Number/percent of pregnant women who received two or more doses of IPTp while attending antenatal care
This facility-based indicator assesses the percent of women attending an antenatal care (ANC) visit who received two or more doses of intermittent preventive treatment in pregnancy (IPTp) to prevent malaria. Ideally, the doses should be administered under direct observation, although this is not always the case.
As a percent, this indicator is often broken down into first and second dose and is calculated as:
(Number of pregnant women who receive [IPTp1 or IPTp2] under observation / Total number of first antenatal clinic visits) x 100
Number of women attending antenatal clinic; number of IPTp doses received per woman
Data for this indicator should be collected at routine antenatal visits on an antenatal clinic register. To facilitate data collection and avoid duplication of work, the existing register should be modified to include columns to record the doses of IPTp (first, second or third) dispensed. The column for IPTp should not be marked if dosing is not observed directly. If no first dose is dispensed, the reasons should be marked in a column of the register designated for comments (e.g. stock-out, allergy, refusal, treatment for malaria illness, etc.). Antenatal clinic cards as well as maternity registers should also be adapted to include a record of the doses received. Treatment
received for acute malaria illness episodes during pregnancy should not be recorded as IPTp, which is administered for prevention. The antenatal clinic register should include a column for recording treatment of malaria illness episodes during pregnancy with the nationally recommended drug for pregnant women.
Health facility records If the data source is household surveys, evaluators should use the indicator Number/percent of women aged 15-49 who received two or more doses of IPTp during their last pregnancy.
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 both access to IPTp among pregnant women as well as service providers’ adherence to malaria in pregnancy protocols.
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, and and the number of women attending at least one antenatal visit in these areas should be used as the denominator.
Antenatal clinic data might be incomplete and not reflect the true situation in settings where a substantial number of women do not access antenatal care at all or have antenatal care at private clinics. Private clinics should be encouraged to provide IPTp to pregnant women according to national guidelines and maintain appropriate records.
Most women attend antenatal clinics for the first time during the second trimester and are therefore eligible for IPTp1 at that time. A few women, however, make their first antenatal visit during the first trimester, at which time they are not eligible for a first dose of treatment. The total number of first visits used as the denominator in this calculation is therefore an overestimate of the total number of women eligible for a first dose of treatment. Overestimations can also occur when re-attendance is incorrectly recorded as new attendance, or first visit.
access, quality, malaria, safe motherhood (SM)
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.