World Health Organization Clarifies Recommendations for Preventing Malaria in Pregnancy

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By: Kate Mitchell, Manager of the MHTF Knowledge Management System, Women and Health Initiative

In malaria endemic regions around the world, malaria in pregnancy continues to contribute significantly to maternal and newborn morbidity and mortality. Intermittent preventive treatment using sulfadoxine-pyrimethamine (IPTp-SP) is one of three critical interventions for addressing malaria in pregnancy. WHO’s three-pronged approach also includes the use of insecticide-treated nets and prompt and effective case management. However, in recent years, there has been a slowing of efforts in several countries in Africa to scale-up the implementation of IPTp-SP. The limited scale-up has been partially attributed to confusion among health workers around the specific recommendations for how to implement this intervention.

Three departments at WHO – the Global Malaria Programme, the Department of Reproductive Health and Research, and the Department of Maternal, Newborn, Child and Adolescent Health – recently teamed up to issue a policy brief with detailed recommendations for implementing IPTp-SP.  The updated policy brief provides clarity for national health authorities on how to administer IPTp-SP. The brief also shares critical information for overcoming various operational challenges—including scale up; management of side-effects; issues surrounding quality, efficacy, and resistance; and co-administration of other medication.

Our colleagues at the World Health Organization encourage national health authorities to disseminate this update widely and to help ensure the correct administration of IPTp-SP.

From the policy brief:

All possible efforts should be made to increase access to IPTp-SP in all areas with moderate to high malaria transmission in Africa, as part of antenatal care services. WHO recommends a schedule of at least four antenatal care visits during pregnancy.

1. Starting as early as possible in the second trimester, IPTp-SP is recommended for all pregnant women at each scheduled antenatal care (ANC) visit until the time of delivery, provided that the doses are given at least one month apart. SP should not be given during the first trimester of pregnancy; however, the last dose of IPTp-SP can be administered up to the time of delivery without safety concerns.

– IPTp-SP should ideally be administered as directly observed therapy (DOT) of three tablets sulfadoxine/pyrimethamine (each tablet containing 500mg/25mg SP) giving the total required dosage of 1500mg/75mg SP.
– SP can be given either on an empty stomach or with food.
– SP should not be administered to women receiving co-trimoxazole prophylaxis due to a higher risk of adverse events.
– WHO recommends the administration of folic acid at a dose of 0.4mg daily; this dose may be safely used in conjunction with SP. Folic acid at a daily dose equal or above 5mg should not be given together with SP as this counteracts its efficacy as an antimalarial.

2. In some countries of sub-Saharan Africa, transmission of malaria has been reduced substantially due to the successful implementation of malaria control efforts. In the absence of data to help determine when to stop IPTp-SP, WHO recommends that countries continue to provide IPTp-SP until data to guide this decision making is available.

3. There is currently insufficient evidence to support a general recommendation for the use of IPTp-SP outside Africa.

Access the full policy brief.

Learn more about malaria in pregnancy:
Read a recent post on the MHTF Blog with highlights from the Malaria in Pregnancy Working Group’s annual meeting.
Visit the MHTF’s malaria in pregnancy topic page.
Follow the MHTF’s malaria in pregnancy list on Twitter.
Take a look at the MHTF’s on-going blog series on malaria in pregnancy.

Interested in contributing a guest blog post to the series on malaria in pregnancy? Please contact Kate Mitchell at