The burden of malaria-attributable maternal anemia and the impact of IPTp across sub-Saharan Africa

The burden of malaria-attributable maternal anemia and the impact of IPTp across sub-Saharan Africa | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article The burden of malaria-attributable maternal anemia and the impact of IPTp across sub-Saharan Africa Patrick Walker, Sequoia Leuba, Robert Verity, Julie Gutman, Daniel Weiss, and 17 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7179149/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 25 Feb, 2026 Read the published version in Nature Health → Version 1 posted You are reading this latest preprint version Abstract Plasmodium falciparum infection during pregnancy is a major contributor to maternal anemia, a leading risk factor for postpartum hemorrhage and maternal death. Yet the scale of malaria-attributable anemia is poorly quantified. We analyzed individual-level hemoglobin data from 12,608 pregnancies across seven African countries and integrated these with gravidity-specific models of malaria exposure and immunity. We estimate that in 2023, 13.1 million pregnancies in endemic African regions were exposed to P. falciparum, resulting in 2.41 million [95% credible interval: 1.98–3.04] cases of moderate or severe anemia, including 600,000 [408,000–906,000] severe cases. The burden was highest in primigravidae and declined with acquired immunity. Intermittent preventive treatment with sulfadoxine–pyrimethamine (IPTp-SP) averted 330,000 [225,000–523,000] severe anemia cases. However, falling transmission has led to a rise in multigravidae without prior exposure, heightening future vulnerability. Sustaining IPTp coverage is critical to prevent resurgence in severe maternal anemia as global malaria funding falters. Health sciences/Diseases/Infectious diseases/Malaria Health sciences/Diseases/Haematological diseases/Anaemia Health sciences/Health care/Public health/Epidemiology Health sciences/Health care/Health policy Full Text Additional Declarations There is NO Competing Interest. Cite Share Download PDF Status: Published Journal Publication published 25 Feb, 2026 Read the published version in Nature Health → Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7179149","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":491995263,"identity":"411fec1e-0d6d-407f-861b-30def6fd24fe","order_by":0,"name":"Patrick Walker","email":"data:image/png;base64,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","orcid":"https://orcid.org/0000-0002-9596-9628","institution":"Imperial College London","correspondingAuthor":true,"prefix":"","firstName":"Patrick","middleName":"","lastName":"Walker","suffix":""},{"id":491995264,"identity":"0d43268b-4733-4d75-90a5-55863a0ec623","order_by":1,"name":"Sequoia Leuba","email":"","orcid":"","institution":"London School of Hygiene and Tropical Medicine","correspondingAuthor":false,"prefix":"","firstName":"Sequoia","middleName":"","lastName":"Leuba","suffix":""},{"id":491995265,"identity":"bf6f4856-726b-4284-8a0c-a14ee7c74ae5","order_by":2,"name":"Robert Verity","email":"","orcid":"https://orcid.org/0000-0002-3902-8567","institution":"Imperial College London","correspondingAuthor":false,"prefix":"","firstName":"Robert","middleName":"","lastName":"Verity","suffix":""},{"id":491995266,"identity":"df072a80-f5fc-466a-9fe9-cc8deef6dc5e","order_by":3,"name":"Julie Gutman","email":"","orcid":"https://orcid.org/0000-0001-6769-7322","institution":"Centers for Disease Control and Prevention","correspondingAuthor":false,"prefix":"","firstName":"Julie","middleName":"","lastName":"Gutman","suffix":""},{"id":491995267,"identity":"bd44c921-710f-4af6-b766-27357d7a965c","order_by":4,"name":"Daniel Weiss","email":"","orcid":"","institution":"Malaria Atlas Project, Telethon Kids Institute, Perth Children’s Hospital","correspondingAuthor":false,"prefix":"","firstName":"Daniel","middleName":"","lastName":"Weiss","suffix":""},{"id":491995268,"identity":"b20876bf-d6c4-4910-9044-b019032db165","order_by":5,"name":"Matt Cairns","email":"","orcid":"https://orcid.org/0000-0003-1068-9713","institution":"Imperial College London","correspondingAuthor":false,"prefix":"","firstName":"Matt","middleName":"","lastName":"Cairns","suffix":""},{"id":491995269,"identity":"470dd8b1-cbe4-45b1-8c57-ea4cdad7442b","order_by":6,"name":"John Williams","email":"","orcid":"","institution":"Dodowa Health Research Centre","correspondingAuthor":false,"prefix":"","firstName":"John","middleName":"","lastName":"Williams","suffix":""},{"id":491995270,"identity":"4d644d28-d201-4091-a42b-f0e1b90647f2","order_by":7,"name":"Carole Khairallah","email":"","orcid":"","institution":"Liverpool School of Tropical Medicine","correspondingAuthor":false,"prefix":"","firstName":"Carole","middleName":"","lastName":"Khairallah","suffix":""},{"id":491995271,"identity":"f818d396-4f84-4583-a8f1-7f750355535c","order_by":8,"name":"Kalifa Bojang","email":"","orcid":"","institution":"MRC Unit, The Gambia at London School of Hygiene and Tropical Medicine","correspondingAuthor":false,"prefix":"","firstName":"Kalifa","middleName":"","lastName":"Bojang","suffix":""},{"id":491995272,"identity":"c1805797-6325-4082-9280-3344abb44d90","order_by":9,"name":"James Dodd","email":"","orcid":"","institution":"Liverpool School of Tropical Medicine","correspondingAuthor":false,"prefix":"","firstName":"James","middleName":"","lastName":"Dodd","suffix":""},{"id":491995273,"identity":"366937d7-055e-4175-906b-419ff0baefa3","order_by":10,"name":"Abidsalan Noor","email":"","orcid":"","institution":"Harvard T.H. 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