Abstract:
BACKGROUND : The growing resistance of Plasmodium falciparum to sulfadoxine–pyrimethamine (SP) treatment for
uncomplicated malaria led to a recommendation by the World Health Organization for the use of artemisinin-based
combination therapy. Inevitably, concerns were also raised surrounding the use of SP for intermittent prevention
treatment of malaria during pregnancy (IPTp) amidst the lack of alternative drugs. Malawi was the first country to
adopt intermittent prevention treatment with SP in 1993, and updated in 2013. This case study examines the policy
updating process and the contribution of research and key stakeholders to this process. The findings support the
development of a malaria research-to-policy framework in Malawi.
METHODS : Documents and evidence published from 1993 to 2012 were systematically reviewed in addition to key
informant interviews.
RESULTS : The online search identified 170 potential publications, of which eight from Malawi met the inclusion criteria.
Two published studies from Malawi were instrumental in the WHO policy recommendation which in turn led to
the updating of national policies. The updated policy indicates that more than two SP doses, as informed by research,
overcome the challenges of the first policy of two SP doses only because of ineffectiveness by P. falciparum resistance
and the global lack of replacement drugs to SP for IPTp.
CONCLUSION : International WHO recommendations facilitated a smooth policy change driven by motivated local
leadership with technical and financial support from development partners. Policy development and implementation
should include key stakeholders and use local malaria research in a research-to-policy framework.
