Just a short article for my post-doc application.. , thanks to Mbak Icha, Mbak Dzerlin dan Mbak Puput

Malaria remains important public health and economic problem. Studies confirmed that malaria hinders economic growth (Gallup and Sachs, 2001; Sarma et al., 2019). Globally, malaria contributes to 1.8% of total DALYs and 1.28% and 0.6% of total DALYs in West Papua and Papua, Indonesia (IHME, 2019). Between 2009 and 2019, the Annual Parasite Incidence (API) in Indonesia decreased from 1.8 to 0.93 per 1000 population, with total spending of around 120 million USD annually (Kemenkes, 2020; IHME, 2020). High endemic incidence provinces are in Papua and Papua Barat, 64.03 and 7.38 per 1000 population (Kemenkes, 2020). Indonesia is in top-five ranked countries with 6.3 million pregnancies exposed to malaria annually (Dellicour et al., 2010).

Efforts have been done to control malaria morbidity and mortality, including curative and preventive. World Health Organizations (WHO) recommended intermittent preventive treatment in pregnancy (IPTp) based on the systematic review in Africa (Kayentao et al., 2013; World Health Organization, 2015). The study showed that IPTp with sulfadoxine-pyrimethamine (SP) reduced low-birth-weight infants, placental parasitemia and maternal parasitaemia (Kayentao et al., 2013). IPTp-SP as part of antenatal care, with dosing start in the second trimester and doses should be given at least 1 month apart, to get at least three doses are received (World Health Organization, 2015).

To have a better understanding of IPTp of malaria we did a rapid literature review from PubMed database. We combined the search concepts of ‘pregnancy’, ‘intermittent preventive treatment’ and ‘malaria’ from 2013. A total of 30 randomized control trials articles included. Studies were mostly conducted in Sub-Saharan Africa (93%) and only 7% in East Asia & Pacific. These articles covered a wide range of IPTp interventions. The issues were the increasing IPTp-SP resistance and contra-indicated in pregnant women with HIV. Therefore, studies were looking for alternatives such as dihydroartemisinin-piperaquine (DP) or mefloquine (MQ). Studies showed IPTp-SP to be superior to IPTp-DP (Madanitsa et al., 2016; Wallender et al., 2019; COSMIC Consortium, 2019; Roh et al., 2020). On the other hand, we found studies with opposite conclusions (Desai et al., 2015; Kakuru et al., 2016). Also, we found no significant differences between IPTp-SP and IPTp-DP (Kakuru et al., 2020). Mixed results also found in IPTp-MQ, where IPTp-MQ was superior (Briand et al., 2015), inferior (González, Mombo-Ngoma, et al., 2014; González, Desai, et al., 2014), or comparable (Green et al., 2016; Akinyotu et al., 2018; Huijben et al., 2020). The potential alternative to IPTp is the intermittent screening and treating of positive women with artemether-lumefantrine (IST-AL) (Pell et al., 2014; Tagbor et al., 2015); cotrimoxazole prophylactic treatment (CPT) for HIV-positive (Dow et al., 2013; Denoeud-Ndam et al., 2014; Klement et al., 2014; Natureeba et al., 2017); and azithromycin (Abdus-Salam et al., 2016; Akinyotu et al., 2019). In the Asia Pacific region, especially Indonesia, malaria prevention is still carried out by single screening and treatment (SST). The use of IPTp-DP has more promising results in controlling the incidence of malaria than SST (Ahmed et al., 2019).

Despite the high efficacy of IPTp, it is not necessarily to be effective in the real world. There are several challenges, including the unavailability of Rapid Diagnostic Test (RDT), health workers are poorly trained, and do not have the authority to prescribe medicines (Hoyt et al., 2018; Hill et al., 2018). Also, no behavioural changes to have outdoor activities at night time which increase the risk to be infected (Rahmawaty, 2016). Therefore, ANC as a group improves compliance with the IPTp-SP program compared to individual ANCs. The reasons are group interaction, knowledge sharing among peers, and addressing obstacles to care-seeking behaviour (Noguchi et al., 2020).

Further research is needed to identify the best choice of drugs, including cost-effectiveness analysis (Sicuri et al., 2010; Fernandes et al., 2020); and determining interventions that can improve and expand the coverage of IPTp programme to the most vulnerable population (Roman et al. 2019).