Uptake of Intermittent Preventive Treatment and Its Associated Factors Among Pregnant Women in Cameroon: A Cross-Sectional Study.

INTRODUCTION

Malaria remains a major public health threat in sub-Saharan Africa. In Cameroon, where malaria is endemic, pregnant women are especially vulnerable due to reduced immunity and placental sequestration of infected erythrocytes. Intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) is recommended by the World Health Organization (WHO) to prevent malaria-related complications. However, national coverage remains below the 80% target. This study aimed to assess IPTp uptake and its associated factors among pregnant women in five diverse regions of Cameroon.

METHODS

A cross-sectional study was conducted between 2020 and 2022 in five health areas, using two-stage cluster sampling. A total of 259 pregnant women aged 15-49 were interviewed using a structured questionnaire. Data collected included sociodemographic characteristics, antenatal care (ANC) attendance, knowledge of malaria and IPTp, and prevention practices. Malaria infection was assessed using rapid diagnostic tests (RDTs). Logistic regression analysis was used to identify factors associated with the uptake of at least three doses of IPTp.

RESULTS

Among participants, 62.55% (CI95%: 56.31% to 68.40%) had received at least three doses of IPTp. Age was a significant predictor: women aged between 25 and 30 years had higher odds of optimal uptake (adjusted odds ratio (aOR): 4.87; 95% CI: 2.15-11.51), and those over 30 had even greater odds (aOR: 7.93; 95% CI: 3.08-21.71) compared to those aged between 21 and 25 years. Marital status also influenced uptake: married women (aOR: 9.52; 95% CI: 4.29-23.27) and cohabiting women (aOR: 2.85; 95% CI: 1.50-5.56) were more likely to receive three doses than single women. Parity was associated with higher adherence, with primiparous (aOR: 8.25; 95% CI: 3.02-26.69) and multiparous women (aOR: 7.26; 95% CI: 2.17-27.74) more likely to complete IPTp than nulliparous women. ANC attendance was a key determinant: women with more than two visits were significantly more likely to complete IPTp (aOR: 2.41; 95% CI: 1.17-4.96). Good malaria knowledge (aOR: 1.99; 95% CI: 1.12-3.58) and good IPTp knowledge (aOR: 2.19; 95% CI: 1.10-4.38) were also positively associated. Testing positive for malaria was associated with lower IPTp adherence (aOR: 0.53; 95% CI: 0.31-0.92).

CONCLUSION

Despite improvements compared to national statistics, IPTp uptake remains below WHO recommendations. Key factors influencing adherence include age, marital status, parity, ANC frequency, and knowledge levels. Higher IPTp uptake was associated with lower malaria prevalence, which suggests but does not confirm a protective effect given the cross-sectional design. Public health strategies should focus on promoting early and regular ANC attendance, improving education on malaria prevention, and encouraging male involvement to boost IPTp coverage and improve maternal outcomes.