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Sulphadoxine-pyrimethamine plus azithromycin for the prevention of low birthweight in Papua New Guinea: a randomised controlled trial

Overview of attention for article published in BMC Medicine, January 2015
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Title
Sulphadoxine-pyrimethamine plus azithromycin for the prevention of low birthweight in Papua New Guinea: a randomised controlled trial
Published in
BMC Medicine, January 2015
DOI 10.1186/s12916-014-0258-3
Pubmed ID
Authors

Holger W Unger, Maria Ome-Kaius, Regina A Wangnapi, Alexandra J Umbers, Sarah Hanieh, Connie SN Li Wai Suen, Leanne J Robinson, Anna Rosanas-Urgell, Johanna Wapling, Elvin Lufele, Charles Kongs, Paula Samol, Desmond Sui, Dupain Singirok, Azucena Bardaji, Louis Schofield, Clara Menendez, Inoni Betuela, Peter Siba, Ivo Mueller, Stephen J Rogerson

Abstract

BackgroundIntermittent preventive treatment in pregnancy has not been evaluated outside of Africa. Low birthweight (LBW, <2,500 g) is common in Papua New Guinea (PNG) and contributing factors include malaria and reproductive tract infections.MethodsFrom November 2009 to February 2013, we conducted a parallel group, randomised controlled trial in pregnant women (¿26 gestational weeks) in PNG. Sulphadoxine-pyrimethamine (1,500/75 mg) plus azithromycin (1 g twice daily for 2 days) (SPAZ) monthly from second trimester (intervention) was compared against sulphadoxine-pyrimethamine and chloroquine (450 to 600 mg, daily for three days) (SPCQ) given once, followed by SPCQ placebo (control). Women were assigned to treatment (1:1) using a randomisation sequence with block sizes of 32. Participants were blinded to assignments. The primary outcome was LBW. Analysis was by intention-to-treat.ResultsOf 2,793 women randomised, 2,012 (72.4%) were included in the primary outcome analysis (SPCQ: 1,008; SPAZ: 1,013). The prevalence of LBW was 15.1% (305/2,021). SPAZ reduced LBW (risk ratio [RR]: 0.74, 95% CI: 0.60¿0.91, P¿=¿0.005; absolute risk reduction (aRR): 4.5%, 95% CI: 1.4¿7.6; number needed to treat: 22), and preterm delivery (0.62, 95% CI: 0.43¿0.89, P¿=¿0.010), and increased mean birthweight (41.9 g, 95% CI: 0.2¿83.6, P¿=¿0.049). SPAZ reduced maternal parasitaemia (aRR: 0.57, 95% CI: 0.35¿0.95, P¿=¿0.029) and active placental malaria (0.68, 95% CI: 0.47¿0.98, P¿=¿0.037), and reduced carriage of gonorrhoea (0.66, 95% CI: 0.44¿0.99, P¿=¿0.041) at second visit. There were no treatment-related serious adverse events (SAEs), and the number of SAEs (intervention 13.1% [181/1,378], control 12.7% [174/1,374], P¿=¿0.712) and AEs (intervention 10.5% [144/1,378], control 10.8% [149/1,374], P¿=¿0.737) was similar. A major limitation of the study was the high loss to follow-up for birthweight.ConclusionsSPAZ was efficacious and safe in reducing LBW, possibly acting through multiple mechanisms including the effect on malaria and on sexually transmitted infections. The efficacy of SPAZ in the presence of resistant parasites and the contribution of AZ to bacterial antibiotic resistance require further study. The ability of SPAZ to improve pregnancy outcomes warrants further evaluation.Trial registrationClinicalTrials.gov NCT01136850 (06 April 2010).

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Mendeley readers

Mendeley readers

The data shown below were compiled from readership statistics for 214 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Ethiopia 1 <1%
Ghana 1 <1%
Australia 1 <1%
United Kingdom 1 <1%
Spain 1 <1%
Unknown 209 98%

Demographic breakdown

Readers by professional status Count As %
Student > Master 37 17%
Researcher 30 14%
Student > Ph. D. Student 25 12%
Other 12 6%
Student > Bachelor 12 6%
Other 45 21%
Unknown 53 25%
Readers by discipline Count As %
Medicine and Dentistry 77 36%
Nursing and Health Professions 21 10%
Pharmacology, Toxicology and Pharmaceutical Science 12 6%
Agricultural and Biological Sciences 11 5%
Biochemistry, Genetics and Molecular Biology 7 3%
Other 29 14%
Unknown 57 27%
Attention Score in Context

Attention Score in Context

This research output has an Altmetric Attention Score of 5. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 11 August 2019.
All research outputs
#6,709,904
of 25,299,129 outputs
Outputs from BMC Medicine
#2,622
of 3,978 outputs
Outputs of similar age
#83,899
of 364,686 outputs
Outputs of similar age from BMC Medicine
#40
of 58 outputs
Altmetric has tracked 25,299,129 research outputs across all sources so far. This one has received more attention than most of these and is in the 73rd percentile.
So far Altmetric has tracked 3,978 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 45.6. This one is in the 33rd percentile – i.e., 33% of its peers scored the same or lower than it.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 364,686 tracked outputs that were published within six weeks on either side of this one in any source. This one has done well, scoring higher than 76% of its contemporaries.
We're also able to compare this research output to 58 others from the same source and published within six weeks on either side of this one. This one is in the 32nd percentile – i.e., 32% of its contemporaries scored the same or lower than it.