The Association Between Early Antenatal Care and Intermittent Preventive Treatment of Malaria in Pregnancy in Sub-Saharan Africa: Effect Modification by Planned Pregnancy Status

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 metaanalytic 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.

Pregnancy and malaria: the perfect storm

“…Many first trimester infections originated before conception [13 ▪▪ ], and subpatent or asymptomatic infections often increase in density in pregnant women. Addressing first trimester infections remains a challenge, because in much of Africa early antenatal attendance is rare [14 ▪ ], and preconception interventions for malaria are absent. Recent studies show that insecticide-treated bed nets (ITNs) and detection and treatment of infection early in pregnancy may translate into substantial gains for the prevention adverse pregnancy outcomes [11 ▪ ,15 ▪ ,16].…”

The moderating role of partners’ education on early antenatal care in northern Ghana

“…We conducted our analyses with five generalized estimating equation (GEE) models to achieve our study objectives using adjusted prevalence ratios (aPRs) [11,21,22]. The first model was used to assess the relationship between partners' education and early ANC, whilst controlling for mothers' education, planned pregnancy, mother's age, employment status, parity, marital status, place of residence, health insurance status, household size and whether COVID-19 pandemic affected a mother's ANC attendance.…”

Malaria-Related Psychosocial Factors, Past Antenatal Care–Seeking Behaviors, and Future Antenatal Care–Seeking Intentions by Maternal Age in Malawi and Democratic Republic of the Congo

“… 3 Antenatal care attendance in the first trimester of pregnancy (early ANC) is associated with a greater likelihood of reducing the risk of MIP as well as associated adverse outcomes through the provision of insecticide-treated nets (ITNs), intermittent preventive treatment during pregnancy (IPTp) for malaria with sulfadoxine-pyrimethamine starting in the second trimester, and other essential screening and treatments. 4 …”