INTEGRATION: Leveraging community platforms to improve malaria prevention in pregnancy

Malaria in pregnancy remains a major public health challenge in sub-Saharan Africa. The World Health Organization (WHO) recommends intermittent preventive treatment in pregnancy (IPTp) with sulphadoxine-pyrimethamine (SP), yet coverage of the recommended three or more doses (IPTp3+) remains low in many countries. By contrast, Seasonal Malaria Chemoprevention (SMC) for children has achieved high coverage across the Sahel region through monthly door-to-door delivery by community health workers.

The INTEGRATION project evaluated whether delivering IPTp-SP through existing SMC strategies could increase IPTp uptake and antenatal care (ANC) attendance in Mali and Burkina Faso. This cluster-randomised implementation trial compared standard ANC delivery with an integrated approach that combined ANC and community-based IPTp delivery during SMC rounds.

The study showed that the integrated strategy significantly increased IPTp3+ coverage from 59% in the control arm to 79% in the intervention arm in Mali, and improved ANC attendance. In Burkina Faso, where baseline IPTp coverage was already high, no significant differences were observed between study arms.

Cost-effectiveness analyses were conducted to inform national decision-making. Overall, results suggest that integrating IPTp delivery into SMC systems can be an effective strategy in settings with low IPTp coverage. By generating rigorous evidence on an innovative delivery strategy, INTEGRATION provides policy-relevant insights for Sahelian countries seeking to close gaps in malaria prevention in pregnancy and improve maternal and newborn health outcomes. Study findings have been disseminated through national stakeholder meetings, international conferences, and a publication in The Lancet Global Health.

Visit the INTEGRATION project website for more information.