Do women attending antenatal clinics who use only intermittent preventive treatment (IPTp) have higher Plasmodium falciparum prevalence compared to those who used both IPTp and slept under insecticide-treated nets?

Background: As global malaria incidence continues to increase across sub-Saharan Africa, tightening usage of existing prevention strategies is crucial for protection of vulnerable populations. Nigeria alone accounted for more than a quarter of the 247 million cases in 2021. During pregnancy, Intermittent Preventive Treatment (IPTp) and use of Insecticide-treated nets (ITNs) are recommended for malaria prevention.

Methods: This study sought to determine whether the combined use of IPTp and ITNs offered better protection from Plasmodium falciparum infection compared to a single strategy alone. A cross-sectional study of 143 pregnant women was carried out among three hospitals across the southern and southeastern regions of Nigeria. IPTp and ITN usage was measured, and P. falciparum prevalence was determined by rapid diagnostic testing.

Results: Plasmodium falciparum was detected in 65 (45%) of participants; prevalence was higher among those who used only Intermittent Preventive Treatment (IPTp) (61.2%) compared to those who used both IPTp and slept under ITNs (17.0%). Logistic regression analyses adjusted for gestational week, income, and education revealed that those using IPTp alone were not significantly protected from infection, while those using IPTp and ITNs had 86% reduced odds of infection. This reduction in odds of infection appears to be driven largely by ITN.

Conclusions: The results affirm the vital role of ITN usage, both independently and in conjunction with IPT, in mitigating the risk of malaria during pregnancy. Efforts should focus on addressing access barriers, enhancing ITN dissemination through ANC services, and prioritizing educational campaigns highlighting the benefits of combined malaria prevention strategies.