title: Coverage of malaria protection in pregnant women in sub-Saharan Africa: a synthesis and analysis of national survey data.
abstract: BACKGROUND
  Insecticide-treated nets and intermittent preventive treatment with sulfadoxine-pyrimethamine are recommended for the control of malaria during pregnancy in endemic areas in Africa, but there has been no analysis of coverage data at a subnational level. We aimed to synthesise data from national surveys about these interventions, accounting for disparities in malaria risk within national borders.
  
  
  METHODS
  We extracted data for specific strategies for malaria control in pregnant women from national malaria policies from endemic countries in Africa. We identified the most recent national household cluster-sample surveys recording intermittent preventive treatment with sulfadoxine-pyrimethamine and use of insecticide-treated nets. We reconciled data to subnational administrative units to construct a model to estimate the number of pregnant women covered by a recommended intervention in 2007.
  
  
  RESULTS
  45 (96%) of 47 countries surveyed had a policy for distribution of insecticide-treated nets for pregnant women; estimated coverage in 2007 was 4·7 million (17%) of 27·7 million pregnancies at risk of malaria in 32 countries with data. 39 (83%) of 47 countries surveyed had an intermittent preventive treatment policy; in 2007, an estimated 6·4 million (25%) of 25·6 million pregnant women received at least one dose of treatment and 19·8 million (77%) visited an antenatal clinic (31 countries). Estimated coverage was lowest in areas of high-intensity transmission of malaria.
  
  
  CONCLUSIONS
  Despite success in a few countries, coverage of insecticide-treated nets and intermittent preventive treatment in pregnant African women is inadequate; increased efforts towards scale-up are needed.
  
  
  BACKGROUND
  The Malaria in Pregnancy Consortium and Wellcome Trust.
authors.affiliation: Child and Reproductive Health Group, Liverpool School of Tropical Medicine, Liverpool, UK. avaneijk@liv.ac.uk
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: van Eijk
authors.forename: Jenny
authors.initials: J
authors.lastname: Hill
authors.forename: Victor A
authors.initials: VA
authors.lastname: Alegana
authors.forename: Viola
authors.initials: V
authors.lastname: Kirui
authors.forename: Peter W
authors.initials: PW
authors.lastname: Gething
authors.forename: Feiko O
authors.initials: FO
authors.lastname: ter Kuile
authors.forename: Robert W
authors.initials: RW
authors.lastname: Snow
mesh_terms: D000293:Adolescent; D000328:Adult; D017954:Africa South of the Sahara / Q000453:epidemiology; D000962:Antimalarials / Q000008:administration & dosage / Q000627:therapeutic use; D004338:Drug Combinations; D005260:Female; D006801:Humans; D057148:Insecticide-Treated Bednets; D008288:Malaria / Q000453:epidemiology / Q000517:prevention & control*; D008875:Middle Aged; D009032:Mosquito Control / Q000379:methods*; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000517:prevention & control*; D011739:Pyrimethamine / Q000008:administration & dosage / Q000627:therapeutic use; D013413:Sulfadoxine / Q000008:administration & dosage / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000962:Antimalarials; D004338:Drug Combinations; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D011739:Pyrimethamine