Prevention Strategy for PNG
Title: Intermittent preventive treatment with azithromycin-containing regimens for the prevention of malarial infections and anaemia and the control of sexually transmitted infections in pregnant women in Papua New Guinea
Project Coordinator: Stephen J Rogerson (Australia)
European Collaborators: Clara Menendez (Spain)
Site PI's: Ivo Mueller and Peter Siba (PNG)
Malaria is a major killer in Papua New Guinea, and pregnant women and young children suffer most from its effects. Both P. falciparum and P. vivax are common in PNG, and show varying levels of resistance to current drugs, such as chloroquine and sulphadoxine-pyrimethamine (SP). At delivery, around 40% of women show evidence of damage to the placenta from malaria. Malaria is a major cause of low birth weight babies and of severe anaemia in mothers.
Recent studies suggest the antibiotic azithromycin has activity against both types of malaria parasite found in PNG, and that it works best in combination with existing drugs such as SP. Azithromycin is also very effective against sexually transmitted infections, such as syphilis, gonorrhoea and chlamydia, all of which are common in PNG. Untreated, each of these infections can have devastating consequences for the baby, and by treating these diseases, azithromycin may further improve pregnancy outcomes.
We are examining whether repeated doses of Intermittent Preventive Treatment in pregnancy (IPTp) with SP and azithromycin (three times over pregnancy) improves babies’ birth weights compared to a single treatment dose of SP and chloroquine. All women are given an insecticide treated bed net, to give additional malaria protection.
As part of these studies, we are also performing the first detailed study of the impact of vivax malaria in pregnancy, contributing to the EU FP7-funded Pregvax study, led by the University of Barcelona, which is measuring the burden of vivax in pregnancy in five countries.
The IPTp study is taking place in Madang District, PNG, as a partnership between the PNG Institute of Medical Research and the University of Melbourne’s Department of Medicine. Almost 2800 women are being enrolled into the study over two years, at the local hospital and nearby health centres. If the study shows significant benefits against malaria and sexually transmitted infections, the inclusion of this drug into antenatal programmes in areas where these infections are common may significantly improve maternal and child health.