Abstract

Malaria during pregnancy posed substantial risks to maternal and fetal health in sub-Saharan Africa, contributing 
to maternal anemia, placental parasitemia, low birth weight, and neonatal mortality. Intermittent preventive 
treatment in pregnancy with sulfadoxine-pyrimethamine represented a cornerstone intervention recommended by 
the World Health Organization for malaria-endemic regions. Community-based delivery of this intervention 
extended coverage beyond facility-based antenatal care, potentially reaching underserved populations with limited 
healthcare access. This review evaluated the efficacy of community-based intermittent preventive treatment 
compared to facility-based delivery and examined factors influencing effectiveness across diverse sub-Saharan 
African settings. A comprehensive synthesis of randomized controlled trials, cohort studies, and implementation 
research conducted across sub-Saharan Africa over the past fifteen years was performed. Community-based delivery 
substantially increased coverage of intermittent preventive treatment, particularly among rural and marginalized 
women, resulting in improved maternal hemoglobin concentrations, reduced placental malaria, and higher mean 
birth weights. Effectiveness varied by transmission intensity, sulfadoxine-pyrimethamine resistance patterns, HIV 
prevalence, and quality of community health worker training. Operational challenges included drug supply chain 
reliability, adherence monitoring, and integration with existing antenatal care systems. Community-based 
intermittent preventive treatment demonstrated significant efficacy for improving pregnancy outcomes in sub
Saharan Africa, but programmatic success required context-specific adaptation, robust pharmaceutical supply 
systems, and sustained investment in community health infrastructure.