Intermittent Preventive Treatment of Malaria In Pregnancy in Tanzania

Intermittent Preventive Treatment of malaria in pregnancy (IPTp) using sulfadoxine-pyrimethamine (SP) has been a long standing intervention to protect pregnant women and their unborn children from the dangerous effects of malaria in stable transmission settings. Placental malaria deprives the fetus of nutrients leading to low birth weight, still birth and miscarriages. The mother herself suffers anemia and potentially, death.

There had always been a challenge to getting pregnant women to obtain at least two doses of IPTp-SP due to a variety of factors ranging from health system lapses to late antenatal care attendance by mothers. This phenomenon of dropping out of multi-contact interventions is not uncommon and seen equally in programs such as childhood immunization. Therefore when the World Health Organization raised the bar and recommended IPTp starting in the 13th week of pregnancy and monthly thereafter, the challenge of providing three or more doses arose.

The Malaria Indicator Surveys (MIS) and the Demographic and Health Surveys (DHS) are an ideal was to trace the progress of malaria intervention over multiple years. With the release of the preliminary results of 2017 Tanzania MIS it is now possible to track this service from over a decade. The Attached chart, using MIS/DHS reports shows that so far Tanzania has not come near achieving 80% coverage of this indicator. While there had been major increases over recent years, reports of IPTp coverage in 2017 show only 56% of recently pregnant women received at least two doses, and only 26% received three or more.

It should be noted that countries are beginning to stratify their interventions according  to available transmission data. Therefore as noted in the US President’s Malaria Initiative Malaria Operations Plan for 2018, Zanzibar where transmission is low, has stopped IPTp and focuses on prompt and appropriate case management, while the mainland of Tanzania continues with all MIP interventions.  Of interest is the most recent child prevalence map found in the 2017 MIS results that shows other parts of the mainland may also be approaching very low transmission.

Moving forward it will be useful if Tanzania and other endemic countries not only gather epidemiological data to help stratify appropriate interventions (as suggested in the WHO malaria elimination framework), but go further to focus reporting by strata. That said, the health system and community difficulties in achieving high IPTp coverage wherever it is appropriate will remain a challenge if services remain based in static health facilities. Community roles must be explored.

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