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

Abstract

Abstract Background: Malaria duringpregnancy is associated with poor maternal, foetal, and neonataloutcomes. To prevent malaria infection during pregnancy, the World Health Organization recommended the use of intermittent preventive therapy with sulfadoxine-pyrimethaminein addition to vector control strategies. Despite that recommendation, the uptake of sulfadoxine-pyrimethamine (SP) has remained low in Ghana;between 2017 and 2019, only 61% of pregnant women received optimal SP (three or more doses) during their most recent pregnancy. This study sought to map the geospatial distribution and identify factors influencing optimal SP uptake during pregnancy in Ghana. Methods: Secondary data analysis was conducted using the Ghana Malaria Indicators Survey 2019 (GMIS-2019). The data analysed wererestricted to women aged 15-49 years who reported having a live birth within the two years preceding the survey. A logistic regression model was usedto determine the factors influencing optimal SP uptake. Geospatial analysis was employed to map the spatial distribution of optimal SP uptake across the ten regions of Ghana using R software. Results: The likelihood that pregnant women received optimal SP (three or more doses) correlated with early initiation of first antenatal care (ANC), the number of ANC visits, and family size. Overall, the greater the number of ANC visits, the more likely for the pregnant woman to receiveoptimal SP. Women with four or more ANC visitswere 4.5 times (aOR: 4.51; 95% CI: [2.49 - 8.16]) more likely to receive the optimal SP thanpregnant women with fewerthan four ANC visits. For the spatial distribution, ahigh uptake of optimal SPwas observed in the Upper East and Upper West regions,whereas the lowest was observed in the Eastern region of Ghana. Conclusions: In Ghana, the uptake of SPduring pregnancy is influenced mainly by the number of ANC contacts. To achieve the country’s targets for malaria control duringpregnancy, there is a need to strengthen intermittent preventive treatment for malaria duringpregnancy by prioritizing comprehensive ANC services.