Abstract
SummaryBackgroundInsecticide-treated nets and intermittent preventive treatment with sulfadoxine–pyrimethamine are recommended for the control of malaria during pregnancy in endemic areas in Africa, but there has been no analysis of coverage data at a subnational level. We aimed to synthesise data from national surveys about these interventions, accounting for disparities in malaria risk within national borders.MethodsWe extracted data for specific strategies for malaria control in pregnant women from national malaria policies from endemic countries in Africa. We identified the most recent national household cluster-sample surveys recording intermittent preventive treatment with sulfadoxine–pyrimethamine and use of insecticide-treated nets. We reconciled data to subnational administrative units to construct a model to estimate the number of pregnant women covered by a recommended intervention in 2007.Findings45 (96%) of 47 countries surveyed had a policy for distribution of insecticide-treated nets for pregnant women; estimated coverage in 2007 was 4·7 million (17%) of 27·7 million pregnancies at risk of malaria in 32 countries with data. 39 (83%) of 47 countries surveyed had an intermittent preventive treatment policy; in 2007, an estimated 6·4 million (25%) of 25·6 million pregnant women received at least one dose of treatment and 19·8 million (77%) visited an antenatal clinic (31 countries). Estimated coverage was lowest in areas of high-intensity transmission of malaria.InterpretationDespite success in a few countries, coverage of insecticide-treated nets and intermittent preventive treatment in pregnant African women is inadequate; increased efforts towards scale-up are needed.FundingThe Malaria in Pregnancy Consortium and Wellcome Trust.
Highlights
Malaria infection during pregnancy can lead to very poor outcomes for the mother and child.[1]
WHO’s recommendation for malaria prevention and control during pregnancy in areas of stable malaria transmission in Africa is a package of intermittent preventive treatment and insecticidetreated nets with effective management of clinical malaria and anaemia, which is commonly delivered through collaboration between malaria and reproductive-health programmes.[3]
Data collection and study population We identified national malaria prevention policies for pregnant women and approximate year of policy adoption from the World Malaria Report[10] and proposals submitted to the Global Fund to Fight AIDS, Tuberculosis and Malaria.[13]
Summary
Malaria infection during pregnancy can lead to very poor outcomes for the mother and child.[1]. These interventions can substantially reduce disease burden and adverse outcomes of malaria in pregnancy,[4,5,6] and are cheap and cost effective.[7,8] The Roll Back Malaria initiative aims to ensure that all pregnant women receive intermittent preventive treatment and at least 80% of people at risk from malaria use insecticide-treated nets in areas of high-intensity transmission by 2010, including those who are pregnant.[9]
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