Journal Article

The impact of maternal antenatal treatment with two doses of azithromycin and monthly sulphadoxine-pyrimethamine on child weight, mid-upper arm circumference and head circumference: A randomized controlled trial

Hallamaa, Lotta, Cheung, Yin Bun, Luntamo, Mari, Ashorn, Per, Ashorn, Ulla, Mangani, Charles, Kulmala, Teija

2019

Overview

Intermittent preventive treatment in pregnancy (IPTp) with azithromycin and monthly sulfadoxine-pyrimethamine increased the mean child weight, mid-upper arm and head circumference at four weeks of age in a rural low-income setting. Now we assess for how long these gains were sustained during 0-5 years of age. We enrolled 1320 pregnant Malawian women in a randomized trial and treated them with two doses of sulfadoxine-pyrimethamine (control) or monthly sulfadoxine-pyrimethamine as IPTp against malaria, or monthly sulfadoxine-pyrimethamine and two doses of azithromycin (AZI-SP) as IPTp against malaria and reproductive tract infections. Child weight, mid-upper arm circumference, head circumference and weight-for-height Z-score were recorded at one, six, 12, 24, 36, 48, and 60 months. Throughout follow-up, the mean child weight was approximately 100 g higher (difference in means 0.12 kg, 95% CI 0.04-0.20, P = 0.003 at one month; 0.19 kg, 95% CI 0.05-0.33, P = 0.007, at six months), mean head circumference 2 mm larger (0.3 cm, 95% CI 0.1 to 0.5, P = 0.004 at one month) and the cumulative incidence of underweight by five years of age was lower (hazard ratio 0.74, 95% CI 0.60 to 0.90, P = 0.002) in the AZI-SP group than in the control group. The 2 mm difference in the mean mid-upper arm circumference at one month (0.2 cm, 95% CI 0.0 to 0.3, P = 0.007) disappeared after three years of age. There was no difference in mean weight-for-height Z-score at any time point. In Malawi, IPTp with azithromycin and monthly sulfadoxine-pyrimethamine has a modest, 3-5-year positive impact on child weight, mid-upper arm circumference and head circumference, but not on weight-for-height Z-score.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Adult / Age / Anthropometry / Anti-Bacterial Agents - administration & dosage / Antibiotics / Antimalarial agents / Antimalarials / Antimalarials - administration & dosage / Arm - anatomy & histology / Arm circumference / Azithromycin / Azithromycin - administration & dosage / Biology and Life Sciences / Birth weight / Birth Weight - drug effects / Body height / Body measurements / Child / Child development / Child, Preschool / Children & youth / Childrens health / Circumferences / Clinical trials / Drug Combinations / Drug dosages / Drug therapy / Enrollments / Female / Follow-Up Studies / Head / Head - anatomy & histology / Health aspects / HIV / Human immunodeficiency virus / Humans / Incidence / Infant / Infant, Newborn / Infection / Malaria / Malaria - epidemiology / Malaria - prevention & control / Malawi / Male / Medical research / Medical schools / Medicine / Medicine and Health Sciences / Mothers / Pediatrics / People and Places / Physiological aspects / Pregnancy / Pregnancy Complications, Infectious - epidemiology / Pregnancy Complications, Infectious - prevention & control / Pregnancy Complications, Parasitic - epidemiology / Pregnancy Complications, Parasitic - prevention & control / Pregnant women / Prenatal influences / Prevention / Preventive medicine / Public health / Pyrimethamine / Pyrimethamine - administration & dosage / Reading / Reproductive system / Respiratory Tract Infections - epidemiology / Respiratory Tract Infections - prevention & control / Sulfadoxine / Sulfadoxine - administration & dosage / Systematic review / Underweight / Vector-borne diseases / Weight / Womens health