Access and Utilization of Intermittent Preventive Treatment of Malaria in Pregnancy Among Pregnant Women in Malaria Endemic Zones in Kenya

Abstract

Malaria continues to be a major public health challenge, particularly in sub-Saharan Africa, where it has a disproportionate impact on pregnant women. In 2020, malaria accounted for 2.6% of the global disease burden, resulting in 627,000 deaths and 241 million clinical episodes worldwide. In Kenya, malaria remains endemic with over 4 million cases reported annually, especially in the lake regions and Coastal areas. Pregnancy elevates the risk of contracting malaria and increases the likelihood of severe disease if infected such as maternal anemia, miscarriage, low birth weight, and heightened neonatal mortality. The World Health Organization (WHO) recommends intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) as a crucial strategy to reduce these risks. Despite its demonstrated efficacy, the use of SP in Kenya has been sub-optimal. By 2022, pregnant women who received the recommended three doses of IPTp-SP were only 22%. This cross-sectional study, nested within the Malaria Indicator Survey of 2020, aimed to identify factors affecting the access and utilization of IPTp-SP among pregnant women in malaria-endemic areas of Kenya. The study assessed IPTp-SP access levels, which include receiving three or more doses (SP3+), and examined socio-demographic factors influencing the uptake. The findings revealed that socio-demographic variables such as age, access to malaria-related messaging, and the timing of antenatal care (ANC) visits significantly impacted IPTp-SP uptake. Pregnant women aged 25-34 years and 40-44 years had a higher chance of completing the recommended IPTp-SP regimen relative to those aged 15-19 years. Moreover, access to malaria messaging was linked to a higher uptake of IPTp-SP (p=0.012), whereas delaying the first ANC visit had a negative impact on IPTp-SP coverage (p=0.001). This study underscores the importance of health education and early ANC visits in enhancing IPTp-SP coverage. It suggests that targeted interventions, including enhanced malaria messaging and timely ANC initiation, are necessary to increase IPTp-SP uptake and reduce malaria-related complications among pregnant women.