Assessment of labor and delivery in pregnant women on sulfadoxine-pyrimethamine regimen in Yaoundé gynaeco-obstetric and paediatric hospital: a comparative study of 313 cases

Background: Malaria is still a major public health problem in sub-Saharan Africa. The aim was to determine the prevalence of malaria infection at the onset of labor and the resulting complications. Methods: We carried out a five-month cross-sectional study at the Yaounde Gyneco-Obstetric and Pediatric Hospital.  We used results from the rapid diagnostic test (RDT) to compare two groups of pregnant women admitted into the labor room. Women who tested positive were assigned to the exposed group versus negative to the non-exposed group. Independent factors associated with malaria infection were investigated by the logistic regression method. Results: Up to 79.6% (249/313) of women had received the sulfadoxin-pyrimethamine regimen with 32.9% (82/249) receiving at least 3 doses.  Malaria infection was detected in 32.2% (101/313) of women. Only 14.9% (15/101) of the exposed group had received 3 doses of SP versus 31.6% (67/212) of the non-exposed group. After univariate analysis, malaria infection at the onset of labor was associated to premature rupture of membranes (OR=1.39; CI=1.01-1.94), fever during labor (OR=73.37; CI=64.80-681.95), non-reassuring fetal status (OR=2.08; CI=1.36-3.20), low birth weight (OR=1.65; CI=1.23-4.13), prematurity (OR=2.79; CI=2.12-367), a poor Apgar score at the 1st minute and postpartum fever (OR=3.19; CI=2.56-4.00). Linear logistic regression indicated that the occurrence of fever during labor (aOR=63.09), and low Apgar score at the first minute (aOR=6.27) remained significant and malaria infection was significantly associated to the single marital status (aOR=2.56) and a history of malaria during the current pregnancy (aOR=2.56). Conclusions: Systematic RDTs is thus recommended at the last antenatal consultation to avoid identified complications.