Intermittent preventive treatment of malaria during pregnancy in central Mozambique.
OBJECTIVE
New WHO strategies for control of malaria in pregnancy (MiP) recommend intermittent preventive treatment (IPTp), bednet use and improved case management.


METHODS
A pilot MiP programme in Mozambique was designed to determine requirements for scale-up.


METHODS
The Ministry of Health worked with a nongovernmental organization and an academic institution to establish and monitor a pilot programme in two impoverished malaria-endemic districts.


RESULTS
Implementing the pilot programme required provision of additional sulfadoxine-pyrimethamine (SP), materials for directly observed SP administration, bednets and a modified antenatal card. National-level formulary restrictions on SP needed to be waived. The original protocol required modification because imprecision in estimation of gestational age led to missed SP doses. Multiple incompatibilities with other health initiatives (including programmes for control of syphilis, anaemia and HIV) were discovered and overcome. Key outputs and impacts were measured; 92.5% of 7911 women received at least 1 dose of SP, with the mean number of SP doses received being 2.2. At the second antenatal visit, 13.5% of women used bednets. In subgroups (1167 for laboratory analyses; 2600 births), SP use was significantly associated with higher haemoglobin levels (10.9 g/dL if 3 doses, 10.3 if none), less malaria parasitaemia (prevalence 7.5% if 3 doses, 39.3% if none), and fewer low-birth-weight infants (7.3% if 3 doses, 12.5% if none).


CONCLUSIONS
National-level scale-up will require attention to staffing, supplies, bednet availability, drug policy, gestational-age estimation and harmonization of vertical initiatives.
Department of Health Services, School of Public Health and Community Medicine, University of Washington, Seattle, Washington 98195, USA. bretp2@u.washington.edu
Paula E
PE
Brentlinger
Martinho
M
Dgedge
Maria Ana Chadreque
MA
Correia
Ana Judith Blanco
AJ
Rojas
Francisco
F
Saúte
Kenneth H
KH
Gimbel-Sherr
Benjamin A
BA
Stubbs
Mary Anne
MA
Mercer
Stephen
S
Gloyd
D000962:Antimalarials / Q000008:administration & dosage / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D004338:Drug Combinations; D005260:Female; D006291:Health Policy; D006801:Humans; D008288:Malaria / Q000517:prevention & control*; D009073:Mozambique / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000517:prevention & control*; D011295:Prenatal Care / Q000458:organization & administration*; D011482:Protective Devices / Q000706:statistics & numerical data / Q000600:supply & distribution; D011739:Pyrimethamine / Q000008:administration & dosage / Q000627:therapeutic use*; D013413:Sulfadoxine / Q000008:administration & dosage / Q000627:therapeutic use*; D014944:World Health Organization
D000962:Antimalarials; D004338:Drug Combinations; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D011739:Pyrimethamine