN, number 34010937. Findings: Between May 16, 2013, and April 21, 2016, 78 clusters (57 in Sumba and 21 in Papua) were randomly assigned to SST, IPT, or IST clusters (26 clusters each). Of 3553 women screened for eligibility, 2279 were enrolled (744 in SST clusters, 681 in IPT clusters, and 854 in IST clusters). At enrolment, malaria prevalence was lower in IST (5·7%) than in SST (12·6%) and IPT (10·6%) clusters. At delivery, malaria prevalence was 20·2% (128 of 633) in SST clusters, compared with 11·6% (61 of 528) in IPT clusters (relative risk [RR] 0·59, 95% CI 0·42–0·83, p=0·0022) and 11·8% (84 of 713) in IST clusters (0·56, 0·40–0·77, p=0·0005). Conditions related to the pregnancy, the puerperium, and the perinatal period were the most common serious adverse events for the mothers, and infections and infestations for the infants. There were no differences between groups in serious adverse events in the mothers or in their infants. Interpretation: IST was associated with a lower prevalence of malaria than SST at delivery, but the prevalence of malaria in this group was also lower at enrolment, making interpretation of the effect of IST challenging. Further studies with highly sensitive malaria rapid diagnostic tests should be considered. Monthly IPT with dihydroartemisinin–piperaquine is a promising alternative to SST in areas in the Asia-Pacific region with moderate or high transmission of malaria. Funding: Joint Global Health Trials Scheme of the Medical Research Council, Department for International-Development, and the Wellcome Trust.en_US
dc.rightsMahidol Universityen_US
dc.titleEfficacy and safety of intermittent preventive treatment and intermittent screening and treatment versus single screening and treatment with dihydroartemisinin–piperaquine for the control of malaria in pregnancy in Indonesia: a cluster-randomised, open-label, superiority trialen_US
Appears in Collections:Scopus 2019

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