Factors influencing the uptake of intermittent preventive treatment among pregnant women in sub-Saharan Africa: a multilevel analysis

Abstract

Background Intermittent Preventive Treatment (IPT) of malaria in pregnancy is a full therapeutic course of antimalarial sulfadoxine-pyrimethamine (SP) medicine given to pregnant women in their second trimester at routine antenatal care visits, regardless of whether the recipient is infected with malaria. Given the negative consequences of malaria in pregnancy, studies on Intermittent Preventive Therapy with Sulfadoxine-Pyrimethamine (IPTp-SP) are important benchmarks for understanding the extent of malaria control and prevention during pregnancy. We, therefore, examined the factors associated with the uptake of IPTp-SP among pregnant women in sub-Saharan Africa. Methods We used data from the current versions of the Malaria Indicators Survey of 12 countries in sub-Saharan Africa. Women aged 15–49 years participated in the surveys. The analyses were carried out using Stata version 14.2. Descriptive (frequencies and percentages) and multilevel regression analyses were carried out. The results of the multilevel regression analysis were presented as adjusted odds ratios (aOR) with 95% confidence intervals (CIs). Results The average prevalence of uptake of IPTp-SP among pregnant women in the studied sub-Saharan African countries was 30.69%, with the highest and lowest prevalences in Ghana (59.64%) and Madagascar (10.08%), respectively. Women aged 40–44 compared to those aged 15–19 (aOR = 1.147, 95%CI = [1.02,1.30) had higher odds of receiving 3 or more doses of IPTp-SP. Women with a secondary/higher level of education compared to those with no formal education (aOR = 1.12, 95%CI = 1.04,1.20] also had higher odds of receiving 3 or more doses of IPTp-SP. Women who were exposed to malaria messages on the radio (aOR = 1.07, 95%CI = 1.02,1.12] and television (aOR = 1.13,95%CI = [1.05,1.21]) had higher odds of receiving 3 or more doses of IPTp-SP compared to those who were not exposed. Conclusion Our study indicates that the uptake of IPTp-SP is relatively low among the countries included in this study, with significant inter-country variations. Higher educational level, exposure to media, low parity, and higher age group were associated with higher odds of optimal IPTp-SP uptake. National policies, programs, guidance services such as information service and counselling and other interventions aimed at improving the coverage and uptake of IPTp-SP must be targeted at women with low level of education, non-exposure to media, high parity, and younger age group to attain the desired outcome.

Retrospective evaluation of referral by community health workers on the uptake of intermittent preventive treatment of Malaria in pregnancy in Ohaukwu, Ebonyi State, Nigeria

“…This is of high importance in sub-Saharan Africa, where health systems face both human resource and financial constraints. However, the low uptake of IPTp3 reported in this study, which is similar to that reported in some sub-Saharan African subregions, [ 11 – 13 ] indicates that more improvements in coverage must be made in order to reach the Sustainable Development Goal Target 3.3, to end the malaria epidemic (in addition to the AIDS and tuberculosis epidemics). We found that pregnant women who were referred to ANC by a CHW had 1.6 times greater odds of completing IPTp3.…”

Effect of referral by community health workers on uptake of intermittent preventive treatment of malaria in pregnancy in Ohaukwu, Ebonyi State Nigeria: An analysis of individual level data from the maternity record booklet.

“…This is of high importance in sub-Saharan Africa, where health systems face both human resource and nancial constraints. However, the low uptake of IPTp3 reported in this study, which is similar to that reported in some sub-Saharan African subregions, (20,27,28) indicates that more improvements in coverage must be made in order to reach the Sustainable Development Goal Target 3.3, to end the malaria epidemic (in addition to the AIDS and tuberculosis epidemics). Future research should explore barriers and facilitators of CHWs interventions to best inform scale-up of these programs.…”

Status of malaria in pregnancy services in Madagascar 2010–2021: a scoping review

“…Exposure to information, education and communication (IEC) campaigns was assessed, but no relationship was established between exposure to these campaigns and IPTp uptake or ITN use. In a secondary analysis of Demographic and Health Survey (DHS) and MIS data, in which researchers developed models to determine predictors of effective IPTp delivery, higher coverage was associated with increased education, living in an area with low to medium malaria transmission, seeking other maternal health services, and seeking care at public-sector health facilities [ 16 ]. A 2020 secondary analysis of MIS data confirmed the association between education and IPTp coverage, and also found that female-led households had higher IPTp uptake than male-led households [ 17 ].…”

“…This is consistent with data reported in the 2008–2009 DHS (91%) [ 20 ] and 2016 MIS (90%) [ 8 ]. The number of ANC visits during a previous pregnancy were more variable; ranging from 71% of women reporting a minimum of four ANC visits in one survey conducted in 2017 in areas with referral strengthening activities [ 18 ] to 47% in other DHS-led surveys [ 16 ].…”