Intermittent preventive treatment in pregnancy (IPTp)
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 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 at antenatal care visit starting as early as possible in the second trimester (i.e. not during the first trimester). Each IPTp-SP dose should be given at least 1 month apart. WHO recommends at least 3 doses during each pregnancy.
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. It is estimated that, in 2015, among 20 countries that reported, 31% of eligible pregnant women received 3 or more doses of IPTp in 36 African countries that have adopted the policy – a large increase from the 18% receiving 3 or more doses in 2014 and 6% in 2010.
- Malaria prevention works: let's close the gap (2017)
- Recommendations on intermittent screening and treatment in pregnancy and the safety of ACTs in the first trimester (2015)
- WHO policy brief for the implementation of intermittent preventive treatment of malaria in pregnancy using sulfadoxine-pyrimethamine (IPTp-SP)