Pregnant mother holding SP tablets and cup, with provider during antenatal care, Malawi. Photo: Aleisha Monique Rozario
Every newborn child deserves a healthy start, yet the babies born each year to mothers with malaria don’t often get one. Babies born to mothers who have had even one episode of malaria in pregnancy (MIP) can be born small or anemic, which can lead to life-threatening consequences. The World Health Organization (WHO) estimates that approximately 200,000 newborns die each year as a result of MIP. And babies born with complications from MIP who survive are more likely to face health problems throughout childhood, adolescence and beyond.
This is exceptionally unfair, as the adverse outcomes associated with MIP are largely preventable. With adequate attention and resource allocation to prevent malaria among pregnant women, newborn children can and should be granted the healthy start they deserve.
In areas of moderate-to-high malaria transmission, IPTp-SP is recommended for all pregnant women at each scheduled antenatal care (ANC) visit. The WHO recommends a schedule of four antenatal care visits:
The first IPTp-SP dose should be administered as early as possible during the 2nd trimester of gestation – not the first trimester
Each dose should be given at least 1 month apart
The last dose of IPTp-SP can be administered up to the time of delivery, without safety concerns
New findings about the effectiveness of intermittent preventive treatment with sulfadoxine pyrimethamine (IPTp-SP) as well as use of insecticide treated bed nets (ITN) during pregnancy demonstrate significant gains in reducing the rates of both neonatal mortality and low birth weight. Results from a randomized controlled trial among more than 1,000 pregnant women in Mozambique found that IPTp-SP reduced neonatal mortality by 61.3 percent. Furthermore, an analysis of 32 national cross-sectional datasets in 25 African countries from 2000–2010 found that full malaria prevention (at least two doses of IPTp and/or ITN in household 6 months prior to birth) was associated with an 18 percent reduction in neonatal mortality and a 21 percent reduction in low birth weight.
A recent study in Mozambique also found that the intervention remained cost effective in reducing neonatal mortality even with an increase in drug cost per dose of up to 183 times. The protective effects of IPTp-SP as well as ITNs—combined with the fact that these interventions are cost-effective—are critically important in preventing the adverse consequences of MIP, and these interventions should be scaled-up in areas of high malaria transmission.
ITN education at antenatal care clinic, Zambia. Photo: Michelle Wallon
The Roll Back Malaria goal of reaching 80 percent of pregnant women with IPTp and ITNs has yet to be reached. Given that MIP is both a maternal and newborn health issue, efforts to prevent MIP should be administered through antenatal care (ANC) platforms, recognizing that the majority of pregnant women in sub-Saharan Africa come to ANC at least one time and often two times during pregnancy.
In countries where this is already working, national malaria control programs and national reproductive health programs are working together to ensure comprehensive care for pregnant women. Integrating ANC services with malaria prevention and control programs affords pregnant women a “no missed opportunities” approach, because this partnership of services increases the likelihood that pregnant women have access to comprehensive care, including IPTp-SP and ITNs. When administered through ANC platforms, IPTp-SP coupled with ITNs is also a highly cost-effective intervention.
These findings further fuel our fight against MIP, and renew our commitment to improving health outcomes for both mothers and newborns.