Discussion
malaria, bacterial sexually-transmitted infections
MALARIA, ADVERSE EVENTS
In this randomized controlled trial conducted in three peripheral health centres of the Yako health district in rural areas of Burkina Faso, systematically adding azithromycin to sulfadoxine-pyrimethamine during the intermittent preventive treatment of malaria in pregnancy did not result in a significantly lower incidence of low birth weight among neonates than the use of sulfadoxine-pyrimethamine. This was inconsistent with the expectations based on studies suggesting that a systematic combination of anti-malarials and antibiotics to prevent bacterial sexually-transmitted infections and malaria in pregnancy is associated with lower incidence of adverse birth outcomes [There are several possible reasons for these finding. First, the overall reduction of the incidence of low birth weight in the control group than that hypothesized to estimate the sample size [Despite that the adjunction of azithromycin to sulfadoxine-pyrimethamine did not offer additional benefits to reduce adverse birth outcomes beyond that of the intermittent preventive treatment of malaria in pregnancy using sulfadoxine-pyrimethamine, the intervention presented a good safety profile. There was no drug related serious adverse events and the frequency of adverse events and serious adverse events did not differ across treatment groups as already noted by several studies [Important study limitations are worth noting as the gestational age was assessed using the last menstrual period or the measurement of the fundal height rather than ultrasounds and this may be subject to misclassification of pregnant women. Also, the investigators and the study participants were not blinded to the treatment and this may have led to selection or information bias. However, these bias effects were mitigated as the main endpoint’s measurements were not subject to a large degree of individual interpretation.