Factors Influencing the Implementation of the Intermittent Preventive Treatment Using Sulphadoxine-Pyrimethamine (IPTP-SP) Policy for Malaria in Pregnancy (MIP) Control in Nigeria: A Multilevel Analysis

Abstract

Malaria poses a grave public health threat in Nigeria, particularly to pregnant women and their unborn babies, hampering the achievement of Sustainable Development Goal 3. Despite adopting and updating the intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP) policy in 2005 and 2014, respectively, its uptake remains low. This dissertation aims to identify and consolidate factors impeding the implementation of the IPTp-SP policy in Nigeria, spanning individual, interpersonal, health system, and community levels. It examines the implications of these findings for healthcare professionals, policymakers, and the government, offering recommendations to bolster IPTp-SP uptake. This dissertation comprises four distinct contributions. The first article conducts a scoping review of barriers and facilitators influencing IPTp-SP access and uptake among pregnant women in Nigeria, highlighting poor provider knowledge and commodity shortages as significant barriers. The second article explores pregnant women's perceptions of malaria and IPTp-SP uptake, revealing misconceptions and doubts about SP's effectiveness. The third article uncovers the influences of community factors on IPTp-SP utilization, including preferences for Traditional Birth Attendants (TBAs) and the influence of stakeholders like mothers-in-law and community leaders. Lastly, the fourth article underscores systemic failures in healthcare, such as SP scarcity and healthcare provider prescription issues, contributing to low IPTp-SP uptake among pregnant women. In conclusion, the study recommends that the government should prioritize ensuring continuous SP supply to clinics and support hiring additional well-trained and well-compensated healthcare professionals proficient in administering IPTp-SP. Healthcare providers should advocate for IPTp-SP use until a better alternative emerges. Strategies to enhance IPTp-SP uptake among rural pregnant women include community distribution, women's education, stakeholder involvement, integration of TBAs, and linguistic considerations in communication. These measures aim to improve IPTp-SP access and comprehension, ensuring effective malaria prevention in rural areas. Additionally, exploring a malaria vaccine for pregnant women presents a promising alternative. Leveraging insights from challenges in SP administration can optimize vaccination success, offering a cost-effective solution for malaria-endemic regions.