Factors associated with the uptake of Intermittent Preventive Treatment (IPTp-SP) for malaria in pregnancy: further analysis of the 2018 Nigeria Demographic and Health Survey

Abstract

Pregnancy-associated malaria is preventable and curable with intermittent preventive treatment with Sulfodoxine-Pyrimethamine (IPTp-SP). However, despite the effectiveness of IPTp-SP against malaria in pregnancy, the uptake among pregnant women in Nigeria remains very low. Thus, this study aimed to establish the factors associated with the uptake of at least one dose and optimal doses of IPTp-SP among pregnant women aged 15 to 49 years living in Nigeria in 2018. The study included 12,742 women aged 15 to 49 years with live births two years before or during the 2018 Nigeria Demographic Health Survey (NDHS) in the analysis. Descriptive analysis was carried out to determine the prevalence of IPTp-SP uptake. Multivariable logistic regression was used to establish the factors associated with receiving IPTp-SP during pregnancy, adjusting for possible confounding factors. Given the complex survey design, all analyses adjusted for sampling weight, stratification and clustering. The p-value of <0.05 was considered significant. In 2018, the prevalence of at least one dose of IPTp-SP was 63.6% (95% CI:62.0–65.1), and optimal doses of IPTp-SP were 16.8% (95% CI:15.8–17.8) during pregnancy. After the multivariable analysis, age group, region, frequency of ANC visits, belief in IPTp-SP effectiveness, and morbidity caused by malaria predicted the uptake of at least one IPTp-SP dose. Similar maternal characteristics, including household wealth index, spouse’s educational level and media exposure, were significantly associated with taking optimal IPTp-SP doses. For instance, women in the wealthiest households whose husbands had secondary education predicted a four-fold increase in uptake of at least one IPTp-SP dose (aOR:4.17; 95% CI:1.11–8.85). The low prevalence and regional variations of IPTp-SP uptake in the study area imply that most pregnant women in Nigeria are at substantial risk of pregnancy-associated malaria. Therefore, stakeholders should explore context-specific strategies to improve the IPTp-SP coverage across the regions in Nigeria.

Spatial distribution and determinants of optimal intermittent preventive treatment for malaria during pregnancy: A secondary data analysis of the 2019 Ghana Malaria Indicators Survey

“…These regional disparities are consistent with ndings from a previous study by (19), which showed that communitybased education and maternal interventions improved the utilization of maternal healthcare services, including IPTp, in northern Ghana. These regional disparities are also consistent with the results reported in two recent studies in Nigeria (31) and Guinea (35). For the study in Nigeria, the highest optimal SP uptake was observed in the South-East and South-South regions, while the lowest was observed in the North-East and North-West regions.…”