Efficacy of dihydroartemisinin-piperaquine to prevent malaria and complication-related malaria during pregnancy compared to sulfadoxine-pyrimethamine: a systematic review, meta-analysis, and meta-regression.

Abstract

This study aimed to evaluate the efficacy of DHP as an alternative to SP for the prevention of malaria and malaria-related complications during pregnancy. A systematic review and meta-analysis were conducted using pooled effect sizes extracted from published studies. Compared to SP, DHP significantly reduced maternal malaria infection by 78% (RR 0.22, 95% CI: 0.09-0.55), placental malaria infection by 73% (RR 0.27, 95% CI: 0.08-0.98), and maternal anaemia by 16% (RR = 0.84, 95% CI: 0.79-0.89). Women randomized to the DHP arm had a 28% lower risk of foetal loss (RR 0.72, 95% CI: 0.40-1.31), a 4% lower risk of low birth weight (RR 0.96, 95% CI: 0.69-1.32), and a 17% lower risk of preterm births compared with those receiving SP (RR 0.83, 95% CI: 0.61-1.13), though the reduction was not statistically significant. Therefore, DHP appears to be more effective than SP as IPTp therapy for reducing maternal malaria infection, placental malaria infection, and maternal anaemia. However, this study does not significant advantage of DHP over SP in reducing adverse birth outcomes.