about how and when to give SP \[[@CR13]\].

Antenatal care and IPTp in Malawi {#Sec2}
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The government of Malawi first adopted a policy of providing IPTp as part of comprehensive antenatal care in 1993. Ministry of Health guidelines of 1997 recommended that two doses of SP be given to pregnant women in ANC clinics: a first dose on the first ANC visit after the first trimester, and the second dose between 28 and 34 weeks (Ministry of Health and Population. National Malaria Policy Guidelines. 1997. Unpublished MOH policy document). The IPTp strategy was revised in 2002 and recommended that pregnant women be given two doses of SP after the first trimester at least one month apart under directly observed therapy (DOT) as part of ANC services.

The Ministry of Health guidelines forthe provision of IPTp have changed over time in Malawi, but the various Ministry divisions did not always make the same recommendations. In 2006 the Ministry of Health adopted a policy of Focused Antenatal Care (FANC) as part of an essential health care package for maternal health (Ministry of Health. Focused Antenatal Care and Prevention of Malaria during Pregnancy. Training Manual for Healthcare Providers. 2006. Unpublished MOH policy document). The policy recommends that pregnant women make at least four ANC visits with the first visit in the first trimester of gestation. The policy guidelines for the provision of IPTp presented in the National Reproductive Health Strategy, 2006--2010 recommended that IPTp be given at 26 and 32 weeks of gestation (Ministry of Health. National Reproductive Health Service Delivery Guidelines. Reproductive