Intermittent Preventive Treatment during Pregnancy

In areas with moderate to high malaria transmission, the World Health Organization (WHO) recommends intermittent preventive treatment during pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP). IPTp reduces the adverse consequences of malaria on maternal and fetal outcomes, including the reduction of maternal malaria episodes, maternal and fetal anemia, and low birthweight (Radeva-Petrova et al. 2014). With IPTp, individual doses of SP are given to pregnant women during antenatal care visits, regardless of malaria status, to clear existing parasites and prevent new infections. Pregnant women should be given at least three tablets of SP, each containing 500 mg/25 mg SP, ideally as directly observed therapy (WHO 2015). IPTp should start as early as possible in the second trimester, with doses given at each scheduled antenatal care visit until delivery, with the doses at least one month apart. The three or more doses of IPTp are associated with greater benefits than taking only one or two doses, including higher mean birth weight and fewer low birth weight births than with two doses (WHO 2013; Kayentao et al. 2013).

IPTp should be provided as part of an antenatal care package that includes other services, such as deworming for soil-transmitted helminths, deworming for schistosomiasis and iron–folic Acid supplementation (WHO 2016). Doses of folic acid equal to 5,000 mcg or above have been shown to counteract the efficacy of the antimalarial SP. Therefore, the folic acid dose given in iron–folic acid supplementation should be 400 mcg, which can be used safely with SP (Roll Back Malaria Partnership 2015; Maternal and Child Survival Program 2015).

Measurement and data sources

Population-based surveys typically report whether women received IPTp if they had a live birth in the two to five years preceding the survey. Survey questions typically include whether drugs were taken to prevent malaria, which drugs were taken, and how many times the drugs were taken. Surveys report IPTp coverage as the percentage of women who received any IPTp; two or more doses of IPTp (minimum WHO requirement); or, in more recent surveys, three or more doses of IPTp.

Surveys that collect information related to coverage of IPTp include—

• Demographic and Health Surveys
• Malaria Indicator Surveys
• Multiple Indicator Cluster Surveys
• National Micronutrient Surveys
• other research or evaluation activities.

In addition, health monitoring information systems may gather data on the coverage of IPTp.

Methodological issues

• Although many population-based surveys only assess the percentage of women who received any IPTp and those who received two or more doses of IPTp, remember that WHO recommends three or more doses, because that dosage is associated with higher benefits.
• Administrative data may not allow you to track multiple doses given to women during the same pregnancy.
• Understanding antenatal care visits is helpful for interpreting data regarding deworming for pregnant women. Many countries, however, do not consistently record or report these data, complicating efforts to explain coverage of antenatal care services (Dwivedi et al. 2014).