Effectiveness of Intermittent Preventive Treatment With Dihydroartemisinin?Piperaqunine Against Malaria in Pregnancy in Tanzania: A Randomized Controlled Trial

Intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) to prevent malaria and adverse birth outcomes is threatened by Plasmodium falciparum resistance sulfadoxine-pyrimethamine. We investigated the effectiveness of intermittent monthly dihydroartemisinin-piperaquine (IPTp-DHP) as an alternative option IPTp-SP. A total 956 malaria-free (malaria rapid diagnostic test (MRDT) negative) pregnant women from moderate transmission areas Tanzania were enrolled randomized receive IPTp-DHP (n = 478) or IPTp-SP followed for maternal outcomes. The primary outcome was prevalence histopathologically confirmed placental (active past infection). Secondary overall at delivery, symptomatic-malaria, parasitemia during pregnancy, a composite spontaneous-abortion, premature birth, stillbirth, low weight (LBW) fetal anemia. Outcome differences between groups expressed protective efficacy (PE), defined 1-prevalence ratios 1-incidence rate ratio. significantly lower (2.5%, 12/478) than (8.2%, 39/478); PE 69% (95% confidence interval (CI): 42–84, P < 0.001). delivery (8.2%) (18.2%, incidence per person-years risk symptomatic-malaria (0.02 vs. 0.12, 0.002) (0.28 0.67, 0.001) group group. any (composite) not (P 0.06) different (17.9%) (23.8%). However, LBW (4.6% 9.6%, 0.003) compared report superior against