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

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.