***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Two hundred Hausa primigravidae at Zaria were divided into five groups in a r and omized double-blind trial of antenatal oral antimalarial prophylaxis , and haematinic supplements . Group 1 received no active treatment . Groups 2 to 5 were given chloroquine 600 mg base once , followed by proguanil 100 mg per day . In addition , group 3 received iron 60 mg daily , group 4 folic acid 1 mg daily , and group 5 iron plus folic acid .  Forty-five percent were anaemic ( haemoglobin ( Hb ) less than 11.0 g dl-1 ) at first attendance before 24 weeks of gestation , and malaria parasitaemia ( predominantly Plasmodium falciparum ) was seen in 27 % , of whom 60 % were anaemic . The mean Hb fell during pregnancy in group 1 , and seven patients in this group had to be removed from the trial and treated for severe anaemia ( packed cell volume ( PCV ) less than 0.26 ) . Only five patients in the other groups developed severe anaemia ( P = 0.006 ) , two of whom had malaria following failure to take treatment . Patients in group 1 had the lowest mean Hb at 28 and 36 weeks of gestation , and patients receiving antimalarials and iron ( groups 3 and 5 ) had the highest Hb at 28 weeks , but differences were not significant , possibly due to removal from the trial of patients with severe anaemia . Anaemia ( Hb less than 12.0 g dl-1 ) at six weeks after delivery was observed in 61 % of those not receiving active treatment ( group 1 ) , in 39 % of those protected against malaria but not receiving iron supplements ( groups 2 and 4 ) and in only 18 % of patients receiving both antimalarials and iron ( groups 3 and 5 ) . Folic acid had no significant effect on mean Hb .  Proguanil was confirmed to be a highly effective causal prophylaxis . Prevention of malaria , without folic acid supplements , reduced the frequency of megaloblastic erythropoiesis from 56 % to 25 % . Folic acid supplements abolished megaloblastosis , except in three patients who were apparently not taking the treatment prescribed . Red cell folate ( RCF ) concentrations were higher in subjects with malaria , probably due to intracellular synthesis by plasmodia . Infants of mothers not receiving antimalarials appeared to have an erythroid hyperplasia . Maternal folate supplements raised infants ' serum folate and RCF .  Fourteen per cent had low birth weight ( less than 2500 g ) , and the perinatal death rate was 11 % ; the greatest number were in group 1 , but not significantly . A regime is proposed for the prevention of malaria , iron deficiency , folate deficiency and anaemia in pregnancy in the guinea savanna of Nigeria Background Intermittent preventive treatment with sulphadoxine-pyrimethamine ( IPTp-SP ) is being implemented in most malaria endemic countries as a st and ard two-doses regimen as it reduces the risk of low birth weight ( LBW ) and the prevalence of maternal anaemia . Nevertheless , where the risk of infection close to delivery is high because of intense transmission , a third IPTp-SP dose may further reduce the negative effects of malaria on pregnancy outcome . Methods Pregnant women in the 2nd or 3rd trimester were r and omized to receive either 2 ( SP2 ) or 3 doses ( SP3 ) of SP . Trained field workers paid home visits to the women for drug administration according to a predefined drug delivery schedule . Women were encouraged to attend their scheduled ANC visits and to deliver at the health facilities where the new-born was weighed . The prevalence of LBW ( < 2500 g ) , severe anaemia ( Hb < 8 g/dL ) and premature birth  was analysed using intention-to-treat ( ITT ) and per- protocol ( PP ) analysis . Results Data from 1274 singleton pregnancies were analysed ( 641 in the SP3 and 633 in the SP2 group ) . The uptake of the intervention appeared to be low . Though the prevalence of LBW in both intervention groups was similar ( adjusted Incident Rate Ratio , AIRR = 0.92 , 95%CI : 0.69 - 1.24 ) in the ITT analysis , the risk of severe anaemia was significantly lower in the SP3 group compared to the SP2 group ( AIRR = 0.38 , 95%CI : 0.16 - 0.90 ) . The PP analysis showed a trend of reduced risk of LBW , severe anaemia and premature delivery in the SP3 group , albeit the difference between two and three IPTp-SP did not reach statistical significance . Conclusion The risk of LBW and severe anaemia tended to be lower in the SP3 group , though this was not statistically significant , probably due to the low uptake of the intervention which reduced the power of the study . Further studies are needed for establishing whether a third SP dose has a real benefit in preventing the negative effects of malaria in pregnancy in setting s where transmission is markedly seasonal To determine the effect of chloroquine chemoprophylaxis during pregnancy on birth weights , a r and omized trial was carried out in 1987 and 1988 in Banfora , Burkina Faso ( West Africa ) . Seven hundred forty-five r and omly selected women treated with chloroquine sulfate were compared to with 719 controls who received no treatment .  In spite of an un question able effect of chloroquine in preventing placental infection ( 4.1 % infected placentas in the treated group versus 19.0 % in the controls ) , the mean difference in birth weights between the two groups ( 6 g ) was not significant . The difference in the proportion of low birth weight ( LBW ) newborn babies in two groups ( 16.3 % versus 16.4 % ) was also not significant . However , there was a strong relationship between placental infection and birth weight ( the mean birth weight difference between infected and uninfected placentas was 113 g , and the proportion of LBW babies was 26.0 % in infected placentas versus 14.8 % in uninfected placentas ) . The small difference in birth weights observed between the two groups may be due to the fact that the prevalence rate of placental infection is low and that prophylaxis is effective only on a portion of the subjects in the treated group . It may also indicate that malaria is only one of several risk factors responsible for LBW . The relatively small increase in birth weight , the expected poor acceptance of mass prophylaxis , and the spreading of chloroquine-resistant Plasmodium strains should be considered before extending malaria chemoprophylaxis to all pregnant women . It might be worth considering to limit prophylaxis to primigravidae Background In the global context of a reduction of under-five mortality , neonatal mortality is an increasingly relevant component of this mortality . Malaria in pregnancy may affect neonatal survival , though no strong evidence exists to support this association . Methods In the context of a r and omised , placebo-controlled trial of intermittent preventive treatment ( IPTp ) with sulphadoxine-pyrimethamine ( SP ) in 1030 Mozambican pregnant women , 997 newborns were followed up until 12 months of age . There were 500 live borns to women who received placebo  and 497 to those who received SP . Findings There were 58 infant deaths ; 60.4 % occurred in children born to women who received placebo and 39.6 % to women who received IPTp ( p = 0.136 ) . There were 25 neonatal deaths ; 72 % occurred in the placebo group and 28 % in the IPTp group ( p = 0.041 ) . Of the 20 deaths that occurred in the first week of life , 75 % were babies born to women in the placebo group and 25 % to those in the IPTp group ( p = 0.039 ) . IPTp reduced neonatal mortality by 61.3 % ( 95 % CI 7.4 % , 83.8 % ) ; p = 0.024 ] . Conclusions Malaria prevention with SP in pregnancy can reduce neonatal mortality . Mechanisms associated with increased malaria infection at the end of pregnancy may explain the excess mortality in the malaria less protected group . Alternatively , SP may have reduced the risk of neonatal infections . These findings are of relevance to promote the implementation of IPTp with SP , and provide insights into the underst and ing of the pathophysiological mechanisms through which maternal malaria affects fetal and neonatal health . Trial Registration Clinical Trials.gov Background New regimens for intermittent preventive treatment in pregnancy ( IPTp ) against malaria are needed as the effectiveness of the st and ard two-dose sulfadoxine-pyrimethamine ( SP ) regimen is under threat . Previous trials have shown that IPTp with monthly SP benefits HIV-positive primi- and secundigravidae , but there is no conclusive evidence of the possible benefits of this regimen to HIV-negative women , or to a population comprising of both HIV-positive and –negative women of different gravidities . Methods This study analyzed 484 sample s collected at delivery as part of a r and omized , partially placebo controlled clinical trial , conducted in rural Malawi between 2003 and 2007 . The study included pregnant women regardless of their gravidity or HIV-infection status . The participants received SP twice ( controls ) , monthly SP , or monthly SP and two doses of azithromycin ( AZI-SP ) . The main outcome was the prevalence of peripheral Plasmodium falciparum malaria at delivery diagnosed with a real-time polymerase chain reaction ( PCR ) assay . Findings Overall prevalence of PCR-diagnosed peripheral P. falciparum malaria at delivery was 10.5 % . Compared with the controls , participants in the monthly SP group had a risk ratio ( 95 % CI ) of 0.33 ( 0.17 to 0.64 , P<0.001 ) and those in the AZI-SP group 0.23 ( 0.11 to 0.48 , P<0.001 ) for malaria at delivery . When only HIV-negative participants were analyzed , the corresponding figures were 0.26 ( 0.12 to 0.57 , P<0.001 ) for women in the monthly SP group , and 0.24 ( 0.11 to 0.53 , P<0.001 ) for those in the AZI-SP group . Conclusions Our results suggest that increasing the frequency of SP administration during pregnancy improves the efficacy against malaria at delivery among HIV-negative women , as well as a population consisting of both HIV-positive and –negative pregnant women of all gravidities , in a setting of relatively low but holoendemic malaria transmission , frequent use of bed nets and high SP resistance . Trial Registration Clinical Trials.gov BACKGROUND In 2003 , Mali introduced intermittent preventive therapy in pregnancy ( ITPp ) with sulfadoxine-pyrimethamine ( SP ) for the control of malaria in pregnancy , consisting of 2 doses of SP given in the 2nd and 3rd trimester . This widely used regimen , although very effective , leaves many women unprotected from malaria during the last 4-to-8 weeks of gestation , which is a pivotal period for fetal weight gain . The aim of the study was to compare the efficacy and safety of 3-dose versus 2-dose IPTp-SP for the prevention of placental malaria and associated low birth weight ( LBW ) . METHODS We conducted a parallel-group , open-label , individually r and omized controlled superiority trial involving 814 women of all gravidity , enrolled from April 2006 through March 2008 . All women were seen at least 3 times and received either 2 ( n = 401 ) or 3 ( n = 413 ) doses of IPTp-SP . The primary endpoint measured was placental malaria , LBW , preterm births , and maternal anemia were secondary endpoints , and severe maternal skin reactions and neonatal jaundice were safety endpoints . RESULTS Among the 96 % of study subjects who were followed up until delivery , the prevalence of placental malaria was 2-fold lower in the 3-dose group ( 8.0 % ) than in the 2-dose group ( 16.7 % ) ; the adjusted prevalence ratio ( APR ) was 0.48 ( 95 % confidence interval [ CI ] , 0.32 - 0.71 ) . LBW and preterm births were also reduced ; the prevalence of LBW was 6.6 % in the 3-dose group versus 13.3 % in the 2-dose group ( APR , 0.50 ; 95 % CI , 0.32 - 0.79 ) , and the prevalence of preterm births was 3.2 % versus 8.9 % ( APR , 0.37 ; 95 % CI , 0.19 - 0.71 ) . No significant reductions in maternal anemia or differences in safety endpoints were observed . CONCLUSIONS Adding a third dose of ITPp-SP halved the risk of placental malaria , LBW , and preterm births in all gravidae , compared with the st and ard 2-dose regimen , in this area of highly seasonal transmission with low levels of SP resistance . CLINICAL TRIALS REGISTRATION IS RCT N 74189211 BACKGRO 
    Output:
    
In trials giving chemoprevention to all pregnant women irrespective of parity , the average effects of chemoprevention measured in all women indicated it may prevent severe anaemia ( defined by authors , but at least < 8 g/L : RR 0.19 , 95 % CI 0.05 to 0.75 ; two trials , 1327 participants , low quality evidence ) , but consistent benefits have not been shown for other outcomes .
Authors ' conclusions Routine chemoprevention to prevent malaria and its consequences has been extensively tested in RCTs , with clinical ly important benefits on anaemia and parasitaemia in the mother , and on birthweight in infants .
8 May 2019 No up date planned Review superseded The intervention is clearly effective .