IPTpSP

IPTp-SP stands for intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine. It is a malaria prevention strategy used for pregnant women in areas with stable malaria transmission. The approach provides a full therapeutic dose of sulfadoxine-pyrimethamine at scheduled antenatal care visits, regardless of infection status, to reduce placental malaria, maternal anemia, low birth weight, and perinatal mortality.

Delivery is integrated into routine antenatal care. A standard dose consists of three fixed-dose tablets containing sulfadoxine 500 mg and pyrimethamine 25 mg each, given together under directly observed therapy. Doses are started after quickening (in the second trimester) and repeated at monthly intervals, with a minimum gap of about one month between doses. National guidelines typically recommend at least three doses during pregnancy, though the exact number may vary with transmission intensity and resistance patterns.

Effectiveness and safety: IPTp-SP reduces placental malaria and adverse pregnancy outcomes in many settings, though its efficacy declines where resistance to sulfadoxine-pyrimethamine is high. The regimen is generally well tolerated, but contraindications include known hypersensitivity to sulfa drugs or other severe reactions. It is not routinely given in the first trimester in many guidelines, due to safety considerations.

Implementation and challenges: IPTp-SP is a core component of malaria in pregnancy programs and is delivered through antenatal care and community outreach. Successful implementation depends on reliable drug supply, trained health workers, and high attendance at prenatal visits. In some areas, alternatives are studied or piloted where SP resistance or safety concerns limit use, but SP remains the standard in many guidelines.