Malaria

Intermittent preventive treatment in pregnancy (IPTp)

Last update: 1 February 2018

Malaria infection during pregnancy is a major public health problem, with substantial risks for the mother, her fetus and the neonate. Intermittent preventive treatment of malaria in pregnancy is a full therapeutic course of antimalarial medicine given to pregnant women at routine antenatal care visits, regardless of whether the recipient is infected with malaria. IPTp reduces maternal malaria episodes, maternal and fetal anaemia, placental parasitaemia, low birth weight, and neonatal mortality.

WHO recommendations

WHO recommends IPTp with sulfadoxine-pyrimethamine (IPTp-SP) in all areas with moderate to high malaria transmission in Africa. As of October 2012, WHO recommends that this preventive treatment be given to all pregnant women starting as early as possible in the second trimester (i.e. not during the first trimester). The women should receive at least 3 doses of SP during her pregnancy, with each dose being given at least 1 month apart – SP can safely be administered up until the time of delivery.

In 2016, WHO published new guidelines on antenatal care: by recommending an increase in the number of contacts between care providers and pregnant women, these guidelines effectively ensure more opportunities to expand IPTp-SP coverage. An inter-agency briefing note published together with the guidelines provides an example of ANC contact schedule with proposed timelines for the implementation of IPTp, to be adapted to the country context.

Based on currently available evidence, IPTp-SP remains effective in preventing the adverse consequences of malaria on maternal and fetal outcomes even in areas where quintuple mutations linked to SP resistance are prevalent in P. falciparum. Therefore, IPTp-SP should still be administered to pregnant women in such areas.

Low uptake of IPTp in some African countries

Among the approximately 840 million persons at risk of malaria in endemic countries in sub-Saharan Africa, an estimated 35 million pregnant women could benefit from IPTp each year. However, during the last few years, WHO has observed a declining effort to scale-up IPTp in a number of African countries. In high-burden countries, IPTp noticeably lags behind other malaria control measures. This does not appear to be due to low levels of antenatal clinic attendance. Uncertainty among health workers about SP administration for IPTp may have also played a role. Simplified IPTp messages and health worker training have been shown to improve IPTp coverage.

As of 2016, 36 African countries have adopted a policy of providing 3 or more doses of IPTp-SP to pregnant women. Recent progress in adherence to this policy has increased only marginally: among the 23 countries that reported in 2016, an estimated 19% of eligible pregnant women received 3 or more doses of IPTp, compared with 18% in 2015 and 13% in 2014.

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