Introduction
Malaria in pregnancy (MIP) is one of the serious global problems and the
morbidity was on the rise in some
localities1. Women are
under the higher risk of poor outcomes for malaria transmission during
pregnancy2. With proper
pregnancy-specific protections, most of
pregnant
women can avoid being
infected3.
The most effective protection was the combination of two antimalarials,
which acts at different biochemical sites and increases the useful
lifetime of the individual
drug4,
5. In sub-Saharan Africa, the World
Health Organization (WHO) currently recommends intermittent preventive
treatment with sulphadoxine-pyrimethamine (IPTp-SP) for HIV-seronegative
pregnant women to reduce
malaria6,
7. The IPTp-SP means at least twice
administration of a single curative dose of SP during pregnancy
regardless whether or not the woman is
infected8.
The effectiveness of SP, however, is threatened by increasing resistance
in eastern and southern
Africa9,
10. In fact, resistance is now common
against all classes of antimalarial drugs apart from artemisinins11. The proposed
alternative strategy to IPTp-SP consists of scheduled antenatal testing
with rapid diagnostic tests (RDTs) and the treatment of RDT-positive
women with artemisinin-based combination therapy (ACT), referred to as
intermittent screening and treatment in pregnancy (ISTp). The efficiency
and safety of intermittent screening and treatment with
dihydroartemisinin-piperaquine (ISTp-DP) had been assessed in many
studies12,
13 and the conclusions remained mixed.
Due to the high costs and some side effects, the use of DP in developing
countries had been
limited14,
15.
The objective of this systematic review and meta-analysis was to assess
the current latest evidence on the efficacy and safety of
DP versus SP for malaria in
pregnancy. Furthermore, we did subgroup analysis about different
intervals, including 4-6 or 8 weeks.