Sulfadoxine-Pyrimethamine Dosing and Malaria Parasitemia Among Pregnant Women at Lira Regional Referral Hospital, Northern Uganda: A Cross-Sectional Study

Sulfadoxine-Pyrimethamine Dosing and Malaria Parasitemia Among Pregnant Women at Lira Regional Referral Hospital, Northern Uganda: A Cross-Sectional Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Sulfadoxine-Pyrimethamine Dosing and Malaria Parasitemia Among Pregnant Women at Lira Regional Referral Hospital, Northern Uganda: A Cross-Sectional Study Ronald Ogwang, Deo Benyumiza, Daniel Chans Mwandah, Rebecca Nakaziba, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8133778/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background : Malaria in pregnancy poses severe adverse effects to both the mother and fetus and the newborn. There is limited literature on the effectiveness of sulfadoxine/pyrimethamine as a malaria preventive measure across Africa and Uganda in particular. Our study assessed sulfadoxine/pyrimethamine dosing and malaria parasitemia among pregnant women at Lira regional referral hospital, northern Uganda. Method : A cross-sectional study that involved 326 pregnant women was conducted at Lira Regional Referral. SP dosages were extracted from antenatal cards, maternal venous blood was collected for assessment of parasitemia, and plasma levels of sulfadoxine were assessed. High-performance liquid chromatography with ultraviolet detection was used to quantify sulfadoxine, whereas microscopy was used to detect malaria parasites. The primary outcome was malaria parasitemia. Data was analysed using STATA version 17. SP dosages and parasitemia were reported as a pie chart and table, respectively. Chi-square was used to determine the relationship between the plasma levels of SP and malaria parasitemia levels. Univariate and multivariate logistic analyses were conducted to determine the correlation between factors and parasitemia levels. Results : In this study SP optimal dosage use was at 70% (228/326) pregnant women attending Lira regional referral hospital, northern Uganda. The mean plasma level of sulfadoxine was 12.76 ± 1.55 μg/mL. Parasitemia level was 7.67%. No significant relationship between optimal SP dosage and malaria parasitemia levels (x 2 = 0.0718, p=0.789). There was no statistically significant relationship between all factors and malaria parasitemia at multivariate analysis. Conclusion and Recommendation : This study has found that most participants took optimal SP dosage. An optimal SP dosage was not associated with increased malaria parasitemia, and similarly, plasma levels of SP had no statistically significant relationship with parasitemia. Sulfadoxine/pyrimethamine dosages plasma levels parasitemia pregnant women Figures Figure 1 Figure 2 Introduction Malaria is a life-threatening parasitic disease transmitted to humans through the bites of infected female Anopheles mosquitoes (1). Globally, about 35.4 million pregnancies were reported in 2022, of which 12.7 million (36%) were exposed to malaria infection during pregnancy (2). In Africa, 13.3 million (32%) of an estimated 40 million pregnancies were exposed to malaria infection during pregnancy (3). Malaria in pregnancy in northern Uganda is estimated at 39.7% among pregnant women (4). Malaria in pregnancy leads to severe complications for the mother and her developing fetus. Malaria in pregnancy affects the placental tissue, leading to maternal anemia, abortions, preterm birth, and stillbirth (5). Malaria parasites also attack the placental tissue, which impede fetal growth, resulting in low birth weight, which is later linked to delayed growth and cognitive development in the child (6). Pregnant women are more susceptible to severe malaria due to reduced acquired immunity and other environmental factors, such as high malaria transmission areas, proximity to stagnant water, and preventive inequities (6,7). Sulfadoxine/Pyrimethamine (sp) has been recommended for malaria prophylaxis in pregnant women by the World Health Organization (WHO) in high malaria intensity areas (8). SP is a combination of a sulphonamide plus a dihydrofolate reductase inhibitor that exhibits synergy in its action against malaria parasites and is given as direct observed therapy from the second trimester (9). SP has a bioavailability > 90% with a long half-life and reaches a peak plasma concentration of about 183 µg/mL (sulfadoxine) and 0.55 ng/mL (pyrimethamine) 2–8 hours after oral administration (10). However, due to changes in the genes of dihydropteroate synthase and dihydrofolate reductase, these key enzymes are very crucial in parasite protein synthesis and overall survival, thus there is widespread resistance following use of SP for malaria prophylaxis, which makes the previously suggested 2 doses ineffective in preventing unfavourable outcomes for both foetus and mother (11). Previous literature shows that use of optimal SP doses still offers potential benefits for malaria prevention among pregnant women (12,13). All pregnant women in Uganda, as recommended by Uganda’s Ministry of Health, should be given SP for presumptive treatment of malaria in pregnancy from 14 weeks of gestation, every four weeks, until delivery (14). Reports from Uganda Demographic Health Survey data analysis showed that only 22.3% of the pregnant women received optimal doses (15). Correspondingly, there is a high prevalence of malaria in pregnancy, 39.7% and 4.4% placental malaria, respectively, in northern Uganda (16,17). Therefore, this study assessed sulfadoxine/pyrimethamine dosing and malaria parasitemia among pregnant women at Lira regional referral hospital, northern Uganda. Materials and Methods Study Design and Setting This was a cross-sectional study that employed quantitative methods of data collection and analysis. The study was conducted in the antenatal clinic department of the maternal and child health of Lira regional referral hospital in Lira City, northern Uganda. Lira city is 340km northwest of Kampala, the capital city of Uganda. Study Population The study enrolled pregnant women in the third trimester who had received at least one dose of SP and whose last dose of SP was a month ago. This period was standardized to ensure there were no variations in the time of drug administration. Pregnant women in the third trimester, HIV positive on cotrimoxazole, allergic to SP, or who haven’t received any dose of SP were excluded from this study. Sample Size Estimation The sample size of this study was calculated using the Kish-Leslie formula for calculating sample size in quantitative studies. Which is denoted as follows; Where; n = estimated sample size of malaria-positive pregnant women, Z-score for a 95% confidence interval to 1.96 p = assumed true population prevalence of malaria in pregnancy. A recent study reported a 26.1% prevalence of placental malaria, so P = 26.1% (18). q = the probability of not being infected with malaria during pregnancy, so 1-p = 73.9% e = Absolute error between the estimated and true population prevalence equal to 5% The calculated sample size = 296.38 = 297 malaria-positive pregnant women. 10% of the calculated sample size was added to cater for non-response. Therefore, the study enrolled 326 pregnant women Sampling Technique A consecutive sampling technique was used to enrol participants in this study. The first participant was randomly selected, and subsequent participants were enrolled consecutively. The researcher enrolled 20 participants per day, thus, it took 16 working days to realise the calculated sample size of 326 participants. Data collection materials An interviewer-administered questionnaire was used to obtain information from the study participants. This questionnaire captured data on socio-demographic, medical, obstetric, and drug-related factors. The study also picked blood samples from the study participants using the laboratory reagents and equipment, like a Light microscope (Olympus type) and a refrigerator from the referral hospital, field stain A (methylene blue and Azure II in phosphate buffer), and Field's stain B (Eosin Y in buffer). ,4 millilitres EDTA vacutainers (purple top), tourniquet (medium type), 5ml syringes, blood cryovials, cotton (1000g roll), hand disinfectant (Savlon), courier box(medium), all purchased from Exper Medical Network Limited (Kampala). Methanol, 1 M perchloric acid, acetonitrile, water, Haake Buchler vortex evaporator, diethyl ether, and ethyl acetate, all from the government analytical laboratory. Study procedure The questionnaire data were collected by four trained research assistants with a medical background. The research assistants obtained informed consent from potential study participants before their full participation in our study. A collection of blood samples was done by a laboratory technologist who also performed microscopy for malaria parasites, whereas HPLC analysis was performed at the Government analytical laboratory located in Wandegeya cell, Kampala Capital City, to determine the plasma concentration levels of Sulfadoxine/pyrimethamine. Procedure for blood sample collection, handling, transportation, and storage The whole process was done according to the WHO guidelines (19). The following steps were taken: The EDTA (Ethylenediaminetetraacetic acid) tubes were labelled with the following information: PTIDS, date and time of sample collection, gestation age. The needle was introduced into the vein at 15–30 degrees, while supporting the patient’s arm. The plunger was pulled from the syringe gently, and allowed blood to fill the syringe. The tourniquet was released and the syringe removed. Pressure was applied to the puncture site using cotton wool to stop bleeding. The syringe was pushed into the ETDA and allowed to empty by pressure while allowing blood to flow slowly down into the tube. The participant was allowed two to three minutes to apply pressure to the area, preferably with their arm raised over their head. All tubes were gently inverted 8 to 10 times to allow adequate mixing of the anticoagulant with the blood. The samples were transported in a sample rack to the Lira regional referral hospital satellite laboratory in a courier box. In the laboratory, a drop of blood, about 50 microliters, was picked to make a thick blood smear for microscopy to detect malaria parasitemia. EDTA tubes were spun at 3000rpm for 10 minutes at 20°C to separate plasma. Plasma was pulled off using a sterile pipette into 2ml cryovials. Blood samples in cryovials for HPLC analysis were stored for a week in a refrigerator at 80°C and were shipped in a courier box to Kampala for HPLC analysis at the Government analytical laboratory. Procedure for Microscopy of Malaria Parasites Microscopy for malaria parasites was done according to the guidelines of WHO (20,21), at the LRRH satellite laboratory by qualified laboratory technologists. The following steps were undertaken: The thick film was positioned beneath the 10x objective lens, and the stained blood film was to the left of the label on the microscope stage. The microscope was turned on, and the light was set to the best possible level. A small amount of immersion oil was applied to the thick layer. A uniformly stained area was identified by scanning the blood film. Changed to the 100x oil immersion objective and let the oil come into contact with the lens. Fine adjustment was used to concentrate on the blood film. The slide was moved to the right, field by field, beginning with the field in the upper left corner of the movie. The slide was slid down and then to the other end of the film. The thick film was examined, either vertically or horizontally, field by field, beneath the oil immersion objective. At least 100 fields were read before concluding that no malaria parasites were observed. The presence of malaria parasites was ascertained and recorded. We started at the upper left corner of the smear and searched for a normal field that contained both white cells and parasites. Then commenced counting every parasite or white cell, and clicked the designated key on the tally counter. They proceeded to the next field and repeated the counting process, thereafter tallying all the parasites, white blood cells, and so on. Once we looked at 200 or 500 white cells, the counting was stopped based on how many parasites we found. Then, I counted every white cell and parasite in the final field. Noted the precise counts of white blood cells and parasites. The density of parasites was determined using: Procedure for analysis using High-Performance Liquid Chromatography (HPLC) We used a method described by Virendra et al (22) with minor modifications. At room temperature, the mobile phase, which consisted of methanol, 1M perchloric acid, acetonitrile, and water, was pumped at a flow rate of 1.5 ml/min. Before being used, the mobile phase underwent ultrasonication to filter and degas. Extraction This was done using a mixture of diethyl ether and ethyl acetate in the ratio of 1:2 and a reversed-phase column. The tubes were shaken for 20 min and then centrifuged at 1000g for 10 min to separate the phases. Using the Haake Buchler vortex evaporator, the organic phase was transferred to a clean glass tube and evaporated to dryness at 60°C. The residue was dissolved in the mobile phase, and part of this solution was injected into the HPLC. Calibration After analyzing 0.5 mL samples of plasma, calibration curves were prepared, and 0.5–100 mg/mL of the sample was used as the range of standards. Calibration standards were used on each day of analysis. The internal standard used was sulfamethoxazole. Plasma samples were analysed together with quality controls and calibration standards. Sulfadoxine detection was used as a proxy for the use of SP. Recovery and reproducibility Peak height ratios of spiked standards were compared with ratios obtained by direct injection of pure standards to assess the recovery (extraction yield) at various doses of sulfadoxine per millilitre of plasma. To separate the sulfadoxine, different ratios of acetonitrile, methanol, perchloric acid, and water were utilized as the mobile phase. Quality control Questionnaires were pretested before use. All questionnaires that have been completed were validated for correctness and completeness at the end of each day. The study was conducted by qualified research assistants who were registered midwives. Slides were examined by two independent laboratory technologists All research staff were trained in good clinical practice and human subject protection All laboratory equipment was calibrated. The microscope was calibrated using a glass or metal slide with a precisely etched scale, often 1mm (divided into 0.01mm increments) or 25mm with subdivisions. Data management and analysis All data were recorded on structured questionnaires, checked for completeness, double-entered into EPI Data, and cross-checked for discrepancies and cleaned. Data were imported into STATA version 17 for analysis. Descriptive statistics were done, and the analysis output was presented in appropriate tables and a pie chart as frequencies and percentages. Logistic regression was done at a confidence level of 95% and 0.05 regression to determine variables independently associated with optimal sulfadoxine/pyrimethamine dosages. Results 4.0 Sociodemographic characteristics of study participants This study was conducted among 326 participants. The participants' mean age was 27.28 years. The majority of the participants were married/cohabiting (93.25% n = 304), had a primary level of education (46.32%, n = 151), and were unemployed (47.55%, n = 155), and used insecticide-treated mosquito nets (96.0%, n = 313), as shown in Table 1 below. Table 1 Showing sociodemographic characteristics of participants(n = 326). Variable Category Frequency Percentage Age Less than 27 years 161 49.39 27 years and above 165 50.61 Marital Status Single 22 6.7 Married/Cohabiting 304 93.3 Education No formal education 5 1.53 Primary 151 46.32 Secondary 97 29.75 Tertiary 73 22.39 Occupation Employed 59 18.10 Self employed 112 34.36 Unemployed 155 47.55 Other malaria preventive measures Mosquito repellent No 305 93.56 Yes 21 6.44 Insecticide-treated net No 13 3.99 Yes 313 96.1 Indoor residual spraying No 225 69.02 Yes 101 30.98 4.1 Clinical and obstetric characteristics of the participants Of the 326 participants majority were multiparas (64.42%, n = 210), of normal weight (54.29, n = 177), had a history of chronic illnesses (5.83%, n = 19), history of malaria in pregnancy (68.1%, n = 222), never reached eight ANC visits (58.0%, n = 189), never used herbal medicine for malaria treatment (99.69%, n = 325), and not allergic to sulfadoxine/pyrimethamine (96.32%, n = 314) as shown in Table 2 below. Table 2 Showing clinical and obstetric characteristics of the participants (n = 326). Variable Category Frequency(n) Percentage (%) Body Mass Index (BMI) Normal 180 55.20 Overweight 104 31.90 Obesity 40 12.30 Systolic BP Below 140 321 98.47 140 and above 5 1.53 Diastolic BP Below 90 317 97.24 90 and above 9 2.76 Temperature Below 37.5 325 99.69 37.5 and above 1 0.31 Pulse Below 90 188 57.67 90 and above 138 42.33 Medical history No 307 94.17 Yes 19 5.83 History of malaria diagnosis/treatment No 104 31.90 Yes 222 68.10 Herbal medicine use No 325 99.69 Yes 1 0.31 Allergy to SP No 314 96.32 Yes 12 3.68 Gravidity Primigravida 62 19.00 Multigravida 264 81.00 ANC contacts 4 contacts 137 42.00 4.2 SP dosages among pregnant women at ANC of LRRH The mean plasma level of SP was 12.76 ± 1.55 µg/mL. It was found that 30% received suboptimal doses of sulfadoxine/pyrimethamine, whereas 70% received optimal doses. 4.3 Parasitemia among pregnant women attending ANC at LRRH Malaria parasitemia was 7.67% whereas the majority, 92.33% had no parasitemia. 4.4 Relationship between SP dosages and parasitemia There was no statistically significant relationship between SP dosages received and parasitemia levels (x 2 = 0.0718, p = 0.789). Table 3 Showing the relationship between SP dosages and parasitemia (n = 326). Parasitemia level SP dosage Chi square value(x 2 ) p value Suboptimal n (%) Optimal n (%) No parasitemia Parasitemia 92(92.93) 7(7.07) 209(92.07) 18(7.93) 0.0718 0.789 Total 99 227 Key : % = percentage, x 2 = Chi square value 4.5 Bivariate and multivariate analysis of factors associated with parasitemia Bivariate analysis was done to assess the relationship between the independent variables and the dependent variable. Age, SP plasma levels, gravidity, and history of treatment/diagnosis of malaria were significant(p 0.05). Table 4 Showing bivariate and multivariate analysis of factors associated with parasitemia. Variable cOR,95%CI p value aOR,95%CI p value SP dosages Suboptimal Optimal Ref 1.13(0.46–2.80) 0.78 SP plasma levels 1.34(0.99–1.80) 0.06* 1.35(0.94–2.15) 0.07 Antenatal visits 4 contacts Ref 1.09(0.48–2.48) 0.83 Age in years 27 Ref 0.52(0.22–1.22) 0.13* 0.60(0.24–1.48) 0.27 Marital status Single Married/cohabiting Ref 0.49(0.14–1.80) 0.28 Education level No education Primary Secondary Tertiary Ref 0.70(0.26–1.91) 0.78(0.27–2.28) 2.65(0.28–25.53) 0.48 0.65 0.39 Occupation status Employed Self employed Unemployed Ref 0.51(0.14–1.82) 1.16(0.40–3.34) 0.29 0.78 Use of mosquito repellents No Yes Ref 2.14(0.59–7.84) 0.24 Insecticide-treated nets No Yes Ref 0.99(0.12–7.99) 0.99 Indoor residual spraying No Yes Ref 1.05(0.44–2.53) 0.90 History of malaria diagnosis No Yes Ref 1.96(0.71–5.37) 0.19* Ref 1.88(0.67–5.23) 0.22 BMI Normal Overweight Obese Ref 0.99(0.40–2.44) 0.62(0.14–2.86) 0.97 0.54 Chronic illnesses No Yes Ref 1.45(0.32–6.68) 0.63 Gravidity Prime gravida Multigravida Ref 0.46(0.19–1.13) 0.09* Ref 0.54(0.21–1.39) 0.20 Key : Ref = Reference, cOR = Crude odds ratio, *= p value < 0.2, aOR = Adjusted odds ratio, **= p value < 0.05 Discussion This study found that 30% of the mothers took suboptimal doses of sulfadoxine/pyrimethamine. The usage of sulfadoxine/pyrimethamine suboptimal doses could be attributed to the fact that most of the mothers in this study had below four antenatal clinic visits, 58%, and it is during these antenatal visits that mothers are dispensed the sulfadoxine/pyrimethamine tablets for malaria prevention. Our finding is consistent with a previous similar study done in Tanzania, which found that 34.2% of pregnant women took suboptimal doses of sulfadoxine/pyrimethamine (23). The similarities in the two studies can be attributed to the fact that the time of enrolment of the study participants, mothers who were in the third trimester, was the same in both studies. However, the finding from our study is higher than the results from a study conducted in Cameroon, which showed that sulfadoxine/pyrimethamine dosages were suboptimal at 65.3% (24). This could all be explained by the difference in the study setting. Our study found malaria parasitemia level was at 7.67% among pregnant women in the third trimester. Our study finding is lower than the findings reported from neighbouring regional referral hospitals, where prevalence was 39.7% in Gulu Regional Referral Hospital, with a prevalence of 39.7% (25), Kole and Arua Regional Referral Hospital, with a prevalence of 15.3% and 26.1% respectively (26,27). This discrepancy in the findings could be explained by the inclusion of pregnant women in all trimesters in the previous studies, yet our study focused solely on pregnant mothers in the third trimester, where malaria parasitemia results were obtained from our own microscopic analysis rather than the history of malaria in pregnancy. Our study further found no significant association between sulfadoxine/pyrimethamine optimal doses and reduced malaria parasitemia. This finding, however, disagrees with results from a previous similar study done in Cameroon, which found that optimal doses of sulfadoxine/pyrimethamine were significantly associated with reduced malaria infection among women and newborns (28). The difference could be due to increased malaria treatment resistance with sulfadoxine/pyrimethamine in the two-study setting. This implies the need for the Ministry of Health of Uganda to implement strategies aimed at optimal uptake of sulfadoxine/pyrimethamine for malaria prophylaxis among high-risk populations such as pregnant women. Our study found no statistically significant relationship between plasma sulfadoxine/pyrimethamine concentration and malaria parasitemia, and this concurs with findings from a previous similar study in Tanzania, which found there was no significant relationship between peripheral malaria prevalence, and the differences in sulfadoxine plasma concentration at birth were not consistent with placental malaria presence (29). This could be due to prolonged actions of sulfadoxine/pyrimethamine in the blood to clear the malaria parasites. This implies the need to encourage the timely uptake of SP among pregnant mothers to maintain a stable state of SP concentration in the blood. Conclusion and Recommendations This study has found a high 70% optimal SP uptake among pregnant women. Optimal SP dosage uptake was not associated with malaria parasitemia among pregnant women. There were no factors significantly associated with malaria parasitemia among pregnant women in the multivariate logistic regression. The Ministry of Health of Uganda and related stakeholders in maternal and child health should strengthen interventions aimed at optimizing uptake of SP dosages among pregnant women for effective malaria prevention. Study Strengths and Limitations The study used a cross-sectional design with analytical laboratory methods to determine plasma SP levels and screen for malaria in the third trimester. This approach provides the true measures of plasma SP level and malaria parasitemia among the study participants. This study was a facility-based, cross-sectional study conducted at Lira Regional Referral Hospital; thus the findings may not be fully generalizable to all pregnant women in Northern Uganda, particularly those who deliver at home or at other health facilities. Abbreviations LMICs Low-middle-income countries WHO World Health Organization DHO District Health Officer SSA sub-Saharan Africa Declarations Ethical Considerations This research was conducted following the Helsinki Declaration. The protocol was reviewed and approved by the Mbarara University of Science and Technology Research Ethics Committee (MUSTREC-2025-282) and the Uganda National Council of Science and Technology (UNCST). Administrative clearance was obtained from the Town clerks, and Principal Medical Officers of Lira Districts before data collection. All study participants provided written informed consent and were interviewed in private locations of their choice. Participants were assured of their anonymity and informed that their participation was entirely voluntary. Consent for Publication Not applicable Availability of Data Materials The dataset supporting the conclusions of this article is accessible on request from the corresponding author. Authors contributions R.O and D.B. idea conceptualization, proposal development, data analysis, manuscript writing D.C.M and R.N. proposal development, manuscript writing and revision R.A and A.O. data collection, data analysis, manuscript writing J.O.O and A.G.A. proposal development, data analysis, manuscript review Acknowledgement We acknowledge our dear participants “pregnant mothers” who took part in this study. Competing Interest The authors declare that they have no competing interests Funding Research reported in this publication was NOT supported by any internal or external funding body. All the funds used in this study were provided by the research team. Clinical Trial Number: Not applicable References World Health Organization malaria report [Internet]. 2024 [cited 2025 Aug 30]. Malaria. Available from: https://www.who.int/news-room/fact-sheets/detail/malaria World malaria report 2023 [Internet]. [cited 2025 Aug 30]. Available from: https://www.who.int/teams/global-malaria-programme/reports/world-malaria-report-2023 World malaria report 2022 [Internet]. [cited 2025 Aug 30]. Available from: https://www.who.int/teams/global-malaria-programme/reports/world-malaria-report-2022 Oguta S, Serumaga B, Odongo L, Otika D, Ayikoru J, Otim R, et al. Factors associated with malaria in pregnancy among antenatal care mothers at Gulu Regional Referral Hospital in northern Uganda. Malar J [Internet]. 2024 Dec 1 [cited 2025 Aug 30];23(1):346. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC11575075/ Minwuyelet A, Yewhalaw D, Siferih M, Atenafu G. Current update on malaria in pregnancy: a systematic review. Tropical Diseases, Travel Medicine and Vaccines 2025 11:1 [Internet]. 2025 May 22 [cited 2025 Aug 30];11(1):1–23. Available from: https://tdtmvjournal.biomedcentral.com/articles/10.1186/s40794-025-00248-1 Bauserman M, Conroy AL, North K, Patterson J, Bose C, Meshnick S. An Overview of Malaria in Pregnancy. Semin Perinatol [Internet]. 2019 Aug 1 [cited 2025 Aug 30];43(5):282. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC7895297/ Balcha F, Menna T, Lombamo F. Prevalence of asymptomatic malaria and associated factors among pregnant women at Boset District in East Shoa Zone, Oromia Region, Ethiopia: a cross-sectional study. Malar J [Internet]. 2023 Dec 1 [cited 2025 Aug 30];22(1):1–9. Available from: https://malariajournal.biomedcentral.com/articles/10.1186/s12936-023-04460-2 van Eijk AM, Stepniewska K, Khairallah C, Rodriguez E, Ahn J, Gutman JR, et al. The impact of sulfadoxine–pyrimethamine resistance on the effectiveness of intermittent preventive treatment for the prevention of malaria in pregnancy in Africa: an updated systematic review and meta-analysis. Lancet Infect Dis [Internet]. 2025 Jul 14 [cited 2025 Aug 30]; Available from: https://www.sciencedirect.com/science/article/pii/S1473309925002191 Mikomangwa WP, Minzi O, Mutagonda R, Baraka V, Mlugu EM, Aklillu E, et al. Effect of sulfadoxine-pyrimethamine doses for prevention of malaria during pregnancy in hypoendemic area in Tanzania. Malar J [Internet]. 2020 Apr 19 [cited 2025 Aug 30];19(1):160. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC7168863/ De Kock M, Tarning J, Workman L, Nyunt MM, Adam I, Barnes KI, et al. Pharmacokinetics of Sulfadoxine and Pyrimethamine for Intermittent Preventive Treatment of Malaria During Pregnancy and After Delivery. CPT Pharmacometrics Syst Pharmacol [Internet]. 2017 Jul 1 [cited 2025 Aug 30];6(7):430–8. Available from: /doi/pdf/10.1002/psp4.12181 Chaponda EB, Mharakurwa S, Michelo C, Bruce J, Chandramoha D, Matthew Chico R. Sulfadoxine-pyrimethamine parasitological efficacy against Plasmodium falciparum among pregnant women and molecular markers of resistance in Zambia: an observational cohort study. Malar J [Internet]. 2021 Dec 1 [cited 2025 Aug 30];20(1):1–10. Available from: https://malariajournal.biomedcentral.com/articles/10.1186/s12936-021-03596-3 Martin MK, Venantius KB, Patricia N, Bernard K, Keith B, Allen K, et al. Correlates of uptake of optimal doses of sulfadoxine-pyrimethamine for prevention of malaria during pregnancy in East-Central Uganda. Malar J [Internet]. 2020 Apr 15 [cited 2025 Sep 30];19(1):1–14. Available from: https://malariajournal.biomedcentral.com/articles/10.1186/s12936-020-03230-8 Figueroa-Romero A, Pons-Duran C, Gonzalez R. Drugs for Intermittent Preventive Treatment of Malaria in Pregnancy: Current Knowledge and Way Forward. Trop Med Infect Dis [Internet]. 2022 Aug 1 [cited 2025 Sep 30];7(8):152. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC9416188/ Oguta S, Serumaga B, Odongo L, Otika D, Ayikoru J, Otim R, et al. Factors associated with malaria in pregnancy among antenatal care mothers at Gulu Regional Referral Hospital in northern Uganda. Malar J [Internet]. 2024 Dec 1 [cited 2025 Sep 30];23(1):346. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC11575075/ Martin MK, Venantius KB, Patricia N, Bernard K, Keith B, Allen K, et al. Correlates of uptake of optimal doses of sulfadoxine-pyrimethamine for prevention of malaria during pregnancy in East-Central Uganda. Malar J. 2020;19(1):1–14. Oguta S, Serumaga B, Odongo L, Otika D, Ayikoru J, Otim R, et al. Factors associated with malaria in pregnancy among antenatal care mothers at Gulu Regional Referral Hospital in northern Uganda. Malaria Journal [Internet]. 2024 Dec 1 [cited 2025 Sep 30];23(1):1–6. Available from: https://malariajournal.biomedcentral.com/articles/10.1186/s12936-024-05184-7 Epuitai J, Ndeezi G, Nabirye RC, Kabiri L, Mukunya D, Tumuhamye J, et al. Prevalence and factors associated with placental malaria in Lira District, Northern Uganda: a cross-sectional study. Malar J [Internet]. 2024 Dec 1 [cited 2025 Sep 30];23(1). Available from: https://pubmed.ncbi.nlm.nih.gov/39604967/ Mangusho C, Mwebesa E, Izudi J, Aleni M, Dricile R, Ayiasi RM, et al. High prevalence of malaria in pregnancy among women attending antenatal care at a large referral hospital in northwestern Uganda: A cross-sectional study. PLoS One [Internet]. 2023 Apr 1 [cited 2025 Sep 30];18(4):e0283755. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10075480/ et al. Dhingra, N. WHO guidelines on drawing blood : best practices in phlebotomy. World Health Organization. 2010;1–105. WHO. Microscopy Examination of Thick and Thin Blood Films for Identification of Malaria Parasites: Malaria Microscopy Standard Operating Procedure-Mm-Sop-08. World Health Organization. 2016;1–6. WHO. Malaria Parasite Counting. World Health Organization. 2016;1–5. Virendra et al. Sulphadoxine concentrations in plasma, red blood cells and whole blood in healthy and Plasmodium falciparum malaria cases after treatment with Fansidar using high-performance liquid chromatography. J Pharm Biomed Anal. 1994;12(10):1317–23. Mikomangwa WP, Minzi O, Mutagonda R, Baraka V, Mlugu EM, Aklillu E, et al. Effect of sulfadoxine-pyrimethamine doses for prevention of malaria during pregnancy in hypoendemic area in Tanzania. Malar J [Internet]. 2020 Apr 19 [cited 2025 Sep 30];19(1):160. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC7168863/ Anchang-Kimbi JK, Kalaji LN, Mbacham HF, Wepnje GB, Apinjoh TO, Ngole Sumbele IU, et al. Coverage and effectiveness of intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) on adverse pregnancy outcomes in the Mount Cameroon area, South West Cameroon. Malar J. 2020;19(1):1–12. Oguta S, Serumaga B, Odongo L, Otika D, Ayikoru J, Otim R, et al. Factors associated with malaria in pregnancy among antenatal care mothers at Gulu Regional Referral Hospital in northern Uganda. Malaria Journal . 2024;23(1). Ssekitooleko J, Mubiru D, Rufus TF, Nyakakye C, Mansen DK. Malaria Prevalence and Associated Factors among Pregnant Women Attending their First Antenatal Care in Kole and Kyenjojo Districts in Uganda. Texila International Journal of Public Health. 2021;9(4):1–11. Mangusho C, Mwebesa E, Izudi J, Aleni M, Dricile R, Ayiasi RM, et al. High prevalence of malaria in pregnancy among women attending antenatal care at a large referral hospital in northwestern Uganda: A cross-sectional study. PLoS One. 2023;18(4 April):1–16. Eboumbou Moukoko CE, Kojom Foko LP, Ayina A, Tornyigah B, Epote AR, Penda IC, et al. Effectiveness of Intermittent Preventive Treatment with Sulfadoxine-Pyrimethamine in Pregnancy: Low Coverage and High Prevalence of Plasmodium falciparum dhfr-dhps Quintuple Mutants as Major Challenges in Douala, an Urban Setting in Cameroon. Pathogens. 2023;12(6). Mikomangwa WP, Minzi O, Mutagonda R, Baraka V, Mlugu EM, Aklillu E, et al. Effect of sulfadoxine-pyrimethamine doses for prevention of malaria during pregnancy in hypoendemic area in Tanzania. Malar J. 2020;19(1):1–11. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8133778","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":546185777,"identity":"44fd9180-e6e8-48f4-9ede-4b87ca2fd571","order_by":0,"name":"Ronald Ogwang","email":"","orcid":"","institution":"Mbarara University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Ronald","middleName":"","lastName":"Ogwang","suffix":""},{"id":546185778,"identity":"4e39a001-95ef-42e5-a13d-ba28566d0d79","order_by":1,"name":"Deo Benyumiza","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA70lEQVRIiWNgGAWjYBACAwglAcQJDAwfgBQbOylaGGeAtDATp4UBrIWZB0QT0mLO3ntMmjfHwp6/PfngY5tf2+T5mBkYP3zMwa3FsudcmjTvNglmiTPPko1z+24btjEzMEvO3IbHYTdyzEBa2BhAjNye24xALWzMvPi03H8D1sIjfyP/m7Rlz217wlpu8IC1SACtY5Nm+HE7kaAWy54cY8u52yQMDM88Mzbsbbid3MbM2IzXL+bsZwxvvN1WZy93PPnhgx9/btvOb28++OEjHi1AwCIBZzK2gckGvOqBgPkDgv2HkOJRMApGwSgYiQAAtTpLFov88x4AAAAASUVORK5CYII=","orcid":"","institution":"Mbarara University of Science and Technology","correspondingAuthor":true,"prefix":"","firstName":"Deo","middleName":"","lastName":"Benyumiza","suffix":""},{"id":546185779,"identity":"970a462c-393c-4816-af39-368c20be0816","order_by":2,"name":"Daniel Chans Mwandah","email":"","orcid":"","institution":"Mbarara University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Daniel","middleName":"Chans","lastName":"Mwandah","suffix":""},{"id":546185780,"identity":"836631bc-0509-4a6f-b85f-3e81a8ea057d","order_by":3,"name":"Rebecca Nakaziba","email":"","orcid":"","institution":"Lira University","correspondingAuthor":false,"prefix":"","firstName":"Rebecca","middleName":"","lastName":"Nakaziba","suffix":""},{"id":546185781,"identity":"bdf50199-dbfc-4f8d-b275-e4c7d4f3fdca","order_by":4,"name":"Rebecca Awili","email":"","orcid":"","institution":"Lira University","correspondingAuthor":false,"prefix":"","firstName":"Rebecca","middleName":"","lastName":"Awili","suffix":""},{"id":546185782,"identity":"b3be5e9e-a6f7-48ee-ac8f-4d61f390650a","order_by":5,"name":"Abel Obeny","email":"","orcid":"","institution":"Lira University","correspondingAuthor":false,"prefix":"","firstName":"Abel","middleName":"","lastName":"Obeny","suffix":""},{"id":546185783,"identity":"9f78929b-23d3-46fc-bfa8-a893259ee7e6","order_by":6,"name":"Jimmy Odongo Ogwal","email":"","orcid":"","institution":"Lira University","correspondingAuthor":false,"prefix":"","firstName":"Jimmy","middleName":"Odongo","lastName":"Ogwal","suffix":""},{"id":546185784,"identity":"7c15223c-062c-4b18-90b2-b3172cb4664e","order_by":7,"name":"Amon Ganafa Agaba","email":"","orcid":"","institution":"Mbarara University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Amon","middleName":"Ganafa","lastName":"Agaba","suffix":""}],"badges":[],"createdAt":"2025-11-17 10:08:11","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8133778/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8133778/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":96250207,"identity":"e8cd50f4-1c3b-4cbe-923e-6ccfa0546158","added_by":"auto","created_at":"2025-11-19 07:37:44","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":205612,"visible":true,"origin":"","legend":"","description":"","filename":"RonaldOgwangManuscript.docx","url":"https://assets-eu.researchsquare.com/files/rs-8133778/v1/9c27ff9196be9ced99389ba0.docx"},{"id":96162572,"identity":"925d2160-a66c-4d42-aee7-7c1ff61bcc60","added_by":"auto","created_at":"2025-11-18 09:00:23","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":9610,"visible":true,"origin":"","legend":"","description":"","filename":"2435cd67a0914cf7b66f4a416b62cc99.json","url":"https://assets-eu.researchsquare.com/files/rs-8133778/v1/87642d1429adccf49740539e.json"},{"id":96162575,"identity":"1cf21692-2c28-4f9f-9f57-699706d4c247","added_by":"auto","created_at":"2025-11-18 09:00:23","extension":"xml","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":87119,"visible":true,"origin":"","legend":"","description":"","filename":"2435cd67a0914cf7b66f4a416b62cc991enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-8133778/v1/54a7b66bacec1b0d72178c69.xml"},{"id":96162577,"identity":"f8024de3-5074-45bb-bc61-cf9a5e4bd8f5","added_by":"auto","created_at":"2025-11-18 09:00:23","extension":"jpeg","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":12403,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8133778/v1/2577afd3bb94c183dbd6746d.jpeg"},{"id":96162571,"identity":"23e59de0-5dcf-4d0e-bc29-aebf1a11443a","added_by":"auto","created_at":"2025-11-18 09:00:23","extension":"jpeg","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":66521,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8133778/v1/58623e9db18a68e3b374a641.jpeg"},{"id":96252024,"identity":"b5d7cf34-b255-45db-be6f-1b91a40c2e29","added_by":"auto","created_at":"2025-11-19 07:40:20","extension":"png","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":3268,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8133778/v1/9b3d93d7084832cd5a9477e1.png"},{"id":96162574,"identity":"3174012f-74ea-44cb-9255-f65549f1b2c4","added_by":"auto","created_at":"2025-11-18 09:00:23","extension":"png","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":12850,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-8133778/v1/7be92d3b623a2c88c4560827.png"},{"id":96162579,"identity":"32d8d846-6d2b-437b-9f27-59e9474ca205","added_by":"auto","created_at":"2025-11-18 09:00:23","extension":"xml","order_by":9,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":81477,"visible":true,"origin":"","legend":"","description":"","filename":"2435cd67a0914cf7b66f4a416b62cc991structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-8133778/v1/1910f6b9b0c257baa00a1ac6.xml"},{"id":96251232,"identity":"b228f850-7d15-4583-a8e6-f0964f853186","added_by":"auto","created_at":"2025-11-19 07:39:32","extension":"html","order_by":10,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":93918,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8133778/v1/849ccb84fd085d55b0bc78e7.html"},{"id":96162566,"identity":"9ffbff55-3fb1-41c1-b1d9-3e9e348198a8","added_by":"auto","created_at":"2025-11-18 09:00:23","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":27543,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 3: Showing sulfadoxine/pyrimethamine dosages received by pregnant women attending ANC at LRRH (n=326).\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-8133778/v1/5fa1a5725aea4a3be3379ad2.png"},{"id":96162570,"identity":"5cdee355-3bc1-4116-8e45-271cd780b03c","added_by":"auto","created_at":"2025-11-18 09:00:23","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":19677,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 4: Showing parasitemia among pregnant women attending ANC at LRRH\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-8133778/v1/f314119572915ddc19b95b59.png"},{"id":101760609,"identity":"a7c22d65-15a4-4bb7-b505-d329d3a9dcae","added_by":"auto","created_at":"2026-02-03 11:15:49","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1227655,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8133778/v1/04af0264-d293-40fb-a258-d8d1ef0c1805.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Sulfadoxine-Pyrimethamine Dosing and Malaria Parasitemia Among Pregnant Women at Lira Regional Referral Hospital, Northern Uganda: A Cross-Sectional Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eMalaria is a life-threatening parasitic disease transmitted to humans through the bites of infected female Anopheles mosquitoes (1). Globally, about 35.4\u0026nbsp;million pregnancies were reported in 2022, of which 12.7\u0026nbsp;million (36%) were exposed to malaria infection during pregnancy (2). In Africa, 13.3\u0026nbsp;million (32%) of an estimated 40\u0026nbsp;million pregnancies were exposed to malaria infection during pregnancy (3). Malaria in pregnancy in northern Uganda is estimated at 39.7% among pregnant women (4).\u003c/p\u003e\u003cp\u003eMalaria in pregnancy leads to severe complications for the mother and her developing fetus. Malaria in pregnancy affects the placental tissue, leading to maternal anemia, abortions, preterm birth, and stillbirth (5). Malaria parasites also attack the placental tissue, which impede fetal growth, resulting in low birth weight, which is later linked to delayed growth and cognitive development in the child (6). Pregnant women are more susceptible to severe malaria due to reduced acquired immunity and other environmental factors, such as high malaria transmission areas, proximity to stagnant water, and preventive inequities (6,7).\u003c/p\u003e\u003cp\u003eSulfadoxine/Pyrimethamine (sp) has been recommended for malaria prophylaxis in pregnant women by the World Health Organization (WHO) in high malaria intensity areas (8). SP is a combination of a sulphonamide plus a dihydrofolate reductase inhibitor that exhibits synergy in its action against malaria parasites and is given as direct observed therapy from the second trimester (9). SP has a bioavailability\u0026thinsp;\u0026gt;\u0026thinsp;90% with a long half-life and reaches a peak plasma concentration of about 183 \u0026micro;g/mL (sulfadoxine) and 0.55 ng/mL (pyrimethamine) 2\u0026ndash;8 hours after oral administration (10). However, due to changes in the genes of dihydropteroate synthase and dihydrofolate reductase, these key enzymes are very crucial in parasite protein synthesis and overall survival, thus there is widespread resistance following use of SP for malaria prophylaxis, which makes the previously suggested 2 doses ineffective in preventing unfavourable outcomes for both foetus and mother (11).\u003c/p\u003e\u003cp\u003ePrevious literature shows that use of optimal SP doses still offers potential benefits for malaria prevention among pregnant women (12,13). All pregnant women in Uganda, as recommended by Uganda\u0026rsquo;s Ministry of Health, should be given SP for presumptive treatment of malaria in pregnancy from 14 weeks of gestation, every four weeks, until delivery (14). Reports from Uganda Demographic Health Survey data analysis showed that only 22.3% of the pregnant women received optimal doses (15). Correspondingly, there is a high prevalence of malaria in pregnancy, 39.7% and 4.4% placental malaria, respectively, in northern Uganda (16,17). Therefore, this study assessed sulfadoxine/pyrimethamine dosing and malaria parasitemia among pregnant women at Lira regional referral hospital, northern Uganda.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy Design and Setting\u003c/h2\u003e\u003cp\u003eThis was a cross-sectional study that employed quantitative methods of data collection and analysis. The study was conducted in the antenatal clinic department of the maternal and child health of Lira regional referral hospital in Lira City, northern Uganda. Lira city is 340km northwest of Kampala, the capital city of Uganda.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eStudy Population\u003c/h3\u003e\n\u003cp\u003eThe study enrolled pregnant women in the third trimester who had received at least one dose of SP and whose last dose of SP was a month ago. This period was standardized to ensure there were no variations in the time of drug administration. Pregnant women in the third trimester, HIV positive on cotrimoxazole, allergic to SP, or who haven\u0026rsquo;t received any dose of SP were excluded from this study.\u003c/p\u003e\n\u003ch3\u003eSample Size Estimation\u003c/h3\u003e\n\u003cp\u003eThe sample size of this study was calculated using the Kish-Leslie formula for calculating sample size in quantitative studies. Which is denoted as follows;\u003c/p\u003e\u003cp\u003e\u003cimg src=\"data:image/png;base64,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\" style=\"width: 104px; height: 54.8661px;\" width=\"104\" height=\"54.8661\"\u003e\u003c/p\u003e\u003cp\u003eWhere;\u003c/p\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;estimated sample size of malaria-positive pregnant women,\u003c/p\u003e\u003cp\u003eZ-score for a 95% confidence interval to 1.96\u003c/p\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;assumed true population prevalence of malaria in pregnancy. A recent study reported a 26.1% prevalence of placental malaria, so P\u0026thinsp;=\u0026thinsp;26.1% (18).\u003c/p\u003e\u003cp\u003eq\u0026thinsp;=\u0026thinsp;the probability of not being infected with malaria during pregnancy, so 1-p\u0026thinsp;=\u0026thinsp;73.9%\u003c/p\u003e\u003cp\u003ee\u0026thinsp;=\u0026thinsp;Absolute error between the estimated and true population prevalence equal to 5%\u003c/p\u003e\u003cp\u003eThe calculated sample size\u0026thinsp;=\u0026thinsp;296.38\u0026thinsp;=\u0026thinsp;297 malaria-positive pregnant women. 10% of the calculated sample size was added to cater for non-response.\u003c/p\u003e\u003cp\u003eTherefore, the study enrolled 326 pregnant women\u003c/p\u003e\n\u003ch3\u003eSampling Technique\u003c/h3\u003e\n\u003cp\u003eA consecutive sampling technique was used to enrol participants in this study. The first participant was randomly selected, and subsequent participants were enrolled consecutively. The researcher enrolled 20 participants per day, thus, it took 16 working days to realise the calculated sample size of 326 participants.\u003c/p\u003e\n\u003ch3\u003eData collection materials\u003c/h3\u003e\n\u003cp\u003eAn interviewer-administered questionnaire was used to obtain information from the study participants. This questionnaire captured data on socio-demographic, medical, obstetric, and drug-related factors. The study also picked blood samples from the study participants using the laboratory reagents and equipment, like a Light microscope (Olympus type) and a refrigerator from the referral hospital, field stain A (methylene blue and Azure II in phosphate buffer), and Field's stain B (Eosin Y in buffer). ,4 millilitres EDTA vacutainers (purple top), tourniquet (medium type), 5ml syringes, blood cryovials, cotton (1000g roll), hand disinfectant (Savlon), courier box(medium), all purchased from Exper Medical Network Limited (Kampala). Methanol, 1 M perchloric acid, acetonitrile, water, Haake Buchler vortex evaporator, diethyl ether, and ethyl acetate, all from the government analytical laboratory.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eStudy procedure\u003c/h2\u003e\u003cp\u003eThe questionnaire data were collected by four trained research assistants with a medical background. The research assistants obtained informed consent from potential study participants before their full participation in our study. A collection of blood samples was done by a laboratory technologist who also performed microscopy for malaria parasites, whereas HPLC analysis was performed at the Government analytical laboratory located in Wandegeya cell, Kampala Capital City, to determine the plasma concentration levels of Sulfadoxine/pyrimethamine.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eProcedure for blood sample collection, handling, transportation, and storage\u003c/h3\u003e\n\u003cp\u003e The whole process was done according to the WHO guidelines (19). The following steps were taken: The EDTA (Ethylenediaminetetraacetic acid) tubes were labelled with the following information: PTIDS, date and time of sample collection, gestation age. The needle was introduced into the vein at 15\u0026ndash;30 degrees, while supporting the patient\u0026rsquo;s arm. The plunger was pulled from the syringe gently, and allowed blood to fill the syringe. The tourniquet was released and the syringe removed. Pressure was applied to the puncture site using cotton wool to stop bleeding. The syringe was pushed into the ETDA and allowed to empty by pressure while allowing blood to flow slowly down into the tube. The participant was allowed two to three minutes to apply pressure to the area, preferably with their arm raised over their head. All tubes were gently inverted 8 to 10 times to allow adequate mixing of the anticoagulant with the blood. The samples were transported in a sample rack to the Lira regional referral hospital satellite laboratory in a courier box. In the laboratory, a drop of blood, about 50 microliters, was picked to make a thick blood smear for microscopy to detect malaria parasitemia. EDTA tubes were spun at 3000rpm for 10 minutes at 20\u0026deg;C to separate plasma. Plasma was pulled off using a sterile pipette into 2ml cryovials. Blood samples in cryovials for HPLC analysis were stored for a week in a refrigerator at 80\u0026deg;C and were shipped in a courier box to Kampala for HPLC analysis at the Government analytical laboratory.\u003c/p\u003e\n\u003ch3\u003eProcedure for Microscopy of Malaria Parasites\u003c/h3\u003e\n\u003cp\u003e Microscopy for malaria parasites was done according to the guidelines of WHO (20,21), at the LRRH satellite laboratory by qualified laboratory technologists. The following steps were undertaken: The thick film was positioned beneath the 10x objective lens, and the stained blood film was to the left of the label on the microscope stage. The microscope was turned on, and the light was set to the best possible level. A small amount of immersion oil was applied to the thick layer. A uniformly stained area was identified by scanning the blood film. Changed to the 100x oil immersion objective and let the oil come into contact with the lens. Fine adjustment was used to concentrate on the blood film. The slide was moved to the right, field by field, beginning with the field in the upper left corner of the movie. The slide was slid down and then to the other end of the film. The thick film was examined, either vertically or horizontally, field by field, beneath the oil immersion objective. At least 100 fields were read before concluding that no malaria parasites were observed. The presence of malaria parasites was ascertained and recorded. We started at the upper left corner of the smear and searched for a normal field that contained both white cells and parasites. Then commenced counting every parasite or white cell, and clicked the designated key on the tally counter. They proceeded to the next field and repeated the counting process, thereafter tallying all the parasites, white blood cells, and so on. Once we looked at 200 or 500 white cells, the counting was stopped based on how many parasites we found. Then, I counted every white cell and parasite in the final field. Noted the precise counts of white blood cells and parasites. The density of parasites was determined using:\u003c/p\u003e\n\u003cp\u003e\u003cimg src=\"data:image/png;base64,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\" style=\"width: 464px; height: 71.619px;\" width=\"464\" height=\"71.619\"\u003e\u003c/p\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eProcedure for analysis using High-Performance Liquid Chromatography (HPLC)\u003c/h2\u003e\u003cp\u003eWe used a method described by Virendra et al (22) with minor modifications.\u003c/p\u003e\u003cp\u003eAt room temperature, the mobile phase, which consisted of methanol, 1M perchloric acid, acetonitrile, and water, was pumped at a flow rate of 1.5 ml/min.\u003c/p\u003e\u003cp\u003eBefore being used, the mobile phase underwent ultrasonication to filter and degas.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eExtraction\u003c/h2\u003e\u003cp\u003eThis was done using a mixture of diethyl ether and ethyl acetate in the ratio of 1:2 and a reversed-phase column. The tubes were shaken for 20 min and then centrifuged at 1000g for 10 min to separate the phases. Using the Haake Buchler vortex evaporator, the organic phase was transferred to a clean glass tube and evaporated to dryness at 60\u0026deg;C. The residue was dissolved in the mobile phase, and part of this solution was injected into the HPLC.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eCalibration\u003c/h2\u003e\u003cp\u003eAfter analyzing 0.5 mL samples of plasma, calibration curves were prepared, and 0.5\u0026ndash;100 mg/mL of the sample was used as the range of standards. Calibration standards were used on each day of analysis. The internal standard used was sulfamethoxazole. Plasma samples were analysed together with quality controls and calibration standards. Sulfadoxine detection was used as a proxy for the use of SP.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eRecovery and reproducibility\u003c/h2\u003e\u003cp\u003ePeak height ratios of spiked standards were compared with ratios obtained by direct injection of pure standards to assess the recovery (extraction yield) at various doses of sulfadoxine per millilitre of plasma. To separate the sulfadoxine, different ratios of acetonitrile, methanol, perchloric acid, and water were utilized as the mobile phase.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eQuality control\u003c/h2\u003e\u003cp\u003eQuestionnaires were pretested before use.\u003c/p\u003e\u003cp\u003eAll questionnaires that have been completed were validated for correctness and completeness at the end of each day.\u003c/p\u003e\u003cp\u003eThe study was conducted by qualified research assistants who were registered midwives.\u003c/p\u003e\u003cp\u003eSlides were examined by two independent laboratory technologists\u003c/p\u003e\u003cp\u003eAll research staff were trained in good clinical practice and human subject protection\u003c/p\u003e\u003cp\u003eAll laboratory equipment was calibrated. The microscope was calibrated using a glass or metal slide with a precisely etched scale, often 1mm (divided into 0.01mm increments) or 25mm with subdivisions.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eData management and analysis\u003c/h2\u003e\u003cp\u003eAll data were recorded on structured questionnaires, checked for completeness, double-entered into EPI Data, and cross-checked for discrepancies and cleaned. Data were imported into STATA version 17 for analysis. Descriptive statistics were done, and the analysis output was presented in appropriate tables and a pie chart as frequencies and percentages. Logistic regression was done at a confidence level of 95% and 0.05 regression to determine variables independently associated with optimal sulfadoxine/pyrimethamine dosages.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cb\u003e4.0 Sociodemographic characteristics of study participants\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis study was conducted among 326 participants. The participants' mean age was 27.28 years. The majority of the participants were married/cohabiting (93.25% n\u0026thinsp;=\u0026thinsp;304), had a primary level of education (46.32%, n\u0026thinsp;=\u0026thinsp;151), and were unemployed (47.55%, n\u0026thinsp;=\u0026thinsp;155), and used insecticide-treated mosquito nets (96.0%, n\u0026thinsp;=\u0026thinsp;313), as shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e below.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eShowing sociodemographic characteristics of participants(n\u0026thinsp;=\u0026thinsp;326).\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCategory\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFrequency\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePercentage\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLess than 27 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e161\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e49.39\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e27 years and above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e165\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e50.61\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarital Status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSingle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMarried/Cohabiting\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e304\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e93.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEducation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo formal education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.53\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePrimary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e151\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e46.32\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSecondary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e29.75\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTertiary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e22.39\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOccupation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEmployed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e18.10\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSelf employed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e112\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e34.36\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUnemployed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e155\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e47.55\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther malaria preventive measures\u003c/p\u003e\u003cp\u003eMosquito repellent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e305\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e93.56\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6.44\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInsecticide-treated net\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3.99\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e313\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e96.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIndoor residual spraying\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e225\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e69.02\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e101\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e30.98\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e4.1 Clinical and obstetric characteristics of the participants\u003c/b\u003e\u003c/p\u003e\u003cp\u003eOf the 326 participants majority were multiparas (64.42%, n\u0026thinsp;=\u0026thinsp;210), of normal weight (54.29, n\u0026thinsp;=\u0026thinsp;177), had a history of chronic illnesses (5.83%, n\u0026thinsp;=\u0026thinsp;19), history of malaria in pregnancy (68.1%, n\u0026thinsp;=\u0026thinsp;222), never reached eight ANC visits (58.0%, n\u0026thinsp;=\u0026thinsp;189), never used herbal medicine for malaria treatment (99.69%, n\u0026thinsp;=\u0026thinsp;325), and not allergic to sulfadoxine/pyrimethamine (96.32%, n\u0026thinsp;=\u0026thinsp;314) as shown in Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e below.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eShowing clinical and obstetric characteristics of the participants (n\u0026thinsp;=\u0026thinsp;326).\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCategory\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFrequency(n)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePercentage (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBody Mass Index (BMI)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNormal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e180\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e55.20\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOverweight\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e104\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e31.90\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eObesity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e12.30\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSystolic BP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBelow 140\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e321\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e98.47\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e140 and above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.53\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDiastolic BP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBelow 90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e317\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e97.24\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e90 and above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.76\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTemperature\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBelow 37.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e325\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e99.69\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e37.5 and above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.31\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePulse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBelow 90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e188\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e57.67\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e90 and above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e138\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e42.33\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMedical history\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e307\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e94.17\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e5.83\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHistory of malaria diagnosis/treatment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e104\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e31.90\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e222\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e68.10\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHerbal medicine use\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e325\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e99.69\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.31\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAllergy to SP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e314\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e96.32\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3.68\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGravidity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePrimigravida\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e19.00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMultigravida\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e264\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e81.00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eANC contacts\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;4 contacts\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e189\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e58.00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;4 contacts\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e137\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e42.00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e4.2 SP dosages among pregnant women at ANC of LRRH\u003c/p\u003e\u003cp\u003eThe mean plasma level of SP was 12.76\u0026thinsp;\u0026plusmn;\u0026thinsp;1.55 \u0026micro;g/mL. It was found that 30% received suboptimal doses of sulfadoxine/pyrimethamine, whereas 70% received optimal doses.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e4.3 Parasitemia among pregnant women attending ANC at LRRH\u003c/p\u003e\u003cp\u003eMalaria parasitemia was 7.67% whereas the majority, 92.33% had no parasitemia.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e4.4 Relationship between SP dosages and parasitemia\u003c/p\u003e\u003cp\u003eThere was no statistically significant relationship between SP dosages received and parasitemia levels (x\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u0026thinsp;\u003cb\u003e=\u003c/b\u003e\u0026thinsp;0.0718, p\u0026thinsp;=\u0026thinsp;0.789).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eShowing the relationship between SP dosages and parasitemia (n\u0026thinsp;=\u0026thinsp;326).\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eParasitemia level\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eSP dosage\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eChi square value(x\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003ep value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSuboptimal\u003c/p\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eOptimal\u003c/p\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo parasitemia\u003c/p\u003e\u003cp\u003eParasitemia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e92(92.93)\u003c/p\u003e\u003cp\u003e7(7.07)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e209(92.07)\u003c/p\u003e\u003cp\u003e18(7.93)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.0718\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.789\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e227\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cb\u003eKey\u003c/b\u003e: % = percentage, x\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;Chi square value\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e4.5 Bivariate and multivariate analysis of factors associated with parasitemia\u003c/p\u003e\u003cp\u003eBivariate analysis was done to assess the relationship between the independent variables and the dependent variable. Age, SP plasma levels, gravidity, and history of treatment/diagnosis of malaria were significant(p\u0026thinsp;\u0026lt;\u0026thinsp;0.2), and at multivariate analysis, all were statistically insignificant(p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eShowing bivariate and multivariate analysis of factors associated with parasitemia.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ecOR,95%CI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ep value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eaOR,95%CI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSP dosages\u003c/p\u003e\u003cp\u003eSuboptimal\u003c/p\u003e\u003cp\u003eOptimal\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003cp\u003e1.13(0.46\u0026ndash;2.80)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.78\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSP plasma levels\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.34(0.99\u0026ndash;1.80)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.06*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.35(0.94\u0026ndash;2.15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.07\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAntenatal visits\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u0026lt;\u0026thinsp;4 contacts\u003c/p\u003e\u003cp\u003e\u0026gt;\u0026thinsp;4 contacts\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003cp\u003e1.09(0.48\u0026ndash;2.48)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge in years\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u0026lt;\u0026thinsp;27\u003c/p\u003e\u003cp\u003e\u0026gt;\u0026thinsp;27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003cp\u003e0.52(0.22\u0026ndash;1.22)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.13*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.60(0.24\u0026ndash;1.48)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.27\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMarital status\u003c/b\u003e\u003c/p\u003e\u003cp\u003eSingle\u003c/p\u003e\u003cp\u003eMarried/cohabiting\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003cp\u003e0.49(0.14\u0026ndash;1.80)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEducation level\u003c/b\u003e\u003c/p\u003e\u003cp\u003eNo education\u003c/p\u003e\u003cp\u003ePrimary\u003c/p\u003e\u003cp\u003eSecondary\u003c/p\u003e\u003cp\u003eTertiary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003cp\u003e0.70(0.26\u0026ndash;1.91)\u003c/p\u003e\u003cp\u003e0.78(0.27\u0026ndash;2.28)\u003c/p\u003e\u003cp\u003e2.65(0.28\u0026ndash;25.53)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.48\u003c/p\u003e\u003cp\u003e0.65\u003c/p\u003e\u003cp\u003e0.39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eOccupation status\u003c/b\u003e\u003c/p\u003e\u003cp\u003eEmployed\u003c/p\u003e\u003cp\u003eSelf employed\u003c/p\u003e\u003cp\u003eUnemployed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003cp\u003e0.51(0.14\u0026ndash;1.82)\u003c/p\u003e\u003cp\u003e1.16(0.40\u0026ndash;3.34)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.29\u003c/p\u003e\u003cp\u003e0.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eUse of mosquito repellents\u003c/b\u003e\u003c/p\u003e\u003cp\u003eNo\u003c/p\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003cp\u003e2.14(0.59\u0026ndash;7.84)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eInsecticide-treated nets\u003c/b\u003e\u003c/p\u003e\u003cp\u003eNo\u003c/p\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003cp\u003e0.99(0.12\u0026ndash;7.99)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eIndoor residual spraying\u003c/b\u003e\u003c/p\u003e\u003cp\u003eNo\u003c/p\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003cp\u003e1.05(0.44\u0026ndash;2.53)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHistory of malaria diagnosis\u003c/b\u003e\u003c/p\u003e\u003cp\u003eNo\u003c/p\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003cp\u003e1.96(0.71\u0026ndash;5.37)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.19*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003cp\u003e1.88(0.67\u0026ndash;5.23)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.22\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBMI\u003c/b\u003e\u003c/p\u003e\u003cp\u003eNormal\u003c/p\u003e\u003cp\u003eOverweight\u003c/p\u003e\u003cp\u003eObese\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003cp\u003e0.99(0.40\u0026ndash;2.44)\u003c/p\u003e\u003cp\u003e0.62(0.14\u0026ndash;2.86)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.97\u003c/p\u003e\u003cp\u003e0.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eChronic illnesses\u003c/b\u003e\u003c/p\u003e\u003cp\u003eNo\u003c/p\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003cp\u003e1.45(0.32\u0026ndash;6.68)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGravidity\u003c/b\u003e\u003c/p\u003e\u003cp\u003ePrime gravida\u003c/p\u003e\u003cp\u003eMultigravida\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003cp\u003e0.46(0.19\u0026ndash;1.13)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.09*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003cp\u003e0.54(0.21\u0026ndash;1.39)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.20\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cb\u003eKey\u003c/b\u003e: \u003cem\u003eRef\u0026thinsp;=\u0026thinsp;Reference, cOR\u0026thinsp;=\u0026thinsp;Crude odds ratio, *= p value\u0026thinsp;\u0026lt;\u0026thinsp;0.2, aOR\u0026thinsp;=\u0026thinsp;Adjusted odds ratio, **= p value\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study found that 30% of the mothers took suboptimal doses of sulfadoxine/pyrimethamine. The usage of sulfadoxine/pyrimethamine suboptimal doses could be attributed to the fact that most of the mothers in this study had below four antenatal clinic visits, 58%, and it is during these antenatal visits that mothers are dispensed the sulfadoxine/pyrimethamine tablets for malaria prevention. Our finding is consistent with a previous similar study done in Tanzania, which found that 34.2% of pregnant women took suboptimal doses of sulfadoxine/pyrimethamine (23). The similarities in the two studies can be attributed to the fact that the time of enrolment of the study participants, mothers who were in the third trimester, was the same in both studies. However, the finding from our study is higher than the results from a study conducted in Cameroon, which showed that sulfadoxine/pyrimethamine dosages were suboptimal at 65.3% (24). This could all be explained by the difference in the study setting.\u003c/p\u003e\u003cp\u003eOur study found malaria parasitemia level was at 7.67% among pregnant women in the third trimester. Our study finding is lower than the findings reported from neighbouring regional referral hospitals, where prevalence was 39.7% in Gulu Regional Referral Hospital, with a prevalence of 39.7% (25), Kole and Arua Regional Referral Hospital, with a prevalence of 15.3% and 26.1% respectively (26,27). This discrepancy in the findings could be explained by the inclusion of pregnant women in all trimesters in the previous studies, yet our study focused solely on pregnant mothers in the third trimester, where malaria parasitemia results were obtained from our own microscopic analysis rather than the history of malaria in pregnancy.\u003c/p\u003e\u003cp\u003eOur study further found no significant association between sulfadoxine/pyrimethamine optimal doses and reduced malaria parasitemia. This finding, however, disagrees with results from a previous similar study done in Cameroon, which found that optimal doses of sulfadoxine/pyrimethamine were significantly associated with reduced malaria infection among women and newborns (28). The difference could be due to increased malaria treatment resistance with sulfadoxine/pyrimethamine in the two-study setting. This implies the need for the Ministry of Health of Uganda to implement strategies aimed at optimal uptake of sulfadoxine/pyrimethamine for malaria prophylaxis among high-risk populations such as pregnant women.\u003c/p\u003e\u003cp\u003eOur study found no statistically significant relationship between plasma sulfadoxine/pyrimethamine concentration and malaria parasitemia, and this concurs with findings from a previous similar study in Tanzania, which found there was no significant relationship between peripheral malaria prevalence, and the differences in sulfadoxine plasma concentration at birth were not consistent with placental malaria presence (29). This could be due to prolonged actions of sulfadoxine/pyrimethamine in the blood to clear the malaria parasites. This implies the need to encourage the timely uptake of SP among pregnant mothers to maintain a stable state of SP concentration in the blood.\u003c/p\u003e"},{"header":"Conclusion and Recommendations","content":"\u003cp\u003eThis study has found a high 70% optimal SP uptake among pregnant women. Optimal SP dosage uptake was not associated with malaria parasitemia among pregnant women. There were no factors significantly associated with malaria parasitemia among pregnant women in the multivariate logistic regression. The Ministry of Health of Uganda and related stakeholders in maternal and child health should strengthen interventions aimed at optimizing uptake of SP dosages among pregnant women for effective malaria prevention.\u003c/p\u003e\u003ch2\u003eStudy Strengths and Limitations\u003c/h2\u003e\u003cp\u003eThe study used a cross-sectional design with analytical laboratory methods to determine plasma SP levels and screen for malaria in the third trimester. This approach provides the true measures of plasma SP level and malaria parasitemia among the study participants. This study was a facility-based, cross-sectional study conducted at Lira Regional Referral Hospital; thus the findings may not be fully generalizable to all pregnant women in Northern Uganda, particularly those who deliver at home or at other health facilities.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eLMICs \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Low-middle-income countries\u003c/p\u003e\n\u003cp\u003eWHO \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; World Health Organization\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDHO \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;District Health Officer\u003c/p\u003e\n\u003cp\u003eSSA \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;sub-Saharan Africa\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical Considerations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was conducted following the Helsinki Declaration. The protocol was reviewed and approved by the Mbarara University of Science and Technology Research Ethics Committee (MUSTREC-2025-282) and the Uganda National Council of Science and Technology (UNCST). Administrative clearance was obtained from the Town clerks, and Principal Medical Officers of Lira Districts before data collection. All study participants provided written informed consent and were interviewed in private locations of their choice. Participants were assured of their anonymity and informed that their participation was entirely voluntary.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data Materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe dataset supporting the conclusions of this article is accessible on request from the corresponding author.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eR.O and D.B. idea conceptualization, proposal development, data analysis, manuscript writing\u003c/p\u003e\n\u003cp\u003eD.C.M and R.N. \u0026nbsp;proposal development, \u0026nbsp;manuscript writing and revision\u003c/p\u003e\n\u003cp\u003eR.A and A.O. data collection, data analysis, \u0026nbsp;manuscript writing\u003c/p\u003e\n\u003cp\u003eJ.O.O and A.G.A. proposal development, data analysis, manuscript review\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe acknowledge our dear participants “pregnant mothers” who took part in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interest\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eResearch reported in this publication was NOT supported by any internal or external funding body. All the funds used in this study were provided by the research team. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial Number:\u0026nbsp;\u003c/strong\u003eNot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWorld Health Organization malaria report [Internet]. 2024 [cited 2025 Aug 30]. Malaria. Available from: https://www.who.int/news-room/fact-sheets/detail/malaria\u003c/li\u003e\n\u003cli\u003eWorld malaria report 2023 [Internet]. [cited 2025 Aug 30]. Available from: https://www.who.int/teams/global-malaria-programme/reports/world-malaria-report-2023\u003c/li\u003e\n\u003cli\u003eWorld malaria report 2022 [Internet]. [cited 2025 Aug 30]. Available from: https://www.who.int/teams/global-malaria-programme/reports/world-malaria-report-2022\u003c/li\u003e\n\u003cli\u003eOguta S, Serumaga B, Odongo L, Otika D, Ayikoru J, Otim R, et al. Factors associated with malaria in pregnancy among antenatal care mothers at Gulu Regional Referral Hospital in northern Uganda. Malar J [Internet]. 2024 Dec 1 [cited 2025 Aug 30];23(1):346. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC11575075/\u003c/li\u003e\n\u003cli\u003eMinwuyelet A, Yewhalaw D, Siferih M, Atenafu G. Current update on malaria in pregnancy: a systematic review. Tropical Diseases, Travel Medicine and Vaccines 2025 11:1 [Internet]. 2025 May 22 [cited 2025 Aug 30];11(1):1\u0026ndash;23. Available from: https://tdtmvjournal.biomedcentral.com/articles/10.1186/s40794-025-00248-1\u003c/li\u003e\n\u003cli\u003eBauserman M, Conroy AL, North K, Patterson J, Bose C, Meshnick S. An Overview of Malaria in Pregnancy. Semin Perinatol [Internet]. 2019 Aug 1 [cited 2025 Aug 30];43(5):282. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC7895297/\u003c/li\u003e\n\u003cli\u003eBalcha F, Menna T, Lombamo F. Prevalence of asymptomatic malaria and associated factors among pregnant women at Boset District in East Shoa Zone, Oromia Region, Ethiopia: a cross-sectional study. Malar J [Internet]. 2023 Dec 1 [cited 2025 Aug 30];22(1):1\u0026ndash;9. Available from: https://malariajournal.biomedcentral.com/articles/10.1186/s12936-023-04460-2\u003c/li\u003e\n\u003cli\u003evan Eijk AM, Stepniewska K, Khairallah C, Rodriguez E, Ahn J, Gutman JR, et al. The impact of sulfadoxine\u0026ndash;pyrimethamine resistance on the effectiveness of intermittent preventive treatment for the prevention of malaria in pregnancy in Africa: an updated systematic review and meta-analysis. Lancet Infect Dis [Internet]. 2025 Jul 14 [cited 2025 Aug 30]; Available from: https://www.sciencedirect.com/science/article/pii/S1473309925002191\u003c/li\u003e\n\u003cli\u003eMikomangwa WP, Minzi O, Mutagonda R, Baraka V, Mlugu EM, Aklillu E, et al. Effect of sulfadoxine-pyrimethamine doses for prevention of malaria during pregnancy in hypoendemic area in Tanzania. Malar J [Internet]. 2020 Apr 19 [cited 2025 Aug 30];19(1):160. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC7168863/\u003c/li\u003e\n\u003cli\u003eDe Kock M, Tarning J, Workman L, Nyunt MM, Adam I, Barnes KI, et al. Pharmacokinetics of Sulfadoxine and Pyrimethamine for Intermittent Preventive Treatment of Malaria During Pregnancy and After Delivery. CPT Pharmacometrics Syst Pharmacol [Internet]. 2017 Jul 1 [cited 2025 Aug 30];6(7):430\u0026ndash;8. Available from: /doi/pdf/10.1002/psp4.12181\u003c/li\u003e\n\u003cli\u003eChaponda EB, Mharakurwa S, Michelo C, Bruce J, Chandramoha D, Matthew Chico R. Sulfadoxine-pyrimethamine parasitological efficacy against Plasmodium falciparum among pregnant women and molecular markers of resistance in Zambia: an observational cohort study. Malar J [Internet]. 2021 Dec 1 [cited 2025 Aug 30];20(1):1\u0026ndash;10. Available from: https://malariajournal.biomedcentral.com/articles/10.1186/s12936-021-03596-3\u003c/li\u003e\n\u003cli\u003eMartin MK, Venantius KB, Patricia N, Bernard K, Keith B, Allen K, et al. Correlates of uptake of optimal doses of sulfadoxine-pyrimethamine for prevention of malaria during pregnancy in East-Central Uganda. Malar J [Internet]. 2020 Apr 15 [cited 2025 Sep 30];19(1):1\u0026ndash;14. Available from: https://malariajournal.biomedcentral.com/articles/10.1186/s12936-020-03230-8\u003c/li\u003e\n\u003cli\u003eFigueroa-Romero A, Pons-Duran C, Gonzalez R. Drugs for Intermittent Preventive Treatment of Malaria in Pregnancy: Current Knowledge and Way Forward. Trop Med Infect Dis [Internet]. 2022 Aug 1 [cited 2025 Sep 30];7(8):152. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC9416188/\u003c/li\u003e\n\u003cli\u003eOguta S, Serumaga B, Odongo L, Otika D, Ayikoru J, Otim R, et al. Factors associated with malaria in pregnancy among antenatal care mothers at Gulu Regional Referral Hospital in northern Uganda. Malar J [Internet]. 2024 Dec 1 [cited 2025 Sep 30];23(1):346. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC11575075/\u003c/li\u003e\n\u003cli\u003eMartin MK, Venantius KB, Patricia N, Bernard K, Keith B, Allen K, et al. Correlates of uptake of optimal doses of sulfadoxine-pyrimethamine for prevention of malaria during pregnancy in East-Central Uganda. Malar J. 2020;19(1):1\u0026ndash;14. \u003c/li\u003e\n\u003cli\u003eOguta S, Serumaga B, Odongo L, Otika D, Ayikoru J, Otim R, et al. Factors associated with malaria in pregnancy among antenatal care mothers at Gulu Regional Referral Hospital in northern Uganda. Malaria Journal [Internet]. 2024 Dec 1 [cited 2025 Sep 30];23(1):1\u0026ndash;6. Available from: https://malariajournal.biomedcentral.com/articles/10.1186/s12936-024-05184-7\u003c/li\u003e\n\u003cli\u003eEpuitai J, Ndeezi G, Nabirye RC, Kabiri L, Mukunya D, Tumuhamye J, et al. Prevalence and factors associated with placental malaria in Lira District, Northern Uganda: a cross-sectional study. Malar J [Internet]. 2024 Dec 1 [cited 2025 Sep 30];23(1). Available from: https://pubmed.ncbi.nlm.nih.gov/39604967/\u003c/li\u003e\n\u003cli\u003eMangusho C, Mwebesa E, Izudi J, Aleni M, Dricile R, Ayiasi RM, et al. High prevalence of malaria in pregnancy among women attending antenatal care at a large referral hospital in northwestern Uganda: A cross-sectional study. PLoS One [Internet]. 2023 Apr 1 [cited 2025 Sep 30];18(4):e0283755. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10075480/\u003c/li\u003e\n\u003cli\u003eet al. Dhingra, N. WHO guidelines on drawing blood : best practices in phlebotomy. World Health Organization. 2010;1\u0026ndash;105. \u003c/li\u003e\n\u003cli\u003eWHO. Microscopy Examination of Thick and Thin Blood Films for Identification of Malaria Parasites: Malaria Microscopy Standard Operating Procedure-Mm-Sop-08. World Health Organization. 2016;1\u0026ndash;6. \u003c/li\u003e\n\u003cli\u003eWHO. Malaria Parasite Counting. World Health Organization. 2016;1\u0026ndash;5. \u003c/li\u003e\n\u003cli\u003eVirendra et al. Sulphadoxine concentrations in plasma, red blood cells and whole blood in healthy and Plasmodium falciparum malaria cases after treatment with Fansidar using high-performance liquid chromatography. J Pharm Biomed Anal. 1994;12(10):1317\u0026ndash;23. \u003c/li\u003e\n\u003cli\u003eMikomangwa WP, Minzi O, Mutagonda R, Baraka V, Mlugu EM, Aklillu E, et al. Effect of sulfadoxine-pyrimethamine doses for prevention of malaria during pregnancy in hypoendemic area in Tanzania. Malar J [Internet]. 2020 Apr 19 [cited 2025 Sep 30];19(1):160. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC7168863/\u003c/li\u003e\n\u003cli\u003eAnchang-Kimbi JK, Kalaji LN, Mbacham HF, Wepnje GB, Apinjoh TO, Ngole Sumbele IU, et al. Coverage and effectiveness of intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) on adverse pregnancy outcomes in the Mount Cameroon area, South West Cameroon. Malar J. 2020;19(1):1\u0026ndash;12. \u003c/li\u003e\n\u003cli\u003eOguta S, Serumaga B, Odongo L, Otika D, Ayikoru J, Otim R, et al. Factors associated with malaria in pregnancy among antenatal care mothers at Gulu Regional Referral Hospital in northern Uganda. Malaria Journal . 2024;23(1). \u003c/li\u003e\n\u003cli\u003eSsekitooleko J, Mubiru D, Rufus TF, Nyakakye C, Mansen DK. Malaria Prevalence and Associated Factors among Pregnant Women Attending their First Antenatal Care in Kole and Kyenjojo Districts in Uganda. Texila International Journal of Public Health. 2021;9(4):1\u0026ndash;11. \u003c/li\u003e\n\u003cli\u003eMangusho C, Mwebesa E, Izudi J, Aleni M, Dricile R, Ayiasi RM, et al. High prevalence of malaria in pregnancy among women attending antenatal care at a large referral hospital in northwestern Uganda: A cross-sectional study. PLoS One. 2023;18(4 April):1\u0026ndash;16. \u003c/li\u003e\n\u003cli\u003eEboumbou Moukoko CE, Kojom Foko LP, Ayina A, Tornyigah B, Epote AR, Penda IC, et al. Effectiveness of Intermittent Preventive Treatment with Sulfadoxine-Pyrimethamine in Pregnancy: Low Coverage and High Prevalence of Plasmodium falciparum dhfr-dhps Quintuple Mutants as Major Challenges in Douala, an Urban Setting in Cameroon. Pathogens. 2023;12(6). \u003c/li\u003e\n\u003cli\u003eMikomangwa WP, Minzi O, Mutagonda R, Baraka V, Mlugu EM, Aklillu E, et al. Effect of sulfadoxine-pyrimethamine doses for prevention of malaria during pregnancy in hypoendemic area in Tanzania. Malar J. 2020;19(1):1\u0026ndash;11. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Sulfadoxine/pyrimethamine, dosages, plasma levels, parasitemia, pregnant women","lastPublishedDoi":"10.21203/rs.3.rs-8133778/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8133778/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: Malaria in pregnancy poses severe adverse effects to both the mother and fetus and the newborn. There is limited literature on the effectiveness of sulfadoxine/pyrimethamine as a malaria preventive measure across Africa and Uganda in particular. Our study assessed sulfadoxine/pyrimethamine dosing and malaria parasitemia among pregnant women at Lira regional referral hospital, northern Uganda.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod\u003c/strong\u003e: A cross-sectional study that involved 326 pregnant women was conducted at Lira Regional Referral. SP dosages were extracted from antenatal cards, maternal venous blood was collected for assessment of parasitemia, and plasma levels of sulfadoxine were assessed. High-performance liquid chromatography with ultraviolet detection was used to quantify sulfadoxine, whereas microscopy was used to detect malaria parasites. The primary outcome was malaria parasitemia. Data was analysed using STATA version 17. SP dosages and parasitemia were reported as a pie chart and table, respectively. Chi-square was used to determine the relationship between the plasma levels of SP and malaria parasitemia levels. Univariate and multivariate logistic analyses were conducted to determine the correlation between factors and parasitemia levels.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: In this study SP optimal dosage use was at 70% (228/326) pregnant women attending Lira regional referral hospital, northern Uganda. The mean plasma level of sulfadoxine was 12.76 ± 1.55 μg/mL. Parasitemia level was 7.67%. No significant relationship between optimal SP dosage and malaria parasitemia levels (x\u003csup\u003e2\u003c/sup\u003e\u003cstrong\u003e=\u003c/strong\u003e0.0718, p=0.789). There was no statistically significant relationship between all factors and malaria parasitemia at multivariate analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion and Recommendation\u003c/strong\u003e: This study has found that most participants took optimal SP dosage. An optimal SP dosage was not associated with increased malaria parasitemia, and similarly, plasma levels of SP had no statistically significant relationship with parasitemia.\u003c/p\u003e","manuscriptTitle":"Sulfadoxine-Pyrimethamine Dosing and Malaria Parasitemia Among Pregnant Women at Lira Regional Referral Hospital, Northern Uganda: A Cross-Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-18 09:00:18","doi":"10.21203/rs.3.rs-8133778/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"deca605d-cf35-46ba-8bac-d89245fd79fb","owner":[],"postedDate":"November 18th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-03T11:07:53+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-18 09:00:18","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8133778","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8133778","identity":"rs-8133778","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}