Summary of findings 2. Summary of findings table 2.
| Malaria chemoprevention for pregnant women (parity 0‐1) living in endemic areas: infant outcomes | |||||
| Patient or population: Pregnant women (parity 0‐1) Settings: Malaria‐endemic areas Intervention: Malaria chemoprevention (any regimen) Control: Placebo or no intervention | |||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of participants (trials) | Quality of the evidence (GRADE) | |
| Assumed risk | Corresponding risk | ||||
| Control | Chemoprevention | ||||
| Spontaneous abortion | 33 per 1000 | 21 per 1000 (13 to 33) | RR 0.65 (0.41 to 1.02) | 2876 (5 trials) | ⊕⊕⊝⊝ low1,2,3,4 |
| Stillbirth | 33 per 1000 | 32 per 1000 (21 to 49) | RR 0.97 (0.64 to 1.49) | 2703 (3 trials) | ⊕⊕⊝⊝ low2,4,5,6, |
| Perinatal mortality | 104 per 1000 | 76 per 1000 (56 to 104) | RR 0.73 (0.54 to 1.00) | 1620 (2 trials) | ⊕⊕⊝⊝ low2,4,5,7, |
| Neonatal mortality | 37 per 1000 | 23 per 1000 (14 to 39) | RR 0.62 (0.37 to 1.05) | 2156 (2 trials) | ⊕⊕⊝⊝ low2,4,5,7, |
| Preterm birth | 164 per 1000 | 140 per 1000 (108 to 181) | RR 0.85 (0.66 to 1.10) | 1493 (2 trials) | ⊕⊕⊝⊝ low1,2,4 |
| Low birthweight | 152 per 1000 | 110 per 1000 (92.7 to 132.2) | RR 0.73 (0.61 to 0.87) | 3619 (8 trials) | ⊕⊕⊕⊝ moderate9,10 |
| Mean birthweight | The mean birthweight in the control groups ranged from 2723 g to 3079 g |
The mean birthweight in the intervention groups was 92.72 g higher (62.05 higher to 123.39 higher) | ‐ | 3936 (9 trials) | ⊕⊕⊕⊝ moderate5,10 |
| Placental parasitaemia | 307 per 1000 | 160 per 1000 (132 to 211) | RR 0.54 (0.43 to 0.69) | 2830 (7 trials) | ⊕⊕⊕⊕ high3,11,12 |
| Cord blood haemoglobin | The mean haemoglobin in the control group was 15.8 g/dL | The mean haemoglobin in the intervention groups was 1.8 g/dL lower (3.46 lower to 0.14 lower) | ‐ | 64 (1 trial) | ⊕⊝⊝⊝ very low1,13,14 |
| *The basis for the assumed risk (eg the median control group risk across trials) is provided in footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio. | |||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | |||||
1 Downgraded by 1 for serious risk of bias: None of the trials described adequate measures to prevent selection bias. 2 No serious inconsistency: The effect is consistent across trials and statistical heterogeneity is low. 3 No serious indirectness: These trials were conducted in The Gambia, Cameroon, Kenya and Mozambique between 1990 and 2002. One gave chemoprevention as weekly chloroquine and four trials gave IPT with SP. 4 Downgraded by 1 for serious imprecision: The 95% CI is wide and sample remains underpowered to detect or rule out an effect. 5 Downgraded by 1 for serious risk of bias: Only one trial adequately described methods to prevent selection bias. 6 No serious indirectness: Trials were conducted in Cameroon and Kenya between 1993 and 1997. One trial gave weekly chloroquine and the others gave IPT as SP. 7 No serious indirectness: The trials were conducted in The Gambia and Kenya between 1984 and 1997. One trial used IPT with SP and one gave pyrimethamine‐dapsone which is no longer in use. 8 No serious indirectness: Both trials were conducted in Kenya and used IPT with SP. 9 Downgraded by 1 for serious risk of bias: Only two of these trials were at low risk of selection bias. 10 No serious indirectness: These trials were conducted in The Gambia, Cameroon, Kenya, Uganda and Mozambique between 1986 and 2005. The majority of trials used IPT with SP. 11 No serious inconsistency: Although statistical heterogeneity was high, all trials favoured chemoprevention but there was variability in the size of the effect. 12 No serious indirectness: These trials were conducted in The Gambia, Cameroon, Kenya, Uganda and Mozambique between 1990 and 2002. The majority of trials used IPT with SP. 13 Downgraded by 1 for serious indirectness: This single trial used a regimen that is no longer in use (proguanil). 14 Downgraded by 1 for serious imprecision: Only a single small trial has evaluated this comparison.