Summary of findings for the main comparison. Primigravidae and secundigravidae.
| Monthly SP during pregnancy compared to two‐doses for HIV +ve women in their first or second pregnancy | ||||||
| Patient or population: HIV‐positive pregnant women living Settings: Malaria endemic areas Intervention: Monthly sulfadoxine‐pyrimethamine (SP) compared to standard 2‐dose SP | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of Participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Standard regimen (2 doses) | Monthly regimen (3 or more doses) | |||||
| Maternal parasitaemia (at delivery) | 22 per 100 | 5 per 100 (3 to 10) | RR 0.25 (0.14 to 0.43) | 463 (2 studies) | ⊕⊕⊝⊝ low1,2 | |
| Placental parasitaemia (at delivery) | 14 per 100 | 5 per 100 (3 to 10) | RR 0.38 (0.21 to 0.7) | 459 (2 studies) | ⊕⊕⊝⊝ low1,2 | |
| Maternal anaemia (Hb < 11 g/dL at delivery) | 66 per 100 | 61 per 100 (47 to 79) | RR 0.93 (0.72 to 1.2) | 447 (2 studies) | ⊕⊕⊝⊝ low1,2 | |
| Low birth weight (< 2.5 kg) | 20 per 100 | 16 per 100 (11 to 25) | RR 0.8 (0.52 to 1.23) | 469 (2 studies) | ⊕⊝⊝⊝ low1,2 | |
| Neonatal mortality | 8 per 100 | 2 per 100 (1 to 8) | RR 0.29 (0.08 to 1.05) | 253 (1 study) | ⊕⊝⊝⊝ very low1,3 | |
| *The basis for the assumed risk (eg the median control group risk across studies) 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 under risk of bias: Both studies had a high proportion of missing outcomes which sensitivity analysis indicates could induce clinically relevant bias. 2 Downgraded by 1 for imprecision: Larger trials would be necessary to have full confidence in this result. 3 Downgraded by 2 for imprecision: The number of neonatal deaths was very low, and the single trial underpowered to detect an effect on mortality. In addition, one study which did not separate women into primigravidae, secundigravidae and multigravidae found a trend towards higher neonatal mortality with monthly SP.