Artemisinin-based and non-Artemisinin-based combination therapies regimen for uncomplicated malaria in pregnancy and its impact on newborn and pregnancy outcomes in Mont Amba district, Kinshasa, Democratic Republic of the Congo

Abstract

During pregnancy, malaria infection in the mother can cause low birth weight and result in poor pregnancy outcomes. The choice of antimalarial drugs is critical in Democratic Republic of the Congo because of its malaria burden which is among the highest in sub-Saharan Africa. Artemisinin –based combination therapies regimen is recommended by World Health Organization for uncomplicated malaria in second or third trimester of pregnancy to treat uncomplicated malaria in pregnancy. However, the choice of drug to treat malaria during pregnancy depends on the prescriber knowledge, socioeconomic status, adherence and drugs availability in the health facility and all these may impact on pregnancy outcomes such as preterm delivery, stillbirth, abortion and newborn weight. This study aimed to examine the association between Artemisinin –based combination therapy regimen and low birth weight including pregnancy outcomes in Mont Amba district, Kinshasa. It was based on patient records, cross-sectional, retrospective study in Mont Amba District, Kinshasa, from January to December 2018.The study population comprised pregnant mothers diagnosed with uncomplicated malaria in second or third trimester whom ages vary between 16 and 49. We used patient registries information about antimalarial drugs received, antenatal care visits, socioeconomic status, origin of those pregnant mothers and delivery information such as term, stillbirth, baby’s weight, sex, from a secondary level health facility. We sampled three hundred and sixty- four mothers and excluded all mothers aged below 16 or above 49, who did not deliver in the same health facility. Finally, two hundred and sixty-four mothers remained for our study. We categorized them in ACTs and non- ACTs groups according the antimalarial regimen they received. Continuous variables were calculated using two-sample Student’s t-test. Categorical variables were analyzed using Chi-square or Fisher’s exact test, as appropriate. Multivariate analysis was performed by logistic regression. All p-values were 2-tailed, with p<0.05 considered to be statistically significant. Statistical analyses were carried out by SPSS® version 25. Among 264 patients, there were 102(38.6%) using artemisinin –based combination therapies and 162(61.4%) using non- artemisinin –based combination therapies. Among these patients, 134(50.8%) were young women aged 20 to 29 years and majority of women came from Kisenso commune 215(81.4%). There were no significant differences in maternal age (28.3±6.4 vs. 27.7±6.3; p=0.782), outcome of pregnancy (term:72(70.6%) vs. 104(64.2%); p=0.283, preterm:28(27.5%) vs. 58(35.8%); p=0.159, stillbirth :2(2.0%) vs. 6(3.7%); p=0.715), infantile birth weight (3211.2g±504.0 vs. 3087.0±546); p=0.133, socioeconomic status (96(94.1%) vs. 160(98.8%); p=0.058), and antennal care (87(85.3%) vs 121(76.1%); p=0.072) between artemisinin –based combination therapies group and non- artemisinin –based combination therapies group. In the multivariate logistic regression, there was no significant difference in birth weight of infants born to women who received artemisinin –based combination therapies and those who did not (odds ratio, 1.208; 95% confidence interval, 0.490-2.976; p=0.682). The current study results suggest that there is no impact of ACTs or non- ACTs treatment regimen on newborn weight preterm, abortion, and stillbirth Keywords: Malaria, pregnancy, artemisisins, infant, low birth weight.