e-Library of Evidence for Nutrition Actions (eLENA)


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Intermittent preventative treatment to reduce the risk of malaria during pregnancy

Intervention | Last updated: 9 August 2023


Malaria infection during pregnancy is a major public health problem. Pregnancy reduces a woman’s immunity, making pregnant women more susceptible to malaria infection and increasing the risk of illness, anaemia, severe disease and death. For the unborn child, maternal malaria increases the risk of spontaneous abortion, stillbirth, premature delivery and low birth weight – a leading cause of child mortality.

WHO recommends a package of interventions for preventing and controlling malaria during pregnancy, which includes promotion and use of insecticide-treated nets, appropriate case management with prompt, effective treatment, and, in areas with moderate to high transmission of P. falciparum, administration of intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP).

Currently available evidence from malaria-endemic countries indicates that IPTp-SP is associated with reduced maternal parasitaemia, reduced low birth weight infants and increased mean birth weight.

WHO Recommendations


In malaria-endemic areas in Africa, intermittent preventive treatment with sulfadoxine-pyrimethamine (SP-IPTp) is recommended for all pregnant women in their first or second pregnancy. Dosing should start in the second trimester and doses should be given at least 1 month apart, with the objective of ensuring that at least three doses are received.

Evidence


Systematic reviews used to develop the guidelines


Intermittent preventive therapy for malaria during pregnancy using 2 vs 3 or more doses of sulfadoxine–pyrimethamine and risk of low birth weight in Africa: systematic review and meta-analysis

Kayentao K, Garner P, van Eijk AM, Naidoo I, Roper C, Mulokozi et al. JAMA. 2013;309(6):594-604.


Related Cochrane reviews


Drugs for preventing malaria in pregnant women in endemic areas: any drug regimen versus placebo or no treatment

Radeva-Petrova D, Kayentao K, ter Kuile FO, Sinclair D, Garner P. Cochrane Database of Systematic Reviews. 2014; Issue 10. Art. No.: CD000169.

Summary of this review Alternate Text

Intermittent preventive treatment regimens for malaria in HIV-positive pregnant women

Mathanga DP, Uthman OA, Chinkhumba J.Cochrane Database of Systematic Reviews 2011, Issue 10. Art. No.: CD006689.

Summary of this review Alternate Text

Other related systematic reviews


Malaria prevention in pregnancy, birthweight, and neonatal mortality: a meta-analysis of 32 national cross-sectional datasets in Africa

Eisele TP, Larsen DA, Anglewicz PA, Keating J, Yukich J, Bennett A, et al. Lancet Infect Dis. 2012;12(12):942-9.


Cost-effectiveness Learn More Alternate Text


Cost-effectiveness analyses


Cost-Effectiveness of Intermittent Preventive Treatment of Malaria in Pregnancy in Southern Mozambique

Sicuri E, Bardají A, Nhampossa T, Maixenchs M, Nhacolo A, Nhalungo D, et al. PLoS One. 2010; 5(10):e13407.


Cost effectiveness of intermittent screening followed by treatment versus intermittent preventive treatment during pregnancy in West Africa: analysis and modelling of results from a non-inferiority trial

Fernandes S, Sicuri E, Halimatou D, Akazili J, Boiang K, Chandramohan D, et al. Malar J. 2016; 15(1):493.


Cost-effectiveness of two versus three or more doses of intermittent preventive treatment for malaria during pregnancy in sub-Saharan Africa: a modelling study of meta-analysis and cost data

Fernandes S, Sicuri E, Kayentao K, van Eijk AM, Hill J, Webster J, et al. Lancet Glob Health. 2015; 3(3):e143-53.


Cost-effectiveness analysis of three health interventions to prevent malaria in pregnancy in an area of low transmission in Uganda

Hansen KS, Ndyomugyenyi R, Magnussen P, Clarke SE. Int Health. 2012; 4(1):38-46.