Malaria remains a significant public health challenge, particularly in sub-Saharan Africa, where pregnant women are especially vulnerable due to decreased immunity during pregnancy. To combat this, the World Health Organization (WHO) recommends intermittent preventive treatment during pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) in malaria-endemic regions. This strategy has shown remarkable success in reducing adverse effects of malaria during pregnancy, including maternal anemia, low birth weight, premature delivery, and infant mortality.
Despite global efforts to enhance IPTp coverage, many areas still lag behind. According to the WHO's 2021 World Malaria Report, while 32 countries had adopted the IPTp-SP+ policy by 2019, only 34% of eligible women received the recommended three doses in 2020. This gap between policy adoption and implementation is particularly evident in sub-Saharan Africa, which bears the highest global burden of malaria.
Sierra Leone, like many sub-Saharan African nations, faces a high malaria burden, posing significant challenges to maternal and child health. The government has implemented WHO-recommended malaria control strategies, including the IPTp-SP+ policy, free malaria treatment for pregnant women, and community-based programs to raise awareness and increase antenatal care attendance. However, access to healthcare facilities, stockouts of sulfadoxine-pyrimethamine, irregular antenatal care attendance, and sociocultural barriers hinder the widespread implementation of IPTp.
This study examines the trends and inequalities in the use of three doses of IPTp-SP among pregnant women in Sierra Leone from 2008 to 2019. The findings reveal an increase in IPTp-SP coverage over the study period, starting at 5.2% in 2008 and reaching 37.5% by 2019. While progress has been made in addressing inequalities, certain gaps remain, particularly provincial inequalities, necessitating targeted efforts to ensure equitable access to IPTp services.
The study recommends a multifaceted approach to achieve universal and equitable coverage of IPTp-SP, combining strengthening the health system, targeted behavior change communication, and addressing social determinants of health. Continuous monitoring and evaluation of these efforts are crucial to ensure sustained progress towards equitable maternal health outcomes in Sierra Leone.
