Is improvement in indicators of women’s empowerment associated with uptake of WHO recommended IPTp-SP levels in sub-Saharan Africa? A multilevel approach

Objectives The global burden of malaria has reducedconsiderably; however, malaria in pregnancy remains a major public healthproblem in sub-Saharan Africa (SSA), where about 32 million pregnant women areat risk of acquiring malaria. The WHO has recommended that pregnant women inhigh malaria transmission locations, including SSA, have intermittentpreventive treatment of malaria during pregnancy with at least three doses ofsulphadoxine-pyrimethamine (IPTp-SP). Therefore, we investigated the prevalenceof IPTp-SP uptake and associated individual-level, community-level andcountry-level predictors in SSA.

 

Design A cross-sectional survey was conducted using recentDemographic and Health Surveys datasets of 20 SSA countries. A total of96 765 women were included. Optimum uptake of IPTp-SP at most recent pregnancywas the outcome variable. We fitted three-level multilevel models: individual,community and country parameters at 95% credible interval.

 

Results In all, 29.2% of the women had optimal IPTp-SPuptake ranging from 55.1% (in Zambia) to 6.9% (in Gambia). The study revealed ahigh likelihood of optimum IPTp-SP uptake among women with high knowledge(aOR=1.298, Crl 1.206 to 1.398) relative to women with low knowledge. Women inupper-middle-income countries were more than three times likely to have atleast three IPTp-SP doses compared with those in low-income countries(aOR=3.268, Crl 2.392 to 4.098). We found that community (σ2=1.999, Crl 1.088to 2.231) and country (σ2=1.853, Crl 1.213 to 2.831) level variations exist inoptimal uptake of IPTp-SP. According to the intracluster correlation, 53.9% and25.9% of the variation in optimum IPTp-SP uptake are correspondinglyattributable to community-level and country-level factors.

 

Conclusions The outcome of our study suggests that low-income SSA countriesshould increase budgetary allocation to maternal health, particularly forIPTp-SP interventions. IPTp-SP advocacy behavioural change communicationstrategies must focus on women with low knowledge, rural dwellers, marriedwomen and those who do not meet the minimum of eight antenatal care visits.