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ABSTRACT
Contexte. En Afrique Subsaharienne, le risque de complications du paludisme est élevé chez les femmes enceintes infectées par le paludisme. Pour la prévention du paludisme chez femmes enceintes, l'administration mensuelle de Sulfadoxine Pyriméthamine en traitement préventif intermittent (TPIg-SP) est recommandée à partir de 13 semaines gestation. L’efficacité de cette stratégie est menacée par l’augmentation du niveau de résistance du P.f à la SP dans certaines régions d’Afrique. Il devient dès lors nécessaire de surveiller l’efficacité de cette molécule. Méthodologie. Une étude d’observation prospective a été réalisée entre 2018 et 2019 au Mali. Les femmes infectées ont été incluses lors de l’administration de la première dose de SP et évaluées cliniquement et biologiquement pendant 42 jours selon le protocole standard de l’OMS de 2009 sur l’efficacité in vivo. La courbe de Kaplan Meier a permis de déterminer le délai de survenue des échecs et le test de Log rank pour l’influence des facteurs sur ce délai. Résultats. Au total 254 femmes ont été inclues, l’âge moyen était de 22 ans. L’efficacité avant et après correction moléculaire était de 81,2% et de 99,2% respectivement. Elle n’était pas influencée par le site, la gestité et l’anémie (p>0,05, Log rank). La proportion de l’anémie a significativement diminué au cours du suivi de 81,4% à 64,5%, p <0,001. Conclusion. Le TPIg-SP reste encore très efficace sur les souches parasitaires de P.f tout en contribuant à la réduction de l’anémie. Une surveillance régulière de son efficacité est recommandée.


RÉSUMÉ
Background. In Sub-Saharan Africa, the risk of malaria complications is high among pregnant women infected. For the prevention of malaria in pregnancy, monthly Intermittent Preventive Treatment (IPTp-SP) with Sulfadoxine Pyrimethamine is recommended since 13 weeks of gestation. The effectiveness of this strategy is threatened by the increase in the level of resistance of P.f to SP in some Africa regions. It therefore becomes necessary to monitor the effectiveness of this molecule. Methods. A prospective observational study was carried out between 2018 and 2019 in Mali. Infected women were included during the first administration of SP and assessed clinically and biologically for 42 days according to the standard 2009 WHO protocol on in vivo efficacy. Kaplan Meier curve was used to determine the time to onset of IPTp-SP failures and the Log rank test for the influence of factors on this time. Results. A total of 254 women were included, the average age was 22 years. The effectiveness before and after molecular correction was 81.2% and 99.2% respectively. But it was not influenced by site, gravida and anemia (p>0.05, Log rank). The proportion of anemia decreased significantly during follow-up from 81.4% to 64.5%, p <0.001. Conclusion. IPTp-SP is still very effective on parasitic strains of P.f while contributing to the reduction of anemia. Regular monitoring of its effectiveness is recommended.

Keywords

Femmes enceintes, Plasmodium falciparum, Sulfadoxine Pyriméthamine, Efficacité in vivo, Mali

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Mariam Tall, Oumou Coulibaly, Souleymane Diarra, Abdou Kassoum dit Baber Kayentao, Mahamadou Dembéle, Mahamadou Guindo, Aliou Traore, Oumar Yattara, & Kassoum Kayentao. (2022). Efficacité in Vivo de la Sulfadoxine Pyriméthamine chez les Femmes Enceintes Infectées par Plasmodium Falciparum au Mali. HEALTH SCIENCES AND DISEASE, 24(1). https://doi.org/10.5281/hsd.v24i1.4149
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