Changing the policy for intermittent preventive treatment with sulfadoxine–pyrimethamine during pregnancy in Malawi

Abstract

BackgroundThe growing resistance of Plasmodium falciparum to sulfadoxine–pyrimethamine (SP) treatment for uncomplicated malaria led to a recommendation by the World Health Organization for the use of artemisinin-based combination therapy. Inevitably, concerns were also raised surrounding the use of SP for intermittent prevention treatment of malaria during pregnancy (IPTp) amidst the lack of alternative drugs. Malawi was the first country to adopt intermittent prevention treatment with SP in 1993, and updated in 2013. This case study examines the policy updating process and the contribution of research and key stakeholders to this process. The findings support the development of a malaria research-to-policy framework in Malawi.MethodsDocuments and evidence published from 1993 to 2012 were systematically reviewed in addition to key informant interviews.ResultsThe online search identified 170 potential publications, of which eight from Malawi met the inclusion criteria. Two published studies from Malawi were instrumental in the WHO policy recommendation which in turn led to the updating of national policies. The updated policy indicates that more than two SP doses, as informed by research, overcome the challenges of the first policy of two SP doses only because of ineffectiveness by P. falciparum resistance and the global lack of replacement drugs to SP for IPTp.ConclusionInternational WHO recommendations facilitated a smooth policy change driven by motivated local leadership with technical and financial support from development partners. Policy development and implementation should include key stakeholders and use local malaria research in a research-to-policy framework.

Uptake of intermittent preventive treatment for malaria during pregnancy with Sulphadoxine-Pyrimethamine in Malawi after adoption of updated World Health Organization policy: an analysis of demographic and health survey 2015–2016

“…In October 2012, however, WHO updated the policy to at least three doses after acknowledgement from Evidence Review Group (ERG) that reviewed research evidence on the efficacy of IPTp-SP and its adverse outcomes in preventing MiP [21][22][23][24][25][26]. The updated policy further says that IPTp with SP should be administered at each antenatal visit, with the first dose to be given early in the second trimester and successive doses to be administered at monthly intervals until the time of delivery [27]. Malawi adopted the updated policy in 2013 [28].…”

Development of a framework to improve the utilisation of malaria research for policy development in Malawi

“…The development of the framework was based on lessons drawn from two case studies [ 22 , 23 ] and an assessment of facilitating factors and barriers to malaria research utilisation in policy development in Malawi [ 24 ]. The methodologies for these studies can be accessed from the respective publications.…”

Uptake of Intermittent Preventive Treatment for Malaria during Pregnancy with Sulphadoxine-Pyrimethamine (IPTp-SP) in Malawi after adoption of updated World Health Organization policy: An Analysis of Demographic and Health Survey 2015-2016

“…In October 2012, however, WHO updated the policy to at least three doses after acknowledgement from Evidence Review Group (ERG) that reviewed research evidence on efficacy of IPTp-SP and its adverse outcomes in preventing MiP [20][21][22][23][24][25]. The updated policy further says that IPTp with SP should be administered at each antenatal visit, with the first dose given early in the second trimester and successive doses administered at monthly intervals until the time of delivery [26]. Malawi adopted the updated policy in 2013 [27].…”

“…A total of 27,516 households were selected, of which 26,564 were occupied. Among the occupied households, 26,361 were interviewed (99% response). From the interviewed households, 25,146 eligible women were identified for individual interviews and only 24,562 women were successfully interviewed (98% response).…”