Uptake of Intermittent Preventive Treatment with Sulfadoxine-Pyrimethamine (IPTp-SP) in Pregnancy and Associated Factors in a Malaria Endemic Setting of Sub-Saharan Africa
Introduction: Malaria in pregnancy (MiP) is a public health issue that poses risks to maternal and fetal health. Although the World Health Organization recommends intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP) to prevent MiP, its uptake remains low among endemic countries. This study evaluated IPTp-SP uptake and factors associated with its use at Bonassama District Hospital (BDH) in the Littoral Region of Cameroon. Methods: A cross-sectional study was conducted at BDH from March to June 2022. Data were collected from antenatal care (ANC) attendees who were over 30 weeks pregnant. Asymptomatic malaria infections were assessed using PfHRP2/pLDH diagnostic testing. Pearson Chi-square and Fisher’s Exact tests evaluated associations, while binary logistic regression assessed predictors of optimal IPTp-SP uptake, with statistical significance set at p < 0.05. Results: Of the 393 participants, 273 (69.5%, 95% CI: 64.7 - 74.0) received optimal IPTp-SP dosing. Predictors of IPTp-SP optimization were level of education, religion, gravida, parity, gestational age at first ANC, number of ANC visits, and maternal knowledge of optimal SP dose. Women who had taken at least three doses of IPTp-SP had fewer P. falciparum infections (aOR = 2.6, 95% CI: 1.65 - 4.14, p < 0.001). Primigravida women (aOR = 3.2, 95% CI: 1.69 - 5.98, p < 0.001), who started ANC during the first trimester of pregnancy (aOR = 28.5, 95% CI: 12.58 - 64.58, p < 0.001), with ≥4 ANC visits (aOR = 16.7, 95% CI 7.9 - 35.3, p < 0.001) and had good knowledge of optimal SP dosing required during pregnancy (aOR = 3.2, 95% CI: 2.0 - 5.22, p < 0.001) were more likely to receive optimal IPTp-SP dosing. IPTp-SP uptake was not associated with the utilization of long-lasting insecticidal nets (LLINs) (p > 0.05). Conclusion: This study revealed that the optimal uptake of IPTp-SP was below the nationwide 80% coverage target set for 2030. This reinforces the urgency to promote early and frequent ANC visits. Additionally, there is a continuous need for health education highlighting the importance of IPTp-SP uptake and using LLINs as essential strategies to reduce MiP.
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