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NUMBER/PERCENT OF WOMEN AGED 15-49 WHO RECEIVED TWO OR MORE DOSES OF
IPTP DURING THEIR LAST PREGNANCY
Definition:
This population-based indicator measures, among the women surveyed aged 15-49 who delivered a live birth
within the last two years, the percent who received two or more doses of intermittent preventive treatment in
pregnancy (IPTp), at least one of which was received during an antenatal care (ANC) visit, to prevent malaria during
their last pregnancy.
As a percent, this indicator is calculated as:
(Number of women aged 15-49 who received two or more doses of IPTp, at least one of which was received during
an ANC visit, to prevent malaria during their last pregnancy that led to a live birth within the last two years / Total
number of women surveyed who delivered a live baby within the last two years) x 100
Data Requirements:
Number of women surveyed who delivered a live baby within the last two years; number of IPTp doses received by
these women; location of where the IPTp doses were received
Because of the limited number of women who delivered a live baby within the previous two years, care should be
taken to ensure surveys are conducted with sufficient sample size and designed to allow comparisons among
regions and urban/rural strata at the individual level.
Data from the women’s questionnaires for all women who delivered a live baby within the last two years within
surveyed household are used to calculate the denominator. The numerator is derived from the number of women
who have delivered in the last two years who mention taking antimalarials for prevention (not treatment) during
their most recent pregnancy, at least one of the doses being provided at an ANC visit.
Data Sources:
Household surveys
If the data source is facility-based, evaluators should use the indicator, Number/percent of pregnant women who
received two or more doses of IPTp while attending antenatal care.
Purpose:
In areas of stable (high) malaria transmission, IPTp with two to three doses of the recommended antimalarial
medicine during pregnancy has been shown to reduce the risk for severe maternal anemia, placental parasitemia
and low birth weight significantly. Therefore, WHO recommends that all pregnant women in areas of stable
malaria transmission receive at least two doses of IPTp after quickening, the first noted movement of the fetus
(WHO, 2004). WHO recommends a schedule of four antenatal clinic visits, with three visits after quickening. IPTp at
each scheduled visit after quickening, but not more than monthly, will ensure that a high proportion of women
receive at least two doses.
Currently, the recommended drug for IPTp is sulfadoxine–pyrimethamine (also known as Fansidar®) because it is
safe for use during pregnancy, effective in women of reproductive age and can be delivered as a single dose under
observation by a health worker. But research to assess the safety, efficacy and program feasibility of other
antimalarials in IPTp is under way.
This indicator measures access to IPTp among pregnant women in surveyed area.
Issue(s):
Data on IPTp coverage at the national level can be misleading in countries with mixed transmission patterns, as
malaria transmission is often localized and IPTp might not be implemented in all areas of the country. Therefore,
the indicator should be calculated only for areas in which the IPTp strategy is implemented.
In household surveys, this indicator is subject to recall bias as some women may be unable to remember if they
received IPTp during their last pregnancy or what type of antimalarial was given. Additionally, household surveys
do not typically measure whether each dose of IPTp was given during ANC visits. At best, it can only be used to
determine whether at least one of the doses received was given during an ANC visit.
In order to obtain accurate data for this indicator, it is also important to differentiate between a treatment dose
for prevention (as prescribed for IPTp) and actual treatment of an existing malaria infection. Although it is
extremely difficult to differentiate in the context of a survey interview, the latter is curative care, and does not
count as standard IPTp procedure. Similarly, women taking weekly chloroquine prophylaxis are not considered to
be covered by IPTp.
Gender Implications:
The unequal balance of power between men and women and inequitable access to health care and financial
resources as a result of gender and other social inequalities paves the way for women’s vulnerability to malaria
and other infectious diseases. It also affects women’s ability to respond appropriately and access prevention and
treatment efforts where available (Roll Back Malaria Partnership, 2006).
References:
WHO. Malaria in Pregnancy: Guidelines for measuring key monitoring and evaluation indicators. 2007.
Roll Back Malaria Partnership. A Guide to Gender and Malaria Resources. 2006.
Roll Back Malaria Partnership. Guidelines for Core Population-Based Indicators. MEASURE Evaluation: Calverton,
MD. 2011.