BACKGROUND:
Malaria during pregnancy is a major risk factor for low birth weight (LBW) in newborns, which in turn negatively affects the growth and development of the child. The World Health Organization (WHO) recommended interventions for pregnant women living in malaria endemic countries that include the use of intermittent preventative treatment in pregnancy (IPTp). However, WHO asserts that the coverage of pregnant women taking the recommended doses of IPTp are still very low. The primary goal of this study was to estimate the effects of increasing the coverage of doses of IPTp and to assess the effect of pregnancy timing in relation to seasonal transmission on malaria infections during pregnancy and neonates with LBW. We explored these effects in moderate and high transmission settings which have Zimbabwe-like characteristics.

METHODS:
A compartmental mathematical model depicting malaria during pregnancy with IPTp doses was formulated to analyze the effects of IPTp, insecticide treated net (ITN) use and seasonal variations in moderate and high malaria transmission settings.

RESULTS:
Our simulation findings suggest that increasing both ITN use and IPTp dose coverages, consistent with the Zimbabwe malaria strategic plan targets, prevented 9.2% and 5% clinical cases in moderate and high transmission respectively. Unprotected pregnancies overlapping the rainy season and peak of malaria incidence in Zimbabwe during the beginning of the second and in the third trimester experience the highest malaria and LBW burden

CONCLUSIONS:
Overall, our results demonstrate that increasing ITN use has a substantial impact in reducing clinical malaria cases during pregnancy. This highlights its importance as a key intervention, and the health benefits it would provide for malaria control goals in Zimbabwe. Pregnancies that overlap with the epidemic peaks in later trimesters lead to a rise in LBWs, indicating the necessity of protecting pregnant women at risk of malaria infection till delivery.