Malaria World this week has an interesting research article published in BMC by Mbishi et al that finds that poverty is a significant factor in the prevalence of malaria. The findings of the pooled data research article found that maternal education, household wealth and rural/urban place of residence had significant effects on the occurrence of malaria. This result concurs with observations from other studies and seems to point to the importance of factors other than mosquito bites.
But the article also found a positive benefit linked to Fansidar uptake during pregnancy. Fansidar is a Hoffmann-La Roche trademark for the malaria drug sulfadoxine/pyrimethamine frequently used in Intermittent Preventive Treatment of Malaria (IPT) programmes in target countries. This drug has the usual long list of potential side effects including stomach pain, feeling full, hair loss, headache, muscle weakness, depression, nervousness, ringing in your ears, sleep problems (insomnia), diarrhoea, dizziness, nausea, vomiting, and loss of appetite. An FDA warning states FATALITIES ASSOCIATED WITH THE ADMINISTRATION OF FANSIDAR (sulfadoxine and pyrimethamine) HAVE OCCURRED DUE TO SEVERE REACTIONS, INCLUDING STEVENS-JOHNSON SYNDROME AND TOXIC EPIDERMAL NECROLYSIS.
The benefit was associated with use during pregnancy. The data sheet also states There are no adequate and well-controlled studies in pregnant women. However, due to the teratogenic effect shown in animals and because pyrimethamine plus sulfadoxine may interfere with folic acid metabolism, Fansidar (sulfadoxine and pyrimethamine) therapy should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Women of childbearing potential who are traveling to areas where malaria is endemic should be warned against becoming pregnant, and should be advised to practice contraception during prophylaxis with Fansidar (sulfadoxine and pyrimethamine) and for three months after the last dose.
It is difficult to understand how their mothers taking Fansidar during pregnancy could cause a 26.9% reduction in the prevalence of malaria in children under five. It is not that the children are taking it. Given the side-effects it is probably wise for them not to. I won’t speculate. It could simply be a confounding of factors, perhaps a greater proportion of wealthier, urban women were enrolled in the IPTp programmes.