Background The burden of MiP remains high with adverse effects on the health of both women and their offspring. In endemic areas, pregnant women are generally asymptomatic with low parasitemia which can be missed by malaria RDTs, but affecting the pregnancy course. We postulate that proactive screening with highly-sensitive RDTs (HS-RDT) and treatment of those found infected using dihydroartemisinin piperaquine (DP), in addition to standard intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) could improve maternal and infant health.

Methods Pregnant women with gestational age of 16 to 24 weeks were randomized to receive screening and treatment with DP and IPTp-SP or IPTp-SP alone until delivery. Biological samples were collected for participant management and study purposes. Primary and secondary end- points were the prevalence of placental malaria, maternal anemia, maternal peripheral infection, and low birth weight.

Results Malaria infection was detected in almost one on four (1/4) of the pregnant women at recruitment. No difference was found between study arms in terms of placental malaria infection (adjusted odds ratio, 1.54 [95% confidence interval, 0.95–2.53]; P = 0.082). At delivery, the prevalence of peripheral maternal infection was slightly lower in the intervention group compared to the one of the control group but the difference was not statistically significant. Increasing number of IPTp-SP doses was associated with a significantly lower risk of peripheral malaria infection and low birth weight.

Conclusion Pregnant women should initiate antenatal care as soon as possible in order to fully benefit of malaria preventives measures. Strategies addressing late attendance to ANC with early start of IPTp-SP among eligible pregnant women should be developed and implemented.

Funding: This project is part of the EDCTP2 programme supported by the European Union (grant number TMA2018CDF-2397-ASSER MALARIA)