IST versus IPTp with SP in West Africa

The goal of this project was to determine whether screening and treatment for malaria at each scheduled antenatal clinic visit of pregnant women sleeping under a long lasting insecticide treated bed net is as effective in protecting them from anaemia, low birth weight and placental infection as Intermittent Preventive Treatment with sulphadoxine-pyrimethamine (SP-IPTp). It was carried out across four sites: Burkina Faso (Ziniare), Ghana (Navrongo), Mali (San & Kita) and The Gambia (Basse).

With the decline in incidence of malaria in pregnant women in general across Africa and the problem of growing resistance to SP there is a need to re-examine the efficacy and cost effectiveness of giving multiple intermittent preventive treatments with SP during pregnancy. This applies especially to areas with highly seasonal malaria transmission where women are at risk of malaria for only a short period during the year.

Results

In areas of low SP resistance intermittent screening and treatment (ISTp) is not inferior to SP-IPTp in prevention of low birth weight and maternal anaemia and was tolerated better, but more women experienced clinical malaria in the ISTp that in the IPTp group. ISTp was also costlier.

The Future

The results formed an important part of the evidence reviewed by WHO’s Evidence Review Group in 2015. The group concluded that there was no clearly defined role for ISTp at present, even in areas of SP resistance.