Prevention of Intrauterine Growth Retardation in Burkina Faso: the Malaria Component

Study Overview
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Brief Summary
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Our objective was to investigate the importance of malaria infection/disease during pregnancy and more particularly during the first trimester; we also looked at the maternal-foetal interactions and their influence on the subsequent child's response to malaria infections during the first year of life. This study was carried out !in the same population recruited for the IUGR study (NCT00642408).

Detailed Description
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A research project aiming at investigating the impact of multivitamin-mineral supplementation (MMS) during pregnancy on intra-uterin growth retardation was carried out in the Hounde district, an area not far from the Centre Muraz located in Bobo Dioulasso, and where malaria is endemic. Malaria during pregnancy increases the risk of low birth weight, infant mortality and morbidity during the first year of life by inducing growth retardation, prematurity and infant anaemia. The administration of an antimalarial drug during pregnancy has a beneficial effect on the mother and child's health by preventing malaria infection and its consequences. However, most studies have been carried out during the second or third trimester of pregnancy: the effect of malaria infection during the first trimester on the mother's and child's health is unknown. It has been reported that even one single infection may have a significant impact on the outcome of pregnancy: if it is true, then early chemoprophylaxis may have an additional advantage. An alternative approach is the administration of intermittent presumptive treatment, which may achieve equal efficacy to continuos chemoprophylaxis; however, no studies compared effective weekly malaria chemoprophylaxis with effective intermittent presumptive treatment. Moreover, the incidence of malaria clinical episodes during SP intermittent preventive treatment has never been investigated. Therefore, this open label, factorial study was carried out in the same women recruited for the IUGR nutritional study (NCT00642408). Women receiving multiple micronutrients supplements (MMS) or dietary supplements (IFA) were further randomised in 2 groups: CQ weekly chemoprophylaxis or SP intermittent preventive treatment. The administration of treatment was directly observed.

Official Title
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Prevention of Intrauterine Growth Retardation in Hounde District, Burkina Faso: the Malaria Component

Conditions
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Malaria, Malaria in Pregnancy

Intervention / Treatment
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* Dietary Supplement: Multiple micronutrients supplements (MMS)
* Dietary Supplement: Iron and folic acid (IFA)
* Drug: Chloroquine (CQ)
* Drug: Sulphadoxyne-pyrimethamine (SP)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 15 to 44 years females living in the study area Exclusion Criteria: planning to move outside the district within two years regularly using a contraceptive methods already pregnant at the start of the trial

Ages Eligible for Study
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Minimum Age: 15 Years
Maximum Age: 44 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Factorial Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: A1<br>Multiple micronutrients supplements (MMS) and weekly chloroquine (CQ) | Dietary Supplement: Multiple micronutrients supplements (MMS)<br>* Vitamin A 800 mcg; vitamin E 10 mg; vitamin D 5 mcg; vitamin B1 1.4 mg; vitamin B2 1.4 mg;niacin 18 mg; vitamin B6 1.9 mg; vitamin B12 2.6 mcg; folic acid 400 mcg; vitamin C 70 mg; iron 30 mg; zinc 15 mg; copper 2 mg; selenium 65 mcg; iodine 150 mcg<br>* Other names: UNIMMAP;Drug: Chloroquine (CQ)<br>* Tablets 100 mg of chloroquine base<br>|
| Experimental: A2<br>Multiple micronutrients supplements (MMS) and intermittent suplphadoxyne-pyrimethamine (SP) | Dietary Supplement: Multiple micronutrients supplements (MMS)<br>* Vitamin A 800 mcg; vitamin E 10 mg; vitamin D 5 mcg; vitamin B1 1.4 mg; vitamin B2 1.4 mg;niacin 18 mg; vitamin B6 1.9 mg; vitamin B12 2.6 mcg; folic acid 400 mcg; vitamin C 70 mg; iron 30 mg; zinc 15 mg; copper 2 mg; selenium 65 mcg; iodine 150 mcg<br>* Other names: UNIMMAP;Drug: Sulphadoxyne-pyrimethamine (SP)<br>* Tablets<br>* Other names: Fansidar;|
| Experimental: B1<br>Iron and folic acid (IFA) and weekly chloroquine (CQ) | Dietary Supplement: Iron and folic acid (IFA)<br>* Iron 60 mg and folic acid 400 mcg<br>Drug: Chloroquine (CQ)<br>* Tablets 100 mg of chloroquine base<br>|
| Experimental: B2<br>Iron and folic acid (IFA) and intermittent sulphadoxyne-pyrimethamine (SP) | Dietary Supplement: Iron and folic acid (IFA)<br>* Iron 60 mg and folic acid 400 mcg<br>Drug: Sulphadoxyne-pyrimethamine (SP)<br>* Tablets<br>* Other names: Fansidar;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Efficacy of standard antimalarial treatment in preventing clinical malaria in pregnant women under weekly chemoprophylaxis or intermittent treatment. |  | Up to delivery | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| To determine if the occurrence of malaria during pregnancy influences the incidence of clinical malaria in infants during their first year of life. |  | Up to one year after delivery | 
| To determine the burden of clinical malaria during pregnancy and its consequences on maternal anaemia, new birth weight and foetal anaemia. |  | Up to delivery | 
| Effect of standard antimalarial treatment on the selection of resistant parasites in pregnant women under weekly chemoprophylaxis or intermittent treatment. |  | Up to one year after delivery | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Malaria, Pregnancy, Prevention, Chloroquine, Sulphadoxine pyrimethamine, Maternal anaemia, Birth weight, Foetal anaemia