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Factors affecting the uptake of optimal doses of intermittent preventive treatment of malaria in pregnancy using sulfadoxine pyrimethamine in Ghana: new evidence from the 2019 malaria indicator survey

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Abstract

Background

Globally, a significant proportion of women in areas with a high malaria burden are susceptible to the risk of malaria during pregnancy. The Ghana Health Service adopted an antimalarial policy that states that intermittent preventive treatment of malaria in pregnancy using sulfadoxine/pyrimethamine (IPTp-SP) shall be administered as directly observed therapy (DOT) monthly during antenatal care (ANC) until delivery. This study, therefore, examined the effect of individual, household and health related factors on the uptake of optimal doses of IPTp-SP for malaria in pregnancy in Ghana.

Methods

Data for this study were obtained from the 2019 Ghana Malaria Indicator Survey (GMIS) conducted between September 25 and November 24, 2019. The weighted sample comprised 353 pregnant women aged 15–49 years. Data were analysed with the Statistical Package for Social Sciences (SPSS) version 25 using both descriptive and multinomial logistic regression modelling.

Results

The study found that 30.5% of pregnant women took optimal (≥ 3) doses of IPTp-SP to prevent malaria. Pregnant women aged 15–24 (aOR = 0.25, 95% CI = 0.09–0.71) were 75% less likely to take optimal doses of IPTp-SP at health facilities than those aged 35–39. Similarly, pregnant women at 16 weeks of gestation (aOR = 0.40,95% CI = 0.20–0.80) were 60% less likely to take 3 or more SP doses than those between the gestational period 24 to 40 weeks. Again, pregnant women who tested negative for malaria (aOR = 0.04, 95% CI = 0.09–0.32) had lower odds of taking up 1–2 SP doses and 3 or more SP doses (aOR = 0.01, 95% CI = 0.04–0.43) than those who tested positive for malaria. Pregnant women who are not anaemic were 87% and 92% less likely to take 1–2 and 3 or more SP doses, respectively, to prevent malaria during pregnancy relative to pregnant women who are anaemic. However, pregnant women residing in urban areas were more likely (aOR = 2.22, 95% CI = 1.01–4.90) to take optimal IPTp-SP doses than those dwelling in rural areas.

Conclusions

Significant reduction of malaria in pregnancy is highly determined by socio-demographic and health factors that affect pregnant women and crucial to the success of Ghana’s antimalarial drug policy. It is therefore recommended that the Ministry of Health, National Malaria Elimination Programme and Ghana Health Service take cognizance of these factors in planning and rolling out programmes towards improving IPTp-SP drug uptake among pregnant women.

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Data availability

The dataset used for this study are openly available and can be accessed via https://dhsprogram.com/.

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Acknowledgements

We would like to acknowledge the academic staff of the Institute of Health Research (IHR) and Ghana Statistical Service (GSS) for their invaluable contribution to this work.

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Authors and Affiliations

  1. Centre for Malaria (CMR), Institute of Health Research (IHR), University of Health and Allied Sciences (UHAS), PMB, 31, Volta Region, Ho, Ghana

    Desmond Klu

  2. Research and Innovation Division, National Development Planning Commission, Accra, Ghana

    Lily Owusu

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Contributions

D.K. conceptualized, designed the study, obtained the data, analysed and interpreted the data. D.K. also drafted the entire manuscript and critically reviewed. D.K. and L.O. together revised and approved the revised manuscript for publication.

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Correspondence to Desmond Klu.

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Ethical consideration

The Ethical Review Committee of Ghana Health Services and Institutional Review Board approved the protocol for the 2019 Ghana Malaria Indicator Survey which was collected and supervised by the Ghana Statistical Service. Informed consent was obtained from respondents before interviews were conducted. Again, all methods used were carried out in accordance with relevant guidelines and procedures.

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All participants gave verbal and written informed consent to participate in the study.

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The authors have no relevant financial or non-financial interests to disclose.

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Klu, D., Owusu, L. Factors affecting the uptake of optimal doses of intermittent preventive treatment of malaria in pregnancy using sulfadoxine pyrimethamine in Ghana: new evidence from the 2019 malaria indicator survey. J Public Health (Berl.) (2023). https://doi.org/10.1007/s10389-023-02024-x

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