Results
A total of 10,364 articles were identified initially. After removing
10324 articles, of which 4284 were duplicates, 4191 articles were
screened out through title review and 1849 through abstract review, 30
articles were still for further consideration. After excluding 25
studies, the full-text articles of five studies were included in final
synthesis (the reasons for their exclusion were given in Figure 1).
Five included RCTs were conducted in 2019, 2018, 2016, 2016, and 2015
respectively and in areas of high malaria-transmission intensity.
A total of 4660 HIV-seronegative
pregnant were included in this meta-analysis, 2628 in DP groups, 2032 in
SP groups (Table 1 presented the characteristics of the included
articles). All participants received long-lasting insecticide-treated
nets (LLINs) at enrolment. Each dose of DP consists of 40 mg of
dihydroartemisinin and 320 mg of piperaquine which was given with a
standard 3-d course. SP was composed by 500 mg of sulfadoxine and 25 mg
of pyrimethamine per dose. In all five studies, Mwayiwawo
Madanitsa22 compared IPTp-SP with ISTp-DP, where study
participants made scheduled antenatal visits every 4–6 weeks
(IPT-SP-4-6w). Abel Kakuru,
M.D.14 and Prasanna
Jagannathan23 compared
IPTp-SP with two IPTp-DP regimens: one was monthly IPTp-DP regimen
(IPT-DP-4w) from 16 or 20 GA, another IPTp-DP group received DP at 20,
28, and 36 GA (IPT-DP-8w). Richard Kajubi24 compared
IPTp-SP with IPTp-DP, every 4 weeks starting at 16 or 20 GA(IPT-DP-4w
and IPT-SP-4w). Meghna
Desai13 compared
IPTp-SP with IPTp-SP and ISTp-DP. The study participants were enrolled
at 16–32 GA and IPTp groups received the interventions at intervals of
4–6 weeks (IPT-DP-4-6w and IPT-SP-4-6w). In subgroup analysis,
we treated 4w as 4-6w when comparing
IPT-DP with IPT-SP.
Risk of bias based on the Cochrane Collaboration tool were presented in
figure 2 and figure 3. All the five studies were randomized controlled
trials and had similar group characteristics at baseline13,
14,
22-24. Of the five included studies,
four had random sequence generation, allocation concealment and
selective reporting 13,
22-24. Two mentioned the blinding of
outcome assessment13,
22 and the blinding of participants and
personnel23,
24. Only one study had the unclear risk
of selective
reporting22. No studies
had incomplete outcome data and other bias.