Abstract
Uptake of intermittent preventive therapy in pregnancy (IPTp) with sulfadoxine-pyrimethamine (IPTp-SP) is a clinically-proven method to prevent the adverse outcomes of malaria in pregnancy (MiP) for the mother, her foetus, and the neonates. The majority of countries in sub-Saharan Africa have introduced IPTp policies for pregnant women during the past decade. Nonetheless, progress towards improving IPTp coverage remains dismal, with widespread regional and socioeconomic disparities in the utilisation of this highly cost-effective service. In the present study, our main objective was to measure the prevalence of IPTp uptake in selected malaria-endemic countries in sub-Saharan Africa, and to investigate the patterns of IPTp uptake among different educational and wealth categories adjusted for relevant sociodemographic factors. For this study, cross-sectional data on 18,603 women aged between 15 and 49 years were collected from the Malaria Indicator Surveys (MIS) conducted in Burkina Faso, Ghana, Mali, Malawi, Kenya, Nigeria, Sierra Leone, and Uganda. The outcome variable was taking three doses of IPTp-SP in the last pregnancy, defined as adequate by the WHO. According to the analysis, the overall prevalence of taking three doses of IPTp-SP in the latest pregnancy was 29.5% (95% CI = 28.2–30.5), with the prevalence being highest for Ghana (60%, 95% CI = 57.1–62.8), followed by Kenya (37%, 95% CI = 35.3–39.2) and Sierra Leone (31%, 95% CI = 29.2–33.4). Women from non-poor households (richer—20.7%, middle—21.2%, richest—18.1%) had a slightly higher proportion of taking three doses of IPTp-SP compared with those from poorest (19.0%) and poorer (21.1%) households. Regression analysis revealed an inverse association between uptake of IPTp-SP and educational level. With regard to wealth status, compared with women living in the richest households, those in the poorest, poorer, middle, and richer households had significantly higher odds of not taking at least three doses of IPTp-SP during their last pregnancy. The present study concludes that the prevalence of IPTp-SP is still alarmingly low and is significantly associated with individual education and household wealth gradient. Apart from the key finding of socioeconomic disparities within countries, were the between-country variations that should be regarded as a marker of inadequate policy and healthcare system performance in the respective countries. More in-depth and longitudinal studies are required to understand the barriers to, and preferences of, using IPTp-SP among women from different socioeconomic backgrounds.
Highlights
Malaria is historically recognised as a significant public health concern for healthcare systems in sub-Saharan Africa (SSA), and to date remains a major contributor to maternal and infant morbidity and mortality in the continent [1,2,3]
malaria in pregnancy (MiP) is associated with a range of complications for mothers, fetuses, and neonates including maternal hypoglycaemia, intrauterine growth retardation, placental malaria (PM), fetal hypotrophy, miscarriage, preterm delivery, and low birth weight, which explains the contribution of malaria to higher maternal and neonatal mortality rates [11,12,13]
The overall prevalence of taking adequate doses of intermittent preventive therapy with sulfadoxine-pyrimethamine (IPTp-SP) during the latest pregnancy was 29.5%
Summary
Malaria is historically recognised as a significant public health concern for healthcare systems in sub-Saharan Africa (SSA), and to date remains a major contributor to maternal and infant morbidity and mortality in the continent [1,2,3]. There is a growing body of evidence that in the endemic regions malaria in pregnancy (MiP) remains a prominent preventable cause of maternal and infant morbidity and mortality [7], accounting for about 75,000–200,000 infant deaths in the region [8,9]. Despite this evidence and the ongoing malaria elimination efforts, the rate of utilisation of preventive measures, especially IPTp, is still unsatisfactory and is far from being universal [4]. Owing to the increased susceptibility to infection during gestation, pregnant women are more likely to develop severe disease than their non-pregnant counterparts and are encouraged to take antimalarial IPTp [2]
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