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.