Intermittent preventive treatment with dihydroartemisinin-piperaquine: a new malaria strategy to prevent adverse birth outcomes in Papua, Indonesia

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Reducing the adverse outcomes of malaria in pregnancy in IndonesiaThe control of malaria in pregnancy in Indonesia, where approximately 10% of pregnant women get infected with malaria, could receive a potential boost through a new study in Papua, Indonesia. A partnership between the Liverpool School of Tropical Medicine (UK) and the Timika Research Facility in Papua Indonesia will conduct a holistic evaluation of a promising new drug-based regimen for preventing malaria and its harmful effects in pregnancy. When pregnant women contract malaria, the infection can have devastating consequences for pregnancy, resulting in fever which may trigger the preterm onset of labour or even pregnancy loss. It is also possible for women to be infected without showing any outward signs or symptoms, yet if these infections are undetected and left untreated, they can cause severe anaemia in the mother and can interfere with the growth of the fetus leading to low birth weight, which makes babies more vulnerable to infections, growth retardation and dying during the first year of life.The new study will support the Indonesian Ministry of Health to identify the best way to deliver a new preventive regimen for the control of malaria in pregnancy called intermittent preventive treatment or IPT for short. IPT is used in most countries in Africa but not yet in Asia. With this IPT strategy, pregnant women without symptoms of malaria attending routine antenatal care in selected health facilities in Papua, Indonesia, will receive monthly treatment with a long-acting antimalarial drug called dihydroartemisinin-piperaquine (DP) that provides four weeks of prophylaxis after each dose. Currently women are screened for malaria at their first antenatal care visit and women are treated with DP only if tested positive. In the new strategy, women will receive the drug as monthly prophylaxis without prior blood testing for malaria parasites. A recent trial in Indonesia has shown that this intervention, when taken as directed, is very effective in preventing malaria in expectant mothers. However, the concept of using drugs for prevention by women who do not have malaria symptoms is new to this region. Indeed, this would be the first time that the IPT strategy would be used in South East Asia. The study is designed to find the best ways for the Ministry of Health to introduce and deliver this new intervention and use stepwise quality improvement approaches to understand what worked, for whom, and why during each step in the implementation phase to help improve delivery of the new intervention and quality of service provision on an ongoing basis. Opportunities to bring the intervention close to the community through health posts where most women receive antenatal care will be strengthened. The study will also determine the costs and cost-effectiveness of the new strategy, compared with the current strategy, to inform policy decision making for malaria prevention among pregnant women in Indonesia. This will also be of relevance to other parts of South East Asia. It is anticipated that the study, by increasing the effectiveness of malaria prevention, has the potential to increase the provision and uptake of additional ANC services that prevent other causes of adverse birth outcomes in pregnancy. The final study results will be shared with the local offices of the Ministry of Health and the National malaria, and reproductive health departments in Indonesia to inform policy decision making for rolling out the strategy. The study will thereby contribute to improved outcomes for mothers and their infants in Indonesia, whose quality of life, health and creative output will be enhanced.This will be a 32-month study, six months for study preparation, 22 months field work, data collection and data processing, and four months to conclude analysis and reporting.