Estimating the impact of different intermittent preventative treatment in pregnancy delivery strategies on low birth weight outcomes under moderate and high malaria transmission setting: A modelling study

Introduction: Malaria during pregnancy is a major risk factor for low birth weight (LBW) in newborns, which in turn negatively affects the growth and development of the child. The World Health Organization (WHO) recommended interventions for pregnant women living in malaria endemic countries that include the use of intermittent preventive treatment in pregnancy (IPTp). However, WHO asserts that the coverage of pregnant women taking the recommended doses of IPTp are still very low. The primary goal of this study was to estimate the effects of increasing the coverage of doses of IPTp and to assess the effect of pregnancy timing in relation to seasonal transmission on malaria infections during pregnancy and neonates with LBW. We explored these effects in moderate and high transmission settings. Methods and Findings: A compartmental mathematical model depicting malaria during pregnancy with IPTp doses was formulated to analyze the effects of IPTp, insecticide treated net (ITN) use and seasonal variations in moderate and high malaria transmission settings. Our simulation findings suggest that increasing both ITN use and IPTp dose coverages to high levels, prevents 90% and 84% clinical cases for pregnancies starting in August in moderate and high transmission, respectively. Our model predicts that increasing the coverage of the first dose of IPTp to 90%, while lowering subsequent doses, averts 44% and 37% LBW cases for the August cohort in moderate and high transmission settings, respectively. Unprotected pregnancies overlapping the January peak in rainfall and malaria incidence during the third trimester experience the highest LBW burden. Conclusions: The highest IPTp coverage prevents the highest number of LBWs providing evidence of the benefits of scaling up IPTp. Overall, our results demonstrate that increasing ITN use has a substantial impact in reducing clinical malaria cases during pregnancy and improves birth outcomes. This highlights its importance as a key intervention, and the health benefits it would provide for malaria control goals for pregnant women. Pregnancies that overlap with the epidemic peaks in later trimesters lead to a rise in LBWs, indicating the necessity of protecting pregnant women at risk of malaria infection till delivery.