In many countries in sub-Saharan Africa, large numbers of children with fever receive antimalarial treatment. Since the early 2000s, almost all sub-Saharan African countries have revised their national drug policies to promote artemisininbased combination therapy (ACT), an efficacious but expensive treatment course. The vast majority of treated children, however, still receive drugs like chloroquine, which is no longer effective in most malaria-endemic areas. Future surveys are expected to show much higher ACT coverage, as ACT procurement has increased 30-fold, from just 5 million treatments in 2004 to 160 million in 2009.

Some countries have begun to scale up the use of diagnostics, employing microscopy at health facilities and rapid diagnostic tests. This shift away from presumptive malaria treatment for all children with fever presents a challenge for interpretation of data. Discerning trends in antimalarial treatment requires an understanding of the country context – lower rates of treatment with antimalarial medicines may indicate better targeting, such that only those children who have malaria are treated for it.

Intermittent preventive treatment during pregnancy (IPTp), which consists of at least two doses of sulfadoxinepyrimethamine received during the second and third trimesters of pregnancy, is highly effective in reducing the prevalence of anaemia and placental malaria infection among women at delivery. It is thus a vital intervention for pregnant women in endemic areas.

In many countries, there is relatively little difference in IPTp coverage between urban and rural areas. In Mozambique and the United Republic of Tanzania, however, pregnant women in urban areas are much more likely than those in rural areas to receive IPTp.