ArticleMalaria journal2025
Inequalities in the use of three-dose of intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine among women in Sierra Leone, 2008-2019.
Article in Malaria journal, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundIntermittent preventive treatment in pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) is a key intervention for preventing malaria during pregnancy in areas with moderate to high malaria transmission. While IPTp-SP coverage has increased in Sierra Leone, disparities in uptake and completion of the recommended three doses persist. Understanding these trends and inequalities is crucial for improving maternal and child health outcomes. This study examined the trends and inequalities in using three doses of IPTp-SP among pregnant women in Sierra Leone between 2008 and 2019.
methodsThe research utilised data from the Sierra Leone Demographic Health Survey conducted in 2008, 2013 and 2019. The World Health Organisation Health Equity Assessment Toolkit software calculated several inequality measures, including simple difference (D), ratio (R), population-attributable risk (PAR), and population-attributable fraction (PAF). Inequality was assessed for four stratifiers: economic status, education level, place of residence, and sub-national province.
resultsIn Sierra Leone, IPTp-SP coverage among pregnant women increased from 5.2% in 2008 to 35.7% in 2019. Economic inequalities among pregnant women in Quintile 5 (richest) and Quintile 1 (poorest) increased from a difference of -1.4 percentage points in 2008 to -5.2 percentage points in 2019. Disparities in education-related outcomes among pregnant women with secondary or higher education compared to those with no education decreased from a difference of 4.4 percentage points in 2008 to -3.8 percentage points in 2019. The disparities in place of residence among pregnant women in urban versus rural areas decreased from a difference of 1.4 percentage points in 2008 to -6.3 percentage points in 2019. Provincial inequalities increased from a difference of 4.1 percentage points in 2008 to 18.4 percentage points in 2019.
conclusionDespite the overall improvement in IPTp-SP coverage and the decreasing economic, educational and place of residence-related inequalities, continued provincial-level disparities indicate the necessity of tailoring interventions to address provincial-specific barriers. To achieve universal and equitable coverage of IPTp-SP, the study recommends a multifaceted approach that combines strengthening the health system, targeted behaviour change communication and addressing social determinants of health.
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