Introduction:
Intermittent preventive treatment or therapy (IPT) is a public health approach that aims at preventing and treating episodes of malaria in infants (IPTi), children (IPTc), school children (IPTsc), and pregnant women (IPTp). This approach is based on the tested malaria control strategies. First, to clear the existing parasite through mass drug administration (MDA), and second, to prevent new infection (prophylaxis measure).
What Is Malaria?
Malaria is a global public health concern, more prevalent in Sub-Saharan Africa. These areas are more prone to malaria because of climatic factors, poor environmental sanitation, and cultural habits. These factors provide a suitable environment for the transmission of parasites year-round. It occurs more commonly in children under five and pregnant women.
It is highly associated with maternal and fetal complications such as maternal anemia, premature delivery, perinatal and neonatal mortality, morbidity, postpartum morbidity, intrauterine growth retardation or death, stillbirth, low birth weight, etc. In Sub-Saharan Africa, nutritional factors, poverty, micronutrient imbalance, human immunodeficiency virus, and limited access to healthcare facilities and emergency obstetric services aggravate the impact of malaria in pregnancy.
Pregnant women infected with malarial infections are at a higher risk of cerebral malaria, pulmonary edema, hypoglycemia, and hemolytic anemia. The effects are more severe in primigravida (a woman who gets pregnant for the first time) than in multigravida (a woman who has been pregnant for at least a second time).
What Are the Approaches and Strategies Used to Tackle Malaria in Pregnancy?
To protect both maternal and child health, the world health organization introduced three approaches for tackling malaria in pregnancy. The strategies and approaches used to tackle malaria in pregnancy include the following:
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Intermittent preventive treatment of malaria by the use of antimalarial drugs. These drugs address asymptomatic infection among pregnant women living in high-risk areas.
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The use of insecticide-treated nets.
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The effective case management of malaria illness and anemia.
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Intermittent preventive treatment of pregnancy (IPTp) by administration of therapeutic doses of antimalarial drugs to the population to reduce morbidity and mortality. The world health organization developed a strategy to control malaria during pregnancy in Africa. It is suggested that pregnant women should receive at least two doses of Sulphadoxine-Pyrimethamine (SP) during the second and third trimesters as a part of the antenatal visits. Chemoprophylaxis is not recommended for several reasons, such as rising resistance rate, poor adherence to weekly drug dosing, and difficulty in delivering this strategy.
Intermittent preventive therapy is far better than malarial chemoprophylaxis, which is why it has been replaced.
Malaria Infection During Pregnancy:
Malaria during pregnancy is a significant health concern with an emerging risk for the mother, fetus, and newborn. In malaria-prone areas with a high risk for Plasmodium falciparum transmission, the world health organization recommends several approaches to control malaria. It includes intermittent preventive treatment with Sulfadoxine-Pyrimethamine (IPTp-SP), insecticide-treated nets (ITNs), and appropriate case management through effective treatment.
What Is the Recommended Schedule of Antimalarial Drugs During Pregnancy?
The World Health Organization schedules at least four antenatal care visits during pregnancy.
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Intermittent preventive treatment with Sulfadoxine-Pyrimethamine (IPTp-SP) is recommended for all pregnant women at each antenatal care visit until the time of delivery, starting from the second trimester of pregnancy.
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All doses should be given at a gap of one month.
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Sulfadoxine-Pyrimethamine (SP) should not be given during the first trimester. However, it can be administered up to the delivery time without any safety concerns.
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Intermittent preventive treatment with Sulfadoxine-Pyrimethamine (IPTp-SP) should ideally be administered as directly observed therapy (DOT) with a total dose of 1500 milligrams and 75 milligrams of Sulfadoxine and Pyrimethamine, respectively.
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Sulfadoxine-Pyrimethamine (SP) can be given on an empty stomach or with food.
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Sulfadoxine-Pyrimethamine (SP) should not be administered to women receiving co-trimoxazole prophylaxis.
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Folic acid at a daily dose should not be given together with Sulfadoxine-Pyrimethamine (SP) as it counteracts its efficacy as an antimalarial.
Why Should Intermittent Preventive Treatment With Sulfadoxine-Pyrimethamine (IPTp-SP) Be Avoided in the First Trimester of Pregnancy?
There is little evidence of teratogenicity when Sulfadoxine-Pyrimethamine (SP) is used in the first trimester of pregnancy. Thus this medicine is prohibited from being used in the first trimester. During the early weeks, women should protect themselves using an insecticide-treated net.
How Many Doses of Sulfadoxine-Pyrimethamine (SP) For Intermittent Preventive Treatment in Pregnancy Can Be Taken?
The world health organization recommends a total of three to four doses of Sulfadoxine-Pyrimethamine (SP). The doses should be taken during each antenatal care visit starting from the second trimester of pregnancy.
What Are the Side Effects Associated With Sulfadoxine-Pyrimethamine (SP)?
Sulfadoxine-Pyrimethamine (SP) for intermittent preventive treatment in pregnancy is very well tolerated. However, mild effects are usually seen, such as nausea, vomiting, weakness, and dizziness following the first dose. The side effects tend to decrease with the administration of further doses.
What Are the Expected Benefits of Intermittent Preventive Treatment With Sulfadoxine-Pyrimethamine (IPTp-SP)?
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Intermittent preventive treatment with Sulfadoxine-Pyrimethamine (IPTp-SP) is found to help prevent the adverse effects of malaria on maternal and fetal outcomes such as maternal or fetal anemia, placental infection, clinical malaria, low birth weight, and neonatal mortality.
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Intermittent preventive treatment with Sulfadoxine-Pyrimethamine (IPTp-SP) is highly cost-effective for preventing malaria and reducing neonatal mortality in high-risk areas.
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Despite the spread of resistance, it has still provided significant benefits.
Conclusion:
Malaria is a life-threatening disease exerting its highest burden in Africa. Although this disease is curable, it is still receiving global attention due to its significant effect on public health in terms of morbidity and mortality. Pregnant women and children are highly affected by the brunt of the disease. Malaria-associated maternal and neonatal morbidity includes preterm delivery, low birth weight, stillbirth, premature death, etc.
Intermittent preventive treatment of malaria in pregnancy (ITPp) using Sulfadoxine-Pyrimethamine (SP) has proved to be an effective strategy for preventing malaria in pregnant women. This strategy recommends administering therapeutic doses of Sulfadoxine-Pyrimethamine (SP) to pregnant women during each antenatal visit (ANC) beginning from the second trimester of pregnancy, regardless of whether the woman has malaria infection or not. The doses should be taken at a time interval of at least one month.
