MALARIA IN EARLY INFANCY: EFFECT OF INTERMITTENT PREVENTIVE TREATMENT OF MALARIA IN PREGNANCY (IPTp) AND MATERNALLY TRANSFERRED ANTIBODIES IN THE KASSENA-NANKANA DISTRICT.

ABSTRACT

Background Beneficial effects of Intermittent Preventive Treatment in pregnancy (IPTP-SP) on the mother and birth outcomes are known. The few studies on the effects of IPTp-SP beyond in utero have been contradictory and tended to focus on late infancy and beyond. Mechanisms and targets explaining effects of IPTp-SP beyond in utero remain largely unknown. This study determined if IPTp-SP use was associated with risk of malaria and all cause mortality in early infancy and if maternally transferred antibody levels (Total IgG) to malarial antigens could explain observed IPTp-SP effects or were independently associated with the aforementioned outcomes. Methods This study was undertaken by conducting secondary analyses of the whole data from a five year cohort of 2279 newborns enrolled between 2006 and 2007 in the Kassena-Nankana Districts. Analysis was restricted to early infancy. Survival techniques (Cox Proportional hazards and Kaplan-Meier plots) were used to estimate frequency of IPT-SP doses and risk of malaria and all cause mortality. ELISA assays performed on a subset of the cohort (672), measured total IgG antibody titres to selected malaria antigens and frequency of IPTp-SP doses. Analyses of variance (ANOVA), simple regression techniques and box plots were employed to determine associations between antibody titres and frequency of IPTp-SP doses. IPTp-SP dosing frequency, Antibody types and risk of malaria and all cause mortality were also measured. Statistical significance was set at 5% with 95% confidence interval. Results Infants of mothers who had one dose of IPTp-SP had 44% less risk of parasitaemia [Hazards Ratio (HR) =0.60(95%CI= 0.45, 0.79), P