Association Between IPTp Uptake and Pregnancy Outcomes in Nigeria: A Case Study of Rural Communities of Abia State

Abstract

Background: Malaria in pregnancy remains a significant public health issue in Nigeria, contributing to adverse health effects for both mothers and their infants. Intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP) is a commonly recommended strategy to reduce these risks in pregnant women. This study examined the relationship between the use of IPTp and health outcomes for mothers and newborns among pregnant women living in rural communities of Abia State, Nigeria. Methods: A descriptive cross-sectional design employing quantitative and qualitative methods was used. The study was conducted in three purposively selected LGAs (Ugwunagbo, Isiala Ngwa South, and Ukwa East) with high malaria transmission. A total of 422 women aged 15–49 who had delivered within the last 12 months were selected using multistage sampling. Structured questionnaires were administered by interviewers to collect quantitative data, which were subsequently analyzed using SPSS version 25. Chi-square tests and multivariate logistic regression were employed to assess associations between IPTp uptake and pregnancy outcomes (birth weight, preterm delivery, stillbirth, neonatal death). Pearson correlation assessed relationships between continuous variables. Qualitative data from 15 key informant interviews with healthcare providers were thematically analyzed using NVivo software. Results: Among the respondents, 94.55% attended ANC, but only 51.18% received the recommended three or more IPTp-SP doses. Uptake of IPTp was significantly associated with higher birth weight (χ²=14.76, p=0.002), lower incidence of preterm delivery (χ²=10.21, p=0.017), and reduced neonatal deaths (χ²=12.43, p=0.006). No significant association was found with stillbirths (p=0.117). A positive correlation was observed between several IPTp doses and both birth weight (r=0.323, p<0.001) and gestational age at delivery (r=0.261, p=0.001). Qualitative findings identified late ANC initiation, drug stock-outs, knowledge gaps, and cultural beliefs as key barriers to IPTp uptake. Conclusion: The study demonstrated a significant positive association between higher IPTp uptake and favourable pregnancy outcomes. Strengthening community awareness, ensuring early ANC attendance, and improving drug availability are critical to enhancing IPTp coverage and maternal-child health in rural Nigeria.