An open letter to world leaders
A staggering 12 million pregnant women in sub-Saharan Africa were infected with malaria in 2019.1 The effects were widespread and included:
Severe disease among pregnant women2 and approximately 10,000 maternal deaths.3
164,000 stillbirths, accounting for 20% of all stillbirths.4
100,000 newborn deaths, accounting for 11% of neonatal mortality.5
822,000 children born with low birthweight,6 which puts babies at higher risk of death, and lifelong disability.7
These outcomes could have been averted with three simple, life-saving interventions.
The World Health Organization (WHO) currently recommends that all pregnant women sleep under an insecticide-treated bednet and receive prompt diagnosis and effective treatment of malaria cases. In addition, a cost-effective tool exists to stop the malaria parasite in its devastating path: Intermittent Preventive Treatment in pregnancy (IPTp) with quality-assured sulfadoxine-pyrimethamine (SP), or IPTp-SP. IPTp-SP is recommended by the WHO for all eligible pregnant women in malaria-endemic areas in Africa. IPTp-SP has been proven to reduce neonatal mortality,8 the number of babies born with a low birthweight,9,10 and maternal anaemia, which is associated with a higher risk of maternal death.11
Pregnant women are particularly vulnerable to malaria infection and need to be prioritized in the response to this disease. Unfortunately, they are often forgotten. In 2020, more than two thirds of eligible pregnant women across sub-Saharan Africa did not receive the recommended three doses of IPTp-SP.12 While uptake has improved slowly in the last decade, it has remained low compared to other malaria-control interventions and falls far short of global targets.
To address this gap in service provision, the RBM Partnership to End Malaria launched a Call to Action in 2015 as well as a renewed appeal to Speed Up Scale-Up of IPTp in 2020.13 Our campaign reaches out to global and national leaders, donors, civil society groups, technical partners and researchers. We call on each to take the required steps to ensure all eligible pregnant women in malaria-endemic regions in sub-Saharan Africa receive at least three doses of IPTp with SP as soon as possible—and at the latest by 2030.
With this letter, we urge global and national decision-makers to lead the way by supporting the following actions:
Provide sufficient funding to address malaria in pregnancy
Ensure adequate quantities of quality-assured SP are available at health facilities
Train antenatal care facility staff to provide quality services to meet women’s comprehensive needs
Promote early ANC attendance and timely IPTp-SP uptake at community level
Remove fees and address other barriers to seeking care.
In the context of the COVID-19 pandemic, the call to Speed Up Scale-Up of IPTp coverage is even more urgent than ever. This crisis in global health highlights that we must be more collaborative and creative to stem the tide of both emerging and existing health threats, while ensuring the most vulnerable populations are not overlooked and can get the prevention and treatment they need. This will be key to achieving Universal Health Coverage by 2030 and ensuring no-one is left behind.
There is reason to be hopeful: the last two decades have demonstrated the power of partnership in reversing the course of an ancient disease. Since the turn of the millennium, global and national actors from a wide variety of sectors set ambitious joint goals, worked together and successfully cut the malaria death rate by half.14 Change is possible.
Together, we can scale up delivery of this key intervention, dramatically improve the lives of mothers and babies, and help to end malaria—for good, and for all, leaving no-one behind.
So, let’s Speed Up Scale-Up of IPTp. Zero Malaria starts with all of us.
1 World Health Organization. World Malaria Report 2020.
3 Roman et al. ‘Determinants of uptake of intermittent preventive treatment during pregnancy: a review.’ Malaria Journal. 2019; 18:372
4 UNICEF, WHO, World Bank Group and United Nations. Levels and Trends in Child Mortality. September 2020.
5 Roman et al. ‘Determinants of uptake of intermittent preventive treatment during pregnancy: a review.’ Malaria Journal. 2019; 18:372
6 World Health Organization. World Malaria Report 2020.
8 Saito M, Briand V et al. Deleterious effects of malaria in pregnancy on the developing foetus: a review on prevention and treatment with antimalarial drugs. Lancet Child and Adolescent Health. Volume 4, ISSUE 10, P761-774, October 01, 2020.
9 World Health Organization. World Malaria Report 2021.
11 World Health Organization. World Malaria Report 2019.
12 World Health Organization. World Malaria Report 2021
13 Renewing the Call to Action: Act Now to Save Lives: Increase IPTp Coverage! RBM Partnership to End Malaria
14 World Health Organization. World Malaria Report 2021.