The World Health Organization recommends insecticidal bednets and intermittent preventive treatment to reduce
malaria in pregnancy. Longitudinal data of
malaria prevalence and pregnancy outcomes are valuable in gauging the impact of these
antimalarial interventions.
METHODOLOGY/PRINCIPAL FINDINGS: We recruited 8,131 women delivering in a single Malawian hospital over 9 years. We recorded demographic data, antenatal prescription of intermittent preventive
therapy during pregnancy with
sulfadoxine-pyrimethamine and bed net use, and examined finger-prick blood for
malaria parasites and
hemoglobin concentration. In 4,712 women, we examined placental blood for
malaria parasites and recorded the infant's
birth weight. Peripheral and placental
parasitemia prevalence declined from 23.5% to 5.0% and from 25.2% to 6.8% respectively. Smaller declines in prevalence of low birth weight and
anemia were observed. Coverage of intermittent preventive treatment and bednets increased. Number of
sulfadoxine-pyrimethamine doses received correlated inversely with placental
parasitemia (Odds Ratio (95% CI): 0.79 (0.68, 0.91)), maternal
anemia (0.81, (0.73, 0.90)) and low birth weight from 1997-2001 (0.63 (0.53, 0.75)), but not from 2002-2006. Bednet use protected from peripheral
parasitemia (0.47, (0.37, 0.60)) and placental
parasitemia (0.41, (0.31, 0.54)) and low birth weight (0.75 (0.59, 0.95)) but not
anemia throughout the study. Compared to women without nets who did not receive 2-dose
sulfadoxine-pyrimethamine, women using nets and receiving 2-dose
sulfadoxine-pyrimethamine were less likely to have
parasitemia or low birth weight babies. Women receiving 2-dose
sulfadoxine-pyrimethamine alone had little evidence of protection whereas bednets alone gave intermediate protection.
CONCLUSIONS/SIGNIFICANCE: