Abstract
Background:Evidence of the association between early antenatal care (ANC) and receiving at least three doses of sulphadoxine–pyrimethamine (IPTp3+) during pregnancy is limited. It’s also unclear whether the association between early ANC and IPTp3+ is modified by planned pregnancy status.Objectives:Our primary aim was to assess the relationship between early ANC and IPTp3+ and to assess whether this relationship is modified by a woman’s planned pregnancy status. We also estimated IPTp3+ coverage across Sub-Saharan African countries.Methods:Data on 77 183 mothers with a live birth in the past two years were analyzed using multiple indicator cluster surveys (MICSs) from 17 Sub-Saharan African countries conducted between 2013 and 2019. We used modified Poisson regression with a robust variance to assess the association between early ANC and IPTp3+, while adjusting for country, clustering, stratification and sample weights. Effect modification by planned pregnancy status was assessed on the additive and multiplicative scales. We used meta-analytic techniques to pool prevalent estimates of IPTp3+ across all countries.Findings:IPTp3+ overall coverage was 22.1% (95% CI: 17.0%, 27.1%), and ranged from 2.9% (95% CI: 1.3%, 4.4%) in São Tomé and Príncipe to 51.7% (95% CI: 49.2%, 54.1%) in Ghana. IPTp3+ coverage was 30% higher among mothers who had early ANC compared to those who did not have early ANC [adjusted prevalence ratio (aPR): 1.30, 95% CI: 1.23,1.36]. There was evidence of effect modification on the additive [relative excess risk due to interaction (RERI): 0.08, 95% CI: 0.0002, 0.15] and multiplicative (aPR: 1.10, 95% CI: 1.01, 1.20) scales.Conclusions:IPTp3+ coverage was low across many of the countries in Sub-Saharan Africa. Women who had early ANC were more likely to receive IPTp3+. Women whose pregnancies were unplanned were less likely to receive IPTp3+, but our effect modification analysis showed that early ANC among such women can increase IPTp3+ coverage.
Highlights
Women whose pregnancies were unplanned were less likely to receive IPTp3+, but our effect modification analysis showed that early antenatal care (ANC) among such women can increase IPTp3+ coverage
We excluded surveys that were conducted before the World Health Organization (WHO) 2012 updated recommendations on IPTp3+ [6]
We found that the relationship between early ANC and IPTp3+ was modified by planned pregnancy status on both multiplicative, and additive (RERI: 0.08, 95% CI: 0.0002, 0.15), scales
Summary
Malaria in pregnancy is a major preventable public health problem with substantial risk to the mother, foetus and newborn [2,3] It is associated with maternal and infant morbidity and mortality, including adverse birth outcomes such as low birthweight, stillbirths, and neonatal deaths [3,4,5]. It is recommended that IPTp with SP should be administered as early as possible within the second trimester of pregnancy and subsequent doses of SP given at each scheduled antenatal care (ANC) contact with an interval of one month apart until delivery [6]. It’s unclear whether the association between early ANC and IPTp3+ is modified by planned pregnancy status
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