What Works for Women and Girls

spraying for HIV-positive women who are at risk for malaria and on the impact of DDT onimmunocompromised women. “Additional research is needed to understand the effects ofDDT/E on the immune system and associated diseases, especially since DDT is used in areaswhere there are often high rates of HIV” (Eskanzi et al., 2009: 25). ITNs are as effective asindoor residual spraying (Yartey, 2006), as long as ITNs are used consistently and appropriately(Robson, 2009).Intermittent Preventive Treatment (IPT) Is an Important Strategy in ReducingMalaria in Pregnant WomenA Cochrane review of six trials involving 2,495 pregnant women having their first or secondbabies found that antimalarial medications given routinely to women in their first or secondpregnancy reduced parasite prevalence and placental malaria. The treatment also had positiveeffects on birth weight and possibly on perinatal death. Treatment must be balanced, however,against drug adverse effects, and against risks of the malaria parasite developing resistance tothese drugs (Garner and Gülmezoglu, 2006). More research is also needed on the potentialinteractions of IPT and antiretroviral medications, particularly during pregnancy (Uneke andOgbonna, 2009).What Works—Preventing, Detecting and Treating Critical Co-Infections: Malaria1. Co-trimoxazole prophylaxis, antiretroviral therapy and ITNs can reduce the incidenceof malaria in women living with HIV by 95%.2. Monthly doses of Intermittent Preventive Treatment (IPT) of malaria with sulfadoxinepyrimethamine(SP) is effective in preventing malaria among pregnant HIV-positivewomen (but should not be combined with co-trimoxazole).Promising Strategies:3. PCR has a higher sensitivity to detect malaria co-infection in HIV-positive and HIVnegativepregnant women.EVIDENCE1. Co-trimoxazole prophylaxis, antiretroviral therapy and ITNs can substantially reduce theincidence of malaria in women living with HIV.A meta-analysis of studies assessing the impact of use of insecticide treated bednets(ITNs) on pregnant women found that use of ITNs compared to no use reducedplacental parasitemia (malaria parasites in the placenta) by 23% and miscarriages and280 CHAPTER 10 PREVENTING, DETECTING AND TREATING CRITICAL CO-INFECTIONS