Factors associated with uptake of intermittent preventive treatment of malaria among pregnant women in the Sene East District, Ghana

Paapa Gondong; Mavis Pearl Kwabla; Jacob Munukpah; Usera Iddrisu; George Wak

doi:10.51867/ajernet.7.1.61

Authors

Paapa Gondong Ghana Health Service, Sene East District Health Directorate, Box 38, Kajaji, Bono-East Region, Ghana https://orcid.org/0009-0004-8341-9209
Mavis Pearl Kwabla Fred Binka School of Public Health, University of Health and Allied Sciences, PMB 31, Ho, Volta Region, Ghana https://orcid.org/0000-0002-1435-0795
Jacob Munukpah Ghana Health Service, Bolgatanga Regional Health Directorate, PMB, Upper East Region, Ghana
Usera Iddrisu Ghana Health Service, Sene East District Health Directorate, Box 38, Kajaji, Bono-East Region, Ghana
George Wak
gwak@uhas.edu.gh
Fred Binka School of Public Health, University of Health and Allied Sciences, PMB 31, Ho, Volta Region, Ghana https://orcid.org/0000-0001-6892-1007

Keywords:

Intermittent Preventive Treatment, Sulfadoxine-Pyrimethamine, Malaria, Pregnancy, Antenatal care, Ghana

Abstract

Malaria poses a significant risk to pregnant women and infants, particularly in sub-Saharan Africa. Intermittent Preventive Treatment with Sulfadoxine Pyrimethamine (IPTp-SP) for malaria in pregnancy is an effective intervention recommended by the World Health Organization (WHO) to protect this vulnerable group. However, uptake of IPTp has been suboptimal in most settings in Ghana, due to several factors. This study, therefore, sought to determine the factors associated with the uptake of IPTp-SP among pregnant women in the Sene-East District of Ghana. The study adopted the facility-based cross-sectional design, where the Cochrane formula for sample size determination was used to select 433 pregnant women with a gestational age of 36+ weeks, as well as postpartum women of at most 4 weeks after birth, at Antenatal Care (ANC) centres in six selected health facilities in the district. The theory underpinning this research was the Health Belief Model (HBM). The model seeks to explain and predict the pathways through which individuals behave to improve health based on their attitudes and beliefs. Data were collected using structured questionnaires and analyzed using logistic regression to assess factors associated with IPTp-SP uptake. Results showed that the level of IPT3+ uptake was 58.4% among the study participants, which is below the WHO-recommended optimal level of IPTp uptake among pregnant women. In the multivariate analysis, women who had some education had higher odds of completing 3+ doses (aOR=1.72, 95% CI:1.002-2.961, p=0.049) compared to those without education. Also, multiparous women were 2.4 times more likely to have 3+ doses of IPTp compared to nulliparous women (aOR: 2.35; 95% CI: 1.341 - 4.128, p=0.003). Pregnant women who took the first dose of IPTp in the 3rd trimester were about 95% less likely to adhere to 3+ doses of IPTp-SP compared to those who started uptake of IPTp-SP at the 2nd trimester (aOR=0.055, p<0.001). Other factors associated with IPTp-SP uptake included knowledge of the ideal number of doses, where women with higher knowledge were more likely to receive the optimal number of IPTp-SP doses. Gestational age at first IPTp-SP uptake was another factor that was associated with optimal uptake of IPTp-SP. Specifically, women who took their first IPTp-SP in the first trimester were more likely to receive all 3+ doses. To improve IPTp-SP adherence, it is essential for stakeholders to engage in the education of younger and first-time mothers about the importance of early IPTp-SP uptake.

Dimensions

REFERENCES

Addai-Mensah, O., Annani-Akollor, M. E., Fondjo, L. A., Sarbeng, K., Anto, E. O., Owiredu, E. W., & Arthur, S. N. (2018). Regular antenatal attendance and education influence the uptake of intermittent preventive treatment of malaria in pregnancy: A cross-sectional study at the University Hospital, Kumasi, Ghana. Journal of Tropical Medicine, 2018, 5019215, 421-440. https://doi.org/10.1155/2018/5019215 DOI: https://doi.org/10.1155/2018/5019215

Agyekum, M. W., Afrifa-Anane, G. F., & Kyei-Arthur, F. (2024). Prevalence and correlates of disability in older adults, Ghana: Evidence from the Ghana 2021 Population and Housing Census. BMC Geriatrics, 24(1), 52. https://doi.org/10.1186/s12877-023-04587-6 DOI: https://doi.org/10.1186/s12877-023-04587-6

Agyeman, Y. N., Bassoumah, B., & Owusu-Marfo, J. (2023). Predictors of optimal uptake of intermittent preventive treatment of malaria in pregnancy using sulfadoxine-pyrimethamine and outcome of pregnancy in selected health facilities: A cross-sectional study in Northern Ghana. Malaria Journal, 22(1), 80. https://doi.org/10.1186/s12936-023-04501-w DOI: https://doi.org/10.1186/s12936-023-04501-w

Agyeman, Y. N., Newton, S. K., Annor, R. B., & Owusu-Dabo, E. (2020). The effectiveness of the revised intermittent preventive treatment with Sulphadoxine Pyrimethamine (IPTp-SP) in the prevention of malaria among pregnant women in Northern Ghana. Journal of Tropical Medicine, 2020, 2325304, 341-360. https://doi.org/10.1155/2020/2325304 DOI: https://doi.org/10.1155/2020/2325304

Agyeman, Y. N., Newton, S., Annor, R. B., & Owusu-Dabo, E. (2021). Intermittent preventive treatment comparing two versus three doses of Sulphadoxine Pyrimethamine (IPTp-SP) in the prevention of anaemia in pregnancy in Ghana: A cross-sectional study. PLoS One, 16(4), e0250350. DOI: https://doi.org/10.1371/journal.pone.0250350

https://doi.org/10.1371/journal.pone.0250350

Akpa, C. O., Akinyemi, J. O., Umeokonkwo, C. D., Bamgboye, E. A., Dahiru, T., Adebowale, A. S., et al. (2019). Uptake of intermittent preventive treatment for malaria in pregnancy among women in selected communities of Ebonyi State, Nigeria. BMC Pregnancy and Childbirth, 19(1), 457. DOI: https://doi.org/10.1186/s12884-019-2629-4

https://doi.org/10.1186/s12884-019-2629-4

Amoako, B. K., & Anto, F. (2021). Late ANC initiation and factors associated with sub-optimal uptake of sulphadoxine-pyrimethamine in pregnancy: A preliminary study in Cape Coast Metropolis, Ghana. BMC Pregnancy and Childbirth, 21(1), 105. https://doi.org/10.1186/s12884-021-03582-2 DOI: https://doi.org/10.1186/s12884-021-03582-2

Anchang-Kimbi, J. K., Kalaji, L. N., Mbacham, H. F., Wepnje, G. B., Apinjoh, T. O., Ngole Sumbele, I. U., Dionne-Odom, J., Tita, A. T. N., & Achidi, E. A. (2020). Coverage and effectiveness of intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) on adverse pregnancy outcomes in the Mount Cameroon area, South West Cameroon. Malaria Journal, 19(1), 100. https://doi.org/10.1186/s12936-020-03155-2 DOI: https://doi.org/10.1186/s12936-020-03155-2

Ansong, D., Otoo, D. M., & Mensah, V. (2025). Knowledge, uptake, and therapeutic effectiveness of sulfadoxine-pyrimethamine (IPTp-SP) among pregnant women attending the antenatal clinic at Ayeduase Health Centre in Oforikrom Municipality in the Ashanti Region, Ghana. BMC Pregnancy and Childbirth, 25(1), 265. https://doi.org/10.1186/s12884-024-07089-4 DOI: https://doi.org/10.1186/s12884-024-07089-4

Aporo, A. J., Namagembe, I., Musaba, M., Wandabwa, J., & Kiondo, P. (2026). Factors associated with uptake of optimal dose of IPTP-SP among pregnant women attending antenatal clinics of Soroti district, Uganda. Scientific Reports, 16(1), 3065. https://doi.org/10.1038/s41598-025-10733-4 DOI: https://doi.org/10.1038/s41598-025-10733-4

Azizi, S. C. (2020). Uptake of intermittent preventive treatment for malaria during pregnancy with Sulphadoxine-Pyrimethamine in Malawi after adoption of updated World Health Organization policy: An analysis of the Demographic and Health Survey, 2015-2016. BMC Public Health, 20(1), 335. https://doi.org/10.1186/s12889-020-08471-5 DOI: https://doi.org/10.1186/s12889-020-08471-5

Azizi, S. C., Chongwe, G., Chipukuma, H., Jacobs, C., Zgambo, J., & Michelo, C. (2018). Uptake of intermittent preventive treatment for malaria during pregnancy among postpartum women in Zomba District, Malawi: A cross-sectional study. BMC Pregnancy and Childbirth, 18(1), 108. https://doi.org/10.1186/s12884-018-1744-y DOI: https://doi.org/10.1186/s12884-018-1744-y

Bajaria, S., Festo, C., Mrema, S., Shabani, J., Hertzmark, E., & Abdul, R. (2019). Assessment of the impact of availability and readiness of malaria services on uptake of intermittent preventive treatment in pregnancy (IPTp) provided during ANC visits in Tanzania. Malaria Journal, 18(1), 229. https://doi.org/10.1186/s12936-019-2862-3 DOI: https://doi.org/10.1186/s12936-019-2862-3

Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 84(2), 191-215. https://doi.org/10.1037//0033-295x.84.2.191 DOI: https://doi.org/10.1037/0033-295X.84.2.191

Bayuo, F. B., Antwi, E. O., Adu-Boahen, N., Effah, E. A., Appiah, S. K., Opoku, H. A., Efiong, M. B., Acheampomaa, G., Senyah, M. M., Bofa, A., Afoakwah, G., & Haile, Z. T. (2025). Association between adequacy of antenatal care and uptake of intermittent preventive treatment of malaria in pregnancy among women in Ghana. Malaria Journal, 24(1), 385. https://doi.org/10.1186/s12936-025-05537-w DOI: https://doi.org/10.1186/s12936-025-05537-w

Berchie, G. O., Doe, P. F., Azu, T. D., Agyeiwaa, J., Owusu, G., Boso, C. M., Yeboa, N. K., Agyare, D. F., Aboh, I. K., Nabe, B., Ofori, G. O., Anumel, B., Kagbo, J. E., Alhassan, A., Offei, F. O., Opoku-Danso, R., Abraham, S. A., Amoadu, M., & Hagan, J. E., Jr. (2024). Uptake and effectiveness of intermittent preventive treatment with sulfadoxine-pyrimethamine during pregnancy in Africa: A scoping review. Diseases, 12(9), 203. https://doi.org/10.3390/diseases12090203 DOI: https://doi.org/10.3390/diseases12090203

Buh, A., Kota, K., Bishwajit, G., & Yahya, S. (2019). Prevalence and associated factors of taking intermittent preventive treatment in pregnancy in Sierra Leone. Tropical Medicine and Infectious Disease, 4(1), 32. https://doi.org/10.3390/tropicalmed4010032 DOI: https://doi.org/10.3390/tropicalmed4010032

Cochran, W. G. (1977). Sampling techniques (3rd ed.). John Wiley & Sons.

De-Gaulle, V. F., Magnussen, P., Kamgno, J., Mbacham, W., Orish, V. N., & Tagbor, H. (2021). Assessing health system factors affecting access and delivery of IPTp-SP and ITN to pregnant women attending ANC clinics in Ghana. BMC Health Services Research, 21(1), 1056. https://doi.org/10.1186/s12913-021-07055-2 DOI: https://doi.org/10.1186/s12913-021-07055-2

Desai, M., ter Kuile, F. O., Nosten, F., McGready, R., Asamoa, K., Brabin, B., & Newman, R. D. (2007). Epidemiology and burden of malaria in pregnancy. The Lancet Infectious Diseases, 7(2), 93-104. https://doi.org/10.1016/S1473-3099(07)70021-X DOI: https://doi.org/10.1016/S1473-3099(07)70021-X

Diengou, N. H., Cumber, S. N., Nkfusai, C. N., Mbinyui, M. S., Viyoff, V. Z., Bede, F., Akwah, L., Tsoka-Gwegweni, J. M., & Judith, A. K. (2020). Factors associated with the uptake of intermittent preventive treatment of malaria in pregnancy in the Bamenda health districts, Cameroon. The Pan African Medical Journal, 35, 42. https://doi.org/10.11604/pamj.2020.35.42.17600 DOI: https://doi.org/10.11604/pamj.2020.35.42.17600

Fathi, A., Sharifirad, G., Gharlipour, Z., Hakimelahi, J., & Mohebi, S. (2017). Effects of a nutrition education intervention designed based on the Health Belief Model (HBM) on reducing the consumption of unhealthy snacks in the sixth-grade primary school girls. International Journal of Pediatrics, 5(2), 4361-4370. DOI: https://doi.org/10.18869/acadpub.jhl.2.1.45

Kumah, E., Duvor, F., Otchere, G., Ankomah, S. E., Fusheini, A., Kokuro, C., Karikari, A. K., & Adom, J. (2022). Intermittent preventive treatment of malaria in pregnancy with Sulphadoxine-Pyrimethamine and its associated factors in the Atwima Kwanwoma District, Ghana. Annals of Global Health, 88(1), 27. https://doi.org/10.5334/aogh.3560 DOI: https://doi.org/10.5334/aogh.3560

Lawn, J. E., Blencowe, H., Waiswa, P., Amouzou, A., Mathers, C., Hogan, D., Flenady, V., Frøen, J. F., Qureshi, Z. U., Calderwood, C., Shiekh, S., Jassir, F. B., You, D., McClure, E. M., Mathai, M., Cousens, S., Lancet Ending Preventable Stillbirths Series Study Group, & Lancet Stillbirth Epidemiology Investigator Group. (2016). Stillbirths: Rates, risk factors, and acceleration towards 2030. Lancet (London, England), 387(10018), 587-603. https://doi.org/10.1016/S0140-6736(15)00837-5

McArthur, L. H., Riggs, A., Uribe, F., & Spaulding, T. J. (2018). The health belief model offers opportunities for designing weight management interventions for college students. Journal of Nutrition Education and Behavior, 50(5), 485-493. https://doi.org/10.1016/j.jneb.2017.09.010 DOI: https://doi.org/10.1016/j.jneb.2017.09.010

Mchwampaka, W. M., Tarimo, D., Chacky, F., Mohamed, A., Kishimba, R., & Samwel, A. (2019). Factors affecting uptake of ≥ 3 doses of Sulfadoxine-Pyrimethamine for malaria prevention in pregnancy in selected health facilities, Arusha region, Tanzania. BMC Pregnancy and Childbirth, 19(1), 440. DOI: https://doi.org/10.1186/s12884-019-2592-0

https://doi.org/10.1186/s12884-019-2592-0

Mutanyi, J. A., Onguru, D. O., Ogolla, S. O., & Adipo, L. B. (2021). Determinants of the uptake of intermittent preventive treatment of malaria in pregnancy with Sulphadoxine Pyrimethamine in Sabatia Sub-County, Western Kenya. Infectious Diseases of Poverty, 10(1), 106. https://doi.org/10.1186/s40249-021-00887-4 DOI: https://doi.org/10.1186/s40249-021-00887-4

Nsibu, C. N., Manianga, C., Kapanga, S., Mona, E., Pululu, P., & Aloni, M. N. (2016). Determinants of antenatal care attendance among pregnant women living in endemic malaria settings: Experience from the Democratic Republic of Congo. Obstetrics and Gynecology International, 2016, 5423413. https://doi.org/10.1155/2016/5423413 DOI: https://doi.org/10.1155/2016/5423413

Odwe, G., Matanda, D. J., Zulu, T., Kizito, S., Okoth, O., & Kangwana, B. (2023). Women's empowerment and uptake of sulfadoxine-pyrimethamine for intermittent preventive treatment of malaria during pregnancy: Results from a cross-sectional baseline survey in the Lake endemic region, Kenya. Malaria Journal, 22(1), 241. https://doi.org/10.1186/s12936-023-04679-z DOI: https://doi.org/10.1186/s12936-023-04679-z

Orish, V. N., Puplampu, P. N., Lokpo, S. Y., Kwadzokpui, P. K., De-Gaulle, V. F., Marinkovic, A., Prakash, S., Annan, R., Okorie, C., & Sanyaolu, A. (2023). Assessing nursing mothers' knowledge, perceptions, and uptake of Sulphadoxine Pyrimethamine (IPTp-SP) during pregnancy in the Ho Teaching Hospital of the Volta Region of Ghana. PLOS Global Public Health, 3(2), e0000904. https://doi.org/10.1371/journal.pgph.0000904 DOI: https://doi.org/10.1371/journal.pgph.0000904

Orji, R., Vassileva, J., & Mandryk, R. (2012). Towards an effective health intervention design: An extension of the health belief model. Online Journal of Public Health Informatics, 4(3), ojphi.v4i3.4321. DOI: https://doi.org/10.5210/ojphi.v4i3.4321

https://doi.org/10.5210/ojphi.v4i3.4321

Simegn, W., Mohammed, S. A., & Moges, G. (2023). Adherence to self-care practice among type 2 diabetes mellitus patients using the theory of planned behavior and health belief model at comprehensive specialized hospitals of Amhara Region, Ethiopia: Mixed method. Patient Preference and Adherence, 17, 3367-3389. https://doi.org/10.2147/PPA.S428533 DOI: https://doi.org/10.2147/PPA.S428533

Vahedian-Shahroodi, M., Tehrani, H., Robat-Sarpooshi, D., Aval, M. G., Jafari, A., & Alizadeh-Siuki, H. (2019). The impact of health education on nutritional behaviors in female students: An application of health belief model. International Journal of Health Promotion and Education, 59(2), 70-82. https://api.semanticscholar.org/CorpusID:212931105 DOI: https://doi.org/10.1080/14635240.2019.1696219

https://doi.org/10.1080/14635240.2019.1696219

WHO. (2014). The contribution of malaria control to maternal and newborn health: Progress and impact series (10[11]), 1-150. Roll Back Malaria Partnership. https://www.mmv.org/sites/default/files/uploads/docs/publications/The_contribution_of_malaria_control_to_maternal_and_newborn_health_3.pdf

WHO. (2025). World Health Organization, Africa Region. Maternal health: Key facts. https://www.afro.who.int/health-topics/maternal-health