Prevention Malawi – ISTp versus IPTp-SP

The objective of the project was to determine how scheduled intermittent screening with malaria rapid diagnostic tests (RDTs) and treatment of RDT-positive women with dihydroartemisinin-piperaquine (ISTp-DP) compared with IPTp-SP in the second and third trimesters of pregnancy among HIV-negative pregnant women protected by insecticide–treated bed nets (ITNs) in an area with decreasing malaria transmission and high levels of SP resistance in southern Malawi is associated with:

>=27.5% reduction in adverse birth outcome (composite of miscarriage, stillbirth, low birth weight or preterm birth) in women in their first and second pregnancies (G1+2)

>=50% reduction in active or recent infection assessed at delivery by placental histopathology or RDT in multigravidae (G3+).

The study was being undertaken in three semi-rural and rural antenatal clinics in southern Malawi in an area with moderate year-round malaria transmission (no IRS programs implemented yet), high levels of SP resistance, and high ITN coverage.

Additional sub-studies include a cost-effectiveness, acceptability and implementability study and an immunological study.


The results demonstrated that ISTp is not a suitable alternative to IPTp-SP even in areas with high levels of resistance to SP.