{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T02:23:27Z","timestamp":1790043807910,"version":"4.0.1"},"reference-count":44,"publisher":"American Academy of Pediatrics (AAP)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,3,1]]},"abstract":"<jats:sec><jats:title>BACKGROUND AND OBJECTIVES:<\/jats:title><jats:p>We showed earlier that presumptive infection treatment in pregnancy reduced the prevalence of neonatal stunting in a rural low-income setting. In this article, we assess how these gains were sustained and reflected in childhood growth, development, and mortality.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS:<\/jats:title><jats:p>We enrolled 1320 pregnant Malawian women in a randomized trial and treated them for malaria and other infections with either 2 doses of sulfadoxine-pyrimethamine (SP) (control), monthly SP, or monthly sulfadoxine-pyrimethamine and 2 doses of azithromycin (AZI-SP). Child height or length and mortality were recorded at 1, 6, 12, 24, 36, 48, and 60 months and development at 60 months by using Griffith\u2019s Mental Development Scales.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS:<\/jats:title><jats:p>Throughout follow-up, the mean child length was 0.4 to 0.7 cm higher (P &amp;lt; .05 at 1\u201312 months), the prevalence of stunting was 6 to 11 percentage points lower (P &amp;lt; .05 at 12\u201336 months), and the 5-year cumulative incidence of stunting was 13 percentage points lower (hazard ratio: 0.70, 95% confidence interval [CI]: 0.60 to 0.83, P &amp;lt; .001) in the AZI-SP group than in the control group. The mean developmental score was 3.8 points higher in the AZI-SP group than in the control group (95% CI: 1.1 to 6.4, P = .005). Total mortality during pregnancy and childhood was 15.3%, 15.1%, and 13.1% (P = .60) in the control, monthly SP, and AZI-SP groups, respectively. Postneonatal mortality (secondary outcome) was 5.5%, 3.3%, and 1.9%, respectively (risk ratio of AZI-SP versus control: 0.34, 95% CI: 0.15 to 0.76, P = .008).<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS:<\/jats:title><jats:p>Provision of AZI-SP rather than 2 doses of SP during pregnancy reduced the incidence of stunting in childhood. AZI-SP during pregnancy also had a positive effect on child development and may have reduced postneonatal mortality.<\/jats:p><\/jats:sec>","DOI":"10.1542\/peds.2017-2459","type":"journal-article","created":{"date-parts":[[2018,2,22]],"date-time":"2018-02-22T13:45:11Z","timestamp":1519307111000},"source":"Crossref","is-referenced-by-count":20,"title":["Child Health Outcomes After Presumptive Infection Treatment in Pregnant Women: A Randomized Trial"],"prefix":"10.1542","volume":"141","author":[{"given":"Lotta","family":"Hallamaa","sequence":"first","affiliation":[{"name":"Center for Child Health Research, Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yin Bun","family":"Cheung","sequence":"additional","affiliation":[{"name":"Center for Quantitative Medicine, Duke\u2013NUS Medical School, National University of Singapore, Singapore;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth","family":"Maleta","sequence":"additional","affiliation":[{"name":"Department of Public Health, School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mari","family":"Luntamo","sequence":"additional","affiliation":[{"name":"Center for Child Health Research, Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulla","family":"Ashorn","sequence":"additional","affiliation":[{"name":"Center for Child Health Research, Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa","family":"Gladstone","sequence":"additional","affiliation":[{"name":"Department of Neurodevelopmental Paediatrics, Women and Children\u2019s Health, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teija","family":"Kulmala","sequence":"additional","affiliation":[{"name":"Center for Child Health Research, Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles","family":"Mangani","sequence":"additional","affiliation":[{"name":"Department of Public Health, School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Per","family":"Ashorn","sequence":"additional","affiliation":[{"name":"Center for Child Health Research, Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland;"},{"name":"Department of Paediatrics, Tampere University Hospital, Tampere, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2018,3,1]]},"reference":[{"issue":"9890","key":"2021120917014656300_B1","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1016\/S0140-6736(13)60937-X","article-title":"Maternal and child undernutrition and overweight in low-income and middle-income countries.","volume":"382","author":"Black","year":"2013","journal-title":"Lancet"},{"key":"2021120917014656300_B2","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1111\/mcn.12075","article-title":"The World Health Organization\u2019s global target for reducing childhood stunting by 2025: rationale and proposed actions.","volume":"9","author":"de Onis","year":"2013","journal-title":"Matern Child Nutr"},{"issue":"3","key":"2021120917014656300_B3","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2009-1519","article-title":"Worldwide timing of growth faltering: revisiting implications for interventions.","volume":"125","author":"Victora","year":"2010","journal-title":"Pediatrics"},{"key":"2021120917014656300_B4","volume-title":"What Works? 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