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Intermittent Preventive Treatment among Pregnant Women
Attending a Tertiary Healthcare Facility in Jos, North Central
Nigeria: Adherence Patterns and Preliminary Assessment of
Associated Factors
Mbah I.O1, Adeola O.A2*, Amaku C.U3, Elisha A2, Wina F.M4, Eseigbe P3, Ekedigwe J.E5, Onubi J6,
Agyema J3, Harrison C7, Chima A.A.G3
1Department of Internal Medicine, College of Medical Sciences, Bingham University, Karu via Abuja
and Jos, Plateau State, Nigeria
2Department of Medical Microbiology and Parasitology, College of Medical Sciences, Bingham
University, Karu via Abuja and Jos, Plateau State, Nigeria
3Department of Family Medicine, College of Medical Sciences, Bingham University, Karu via Abuja and
Jos, Plateau State, Nigeria
4Department of Surgery, College of Medical Sciences, Bingham University, Karu via Abuja and Jos,
Plateau State, Nigeria
5Department of Radiology, College of Medical Sciences, Bingham University, Karu, via Abuja and Jos,
Plateau State, Nigeria
6Department of Chemical Pathology, College of Medical Sciences, Bingham University, Karu via Abuja
and Jos, Plateau State, Nigeria
7APIN Public Health Initiative, Nigeria
*Correspondence Author
DOI: https://doi.org/10.51244/IJRSI.2025.120800184
Received: 05 Aug 2025; Accepted: 13 Aug 2025; Published: 18 September 2025
ABSTRACT
Adherence to intermittent preventive treatment with Sulphadoxine-Pyrimethamine (IPTp-SP) for malaria
prevention in pregnancy remains a challenge in Nigeria. This retrospective cross-sectional study investigated
IPTp-SP adherence patterns among pregnant women attending antenatal clinics at a tertiary healthcare facility
in Jos, North Central Nigeria, from January 2022 to December 2024. A preliminary assessment of
sociodemographic factors associated with IPTp-SP adherence was also conducted using univariate analysis,
with statistical significance set at p<0.05. Most participants were aged 21-30 years (50.0%), resided in urban
and peri-urban areas (80.0%), and were multigravida (40.0%). Overall, 60.1% initiated IPTp-SP in the second
trimester, while 60.0% received at least two doses. Adherence was assessed based on the time of IPTp-SP
initiation, the number of doses received, and intake intervals. Across these three criteria, IPTp-SP adherence
was consistently and significantly associated with occupation (χ²=34.89, p<0.001; χ²=14.38, p<0.01; χ²=28.51,
p<0.001) and residence (χ²=19.93, p<0.001; χ²=25.79, p<0.001; χ²=10.81, p<0.01). Additionally, the time of
IPTp-SP initiation was significantly associated with the timing of antenatal registration (χ²=9.18, p<0.01). In a
subset of participants, 73.9% of second-trimester initiators and 30.4% of third-trimester initiators tested
negative for malaria parasitemia, suggesting that earlier initiation of IPTp-SP enhances the reduction of
maternal malaria burden. Targeted interventions addressing access barriers and promoting early antenatal
enrollment and adherence to IPTp-SP guidelines are critical for improving malaria prevention and maternal
health outcomes in North Central Nigeria.
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Keywords: Malaria prevention, Intermittent Preventive Treatment, IPTp-SP Adherence, Sulphadoxine-
Pyrimethamine, Antenatal care, Pregnant women; Northcentral Nigeria
INTRODUCTION
Malaria is a protozoan disease caused by five Plasmodium species and spread by the female Anopheles
mosquitoes [1]. It is one of the leading causes of morbidity and mortality, with enormous medical and
economic impact [2]. Several species, including P. vivax and P. falciparum, are known to infect humans in
Nigeria and are the most common and widely distributed parasites [3, 4]. According to the World Malaria
Report 2024, about half of the world's population live in regions at risk of malaria transmission, with an
estimated 263 million cases in 2023 representing about 11 million increase from 2022 [5]. It is a major public
health issue in humid and subtropical areas [6, 7]. In 2020, about 130 million pregnancies occured in malaria
transmission areas, mostly in Africa [8]. In 2021, in 38 malaria transmission countries in the WHO African
Region, an estimated 40 million pregnancies occurred, out of which 13.3 million were exposed to malaria
infection, with West Africa having the highest malaria exposure prevalence [9]. In Nigeria, malaria continues
to cause significant morbidity and mortality particularly among pregnant women, who are known to have a
higher risk of contracting malaria than non-pregnant women [10, 11].
Malaria during pregnancy is associated with serious adverse consequences such as maternal deaths, abortion,
premature labour, maternal anaemia and low birth weight resulting in maternal and infant morbidity and
mortality [10, 12]. These unfavorable pregnancy outcomes relate to sequestration of malaria parasites in the
placental intervillous spaces attached to chondroitin-sulphate-A. When pro-inflammatory cells and cytokines
invade the placental bed, the net result is impairment of foetal blood and nutrient supply, which results in low
birth weight, which is reported as a critical risk factor for neonatal mortality [13].
In April 2000, the African Summit on Roll Back Malaria adopted the Abuja Declaration in which regional
leaders committed themselves to ensuring that 60% of pregnant women in malaria-endemic communities
accessed effective prevention and treatment of malaria by 2005 [14]. In addition, 80% scale-up was also
initiated by the Nigeria Federal Government to ensure that at least 80% of pregnant women in the country
participated in intermittent preventive treatment [IPT] with pyrimethamine or chloroquine. However, poor
compliance contributing to emergence of drug-resistant strains of Plasmodium falciparum compromised the
efficacy of these drugs [15]. To enhance the prevention of malaria in pregnancy and its subsequent adverse
effects, the World Health Organization recommends IPT with sulphadoxine-pyrimethamine (IPTp-SP) for all
pregnant women in malaria-endemic areas in Africa starting in the second trimester with at least two doses
taken at one month intervals [16]. IPT is provided as part of a comprehensive antenatal package to control
maternal anaemia, and it has proved to be safe, inexpensive and effective, with attendant increase in maternal
haemoglobin levels and birth weight [5].
While majority of pregnant women attend antenatal clinic at least once during pregnancy, recent reports show
that IPTp-SP compliance has been low, particularly in countries with the highest transmission of malaria [5].
In order to develop intervention strategies for improvement of the effectiveness of IPTp-SP in Northcentral
Nigeria, this study was designed to assess the patterns of adherence to IPTp-SP guidelines among pregnant
women receiving antenatal care (ANC) at a university teaching hospital in Jos, Plateau State, Nigeria. A
preliminary assessment of sociodemographic factors associated with IPTp-SP adherence among participants
was also conducted.
MATERIALS AND METHODS
Study Design and Setting
This cross-sectional study was conducted using records of pregnant women enrolled at the Antenatal Clinics of
Bingham University Teaching Hospital, Jos, Plateau State, Nigeria over a three-year period, from January
2022 to December 2024. The hospital, located in Jos, the metropolitan capital of Plateau State, serves as a
major referral center providing comprehensive antenatal, obstetric, and gynecological services to urban, peri-
urban, and rural populations across the State. Jos hosts various large agricultural produce markets that are
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frequently visited by people, mostly women, from various agrarian peri-urban and rural communities within
the State [17].
Study Population, Inclusion and Exclusion Criteria
The study population comprised pregnant women attending antenatal care (ANC) at the facility during the
study period. Inclusion criteria were confirmed pregnancyand history of receiving at least one dose of
Sulphadoxine-Pyrimethamine (SP) during the index pregnancy. Records of pregnant women who had not
received at least one dose of SP were excluded.
Sample Size, Sampling Technique, and Data Collection Tools and Procedures
The study included 2,316 participants, using consecutive sampling technique. Data were collected through a
review of participants' antenatal clinic records using a structured questionnaire. The questionnaire captured
sociodemographic characteristics (age, education, marital status, residence, occupation, religion, parity, and
monthly income), antenatal registration details, IPTp-SP initiation time, number of SP doses received, and SP
intake intervals. Clinical data on febrile illness episodes during pregnancy and malaria parasitemia at delivery
were obtained from medical records and laboratory reports on malaria parasite microscopy.
Operational Definitions
Adherence to IPTp-SP was premised on three criteria, based on WHO recommendations. These were initiation
of SP in the second trimester, receipt of at least two doses of SP, and intake of SP at least one month apart [4,
5]. Febrile illness referred to self-reported or clinically documented episodes of fever during the current
pregnancy. Malaria parasitemia was confirmed via microscopic examination of blood smears.
Data Analysis
Data were cleaned and entered into Microsoft Excel and analyzed using SPSS version 27 (Armonk, USA).
Descriptive statistics were computed to summarize socio-demographic characteristics and IPTp-SP adherence
patterns. Categorical variables were presented as frequencies and percentages. Chi-square test was used to
examine associations between IPTp-SP adherence criteria and socio-demographic factors, as well as between
IPTp-SP adherence and clinical outcomes (febrile illness and malaria parasitemia). Statistical significance was
determined at p<0.05.
Ethical Considerations
Ethical approval was obtained from the Health Research and Ethics Committee, Bingham University Teaching
Hospital, Jos, Nigeria with reference number NHREC/21/05/2005/01598. The requirement for informed
consent from each participant was waived as data used for the study were obtained from clinical records as part
of routine ANC. Data were completely anonymized.
RESULTS
Socio-demographic Characteristics
A total of 2,316 pregnant women participated in the study. Table 1 shows the socio-demographic
characteristics of participants. Most were aged 21-30 years, had secondary education, were married and resided
in urban and peri-urban areas. About half of the participants were engaged in private businesses, received a
monthly income below ₦50,000, and were multigravida, while 60.0% registered for antenatal care in the
second trimester. Figure 1 is a chart showing the proportional representation of various categories of
participants.
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Table 1: Socio-demographic characteristics of study participants
Variables Categories Frequency Percentage (%)
Age Groups 16-20 232 10.0
21-30 1158 50.0
31-40 579 25.0
41-50 347 15.0
Total 2316 100.0
Educational Status None 237 10.2
Primary School 458 19.8
Secondary School 1042 45.0
Tertiary 579 25.0
Total 2316 100.0
Marital Status Single 232 10.0
Married 1505 65.0
Divorced 232 10.0
Widowed 347 15.0
Total 2316 100.0
Residence Rural 463 20.0
Urban and Periurban 1853 80.0
Total 2316 100.0
Occupation Unemployed 347 15.0
Private Business 1158 50.0
Civil Servant 162 7.0
Medical Staff 162 7.0
Other Hospital Staff 487 21.0
Total 2316 100.0
Religion Christianity 926 40.0
Islam 1390 60.0
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Total 2316 100.0
Parity Primigravida 579 25.0
Secondigravida 695 30.0
Multigravida 1042 45.0
Total 2316 100.0
Time of Antenatal Registration 1st Trimester 232 10.0
2nd Trimester 1389 60.0
3rd Trimester 695 30.0
Total 2316 100.0
Monthly Income Below N50,000 1158 50.0
50,000-100,000 811 35.0
100,000-500,000 347 15.0
Above 500,000 0 0.0
Total 2316 100.0
Fig. 1: Chart Showing the Proportional Representation of Various Categories of Participants
Adherence to IPTp-SP Guidelines on Time of Initiation
Table 2 reveals the pattern of participants’ adherence to IPTp-SP guidelines based on time of initiation.
Overall, 60.1% of the respondents commenced IPTp-SP in the second trimester, while 39.9% initiated it in the
third trimester. A significant association was observed between IPTp-SP initiation time and occupation
(χ²=34.89, p<0.001), residence (χ²=19.93, p<=0.001), parity (χ²=7.86, p<0.02), and time of ANC registration
(χ²=9.18, p<0.01). Civil servants and medical staff had notably lower second-trimester initiation rates (46.9%
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and 45.1%, respectively) compared to unemployed women (65.7%) and private business owners (60.6%). A
higher proportion of urban and peri-urban residents were more likely to commence IPTp-SP in the second
trimester (62.3%) than rural dwellers (51%), and multigravida women had a higher proportion of early IPTp-
SP initiation (62.5%) compared to primigravida women (60.8%). Early ANC registration was also associated
with timely IPTp-SP initiation, with 59.5% of first-trimester registrants commencing IPT in the second
trimester.
Table 2: Assessment of adherence to IPT guidelines based on time of initiation
Variables Categories Commencement of IPT (%) Chi-square p-value
Second
Trimester
Third
Trimester
Age Groups 16-20 (n = 232) 134 (58.8) 98 (42.2) 4.63 0.20
21-30 (n = 1158) 698 (60.3) 460 (39.7)
31-40 (n = 579) 335 (57.9) 244 (42.1)
41-50 (n = 347) 224 (64.6) 123 (35.4)
Total (N = 2316) 1391 (60.1) 925 (39.9)
Marital Status Single (n = 232) 136 (58.6) 96 (41.4) 0.94 0.82
Married (n = 1505) 900 (59.8) 605 (40.2)
Divorced (n = 232) 139 (59.9) 93 (40.1)
Widowed (n = 347) 216 (62.2) 131 (37.8)
Total (N = 2316) 1391 (60.1) 925 (39.9)
Educational Status None (n = 237) 138 (58.2) 99 (41.8) 3.38 0.34
Primary (n = 458) 278 (60.7) 180 (39.3)
Secondary (n = 1042) 643 (61.7) 399 (38.3)
Tertiary (n = 579) 332 (57.3) 247 (42.7)
Total (N = 2316) 1391 (60.1) 925 (39.9)
Occupation Unemployed (n = 347) 228 (65.7) 119 (34.3) 34.89 0.001*
Private Business (n = 1158) 702 (60.6) 456 (39.4)
Civil Servant (n = 162) 76 (46.9) 86 (53.1)
Medical Staff (n = 162) 73 (45.1) 89 (54.9)
Other Hospital Staff (n = 487) 312 (64.1) 175 (35.9)
Total (N = 2316) 1391 (60.1) 925 (39.9)
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Residence Rural (n = 463) 236 (51.0) 227 (49.0) 19.93 0.001*
Urban and Periurban (n = 1853) 1155 (62.3) 698 (37.7)
Total (N = 2316) 1391 (60.1) 925 (39.9)
Religion Christianity (n = 926) 548 (59.2) 378 (40.8) 0.50 0.49
Islam (n = 1390) 843 (60.6) 547 (39.4)
Total (N = 2316) 1391 (60.1) 925 (39.9)
Parity Primigravida (n = 579) 352 (60.8) 227 (39.2) 7.86 0.02*
Secondigravida (n = 695) 388 (55.8) 307 (44.2)
Multigravida (n = 1042) 651 (62.5) 391 (37.5)
Total (N = 2316) 1391 (60.1) 925 (39.9)
Time of Antenatal
Registration
1st Trimester (n = 232) 138 (59.5) 94 (40.5) 9.18 0.01*
2nd Trimester (n = 1389) 867 (62.4) 522 (37.6)
3rd Trimester (n = 695) 386 (55.5) 309 (44.5)
Total (N = 2316) 1391 (60.1) 925 (39.9)
Monthly Income
(₦)
Below N50,000 (n = 1158) 698 (60.3) 460 (39.7) 4.63 0.10
50,000-100,000 (n = 811) 469 (57.8) 342 (42.2)
100,000-500,000 (n = 347) 224 (64.6) 123 (35.4)
Total (N = 2316) 1391 (60.1) 925 (39.9)
*Statistically significant association (p<0.05) IPT: Intermittent Preventive Treatment
Adherence to IPT Guidelines on Number of Sulphadoxine-Pyrimethamine Doses
About 60.0% of respondents received two doses of SP, while 40.0% received only one dose. Educational status
(χ²=9.38, p<0.03), occupation (χ²=14.38, p<0.01), residence (χ²=25.79, p<0.001), and monthly income
(χ²=13.16, p<0.001) were significantly associated with the number of SP doses received. Women with
secondary education (63.1%) and those with no formal education (58.2%) had higher rates of completing two
doses compared to those with tertiary education (55.4%). Unemployed women had the highest adherence to the
two-dose recommendation (66.3%), while civil servants (54.9%) and medical staff (53.7%) had lower
adherence rates. Urban residents (62.6%) were more likely to complete two doses than rural residents (49.7%).
Higher adherence was also observed among women earning below ₦50,000 (61.6%) compared to those in the
₦50,000-₦100,000 income bracket (55.4%). These results are shown in Table 3.
Adherence to IPT Guidelines on SP Intake Intervals
Table 4, which reveals adherence patterns in relation to SP intake intervals, shows that 30.0%, 40.0%, and
30.0% of respondents received SP at one-month, two-month, and three-month intervals, respectively.
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Significant associations were noted with occupation (χ²=28.51, p<0.001), residence (χ²=10.81, p<0.01), and
religion (χ²=9.42, p<0.01).
Table 3: Assessment of adherence to IPT guidelines based on number of doses of Sulphadoxine-
Pyrimethamine received
Variables Categories Number of S-P Doses (%) Chi-square p-value
One Two
Age Groups 16-20 (n = 232) 99 (42.7) 133 (57.3) 7.84 0.05
21-30 (n = 1158) 443 (38.3) 715 (61.7)
31-40 (n = 579) 256 (44.2) 323 (55.8)
41-50 (n = 347) 128 (36.9) 219 (63.1)
Total (N = 2316) 926 (40.0) 1390 (60.0)
Marital Status Single (n = 232) 105 (45.3) 127 (54.7) 3.42 0.33
Married (n = 1505) 589 (39.1) 916 (60.9)
Divorced (n = 232) 96 (41.4) 136 (58.6)
Widowed (n = 347) 136 (39.2) 211 (60.8)
Total (N = 2316) 926 (40.0) 1390 (60.0)
Educational Status None (n = 237) 99 (41.8) 138 (58.2) 9.38 0.03*
Primary (n = 458) 184 (40.2) 274 (59.8)
Secondary (n = 1042) 385 (36.9) 657 (63.1)
Tertiary (n = 579) 258 (44.6) 321 (55.4)
Total (N = 2316) 926 (40.0) 1390 (60.0)
Occupation Unemployed (n = 347) 117 (33.7) 230 (66.3) 14.38 0.01*
Private Business (n = 1158) 484 (41.8) 674 (58.2)
Civil Servant (n = 162) 73 (45.1) 89 (54.9)
Medical Staff (n = 162) 75 (46.3) 87 (53.7)
Other Hospital Staff (n = 487) 177 (36.3) 310 (63.7)
Total (N = 2316) 926 (40.0) 1390 (60.0)
(0.0)
Residence Rural (n = 463) 233 (50.3) 230 (49.7) 25.79 0.001*
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Urban and Periurban (n = 1853) 693 (37.4) 1160 (62.6)
Total (N = 2316) 926 (40.0) 1390 (60.0)
Religion Christianity (n = 926) 388 (41.9) 538 (58.1) 2.37 0.12
Islam (n = 1390) 538 (38.7) 852 (61.3)
Total (N = 2316) 926 (40.0) 1390 (60.0)
Parity Primigravida (n = 579) 242 (41.8) 337 (58.2) 3.40 0.18
Secondigravida (n = 695) 289 (41.6) 406 (58.4)
Multigravida (n = 1042) 395 (37.9) 647 (62.1)
Total (N = 2316) 926 (40.0) 1390 (60.0)
Time of Antenatal
Registration
1st Trimester (n = 232) 97 (41.8) 135 (58.2) 1.77 0.41
2nd Trimester (n = 1389) 540 (38.9) 849 (61.1)
3rd Trimester (n = 695) 289 (41.6) 406 (58.4)
Total (N = 2316) 926 (40.0) 1390 (60.0)
Monthly Income
(₦)
Below N50,000 (n = 1158) 445 (38.4) 713 (61.6) 13.16 0.001*
50,000-100,000 (n = 811) 362 (44.6) 449 (55.4)
100,000-500,000 (n = 347) 119 (34.3) 228 (65.7)
Total (N = 2316) 926 (40.0) 1390 (60.0)
*Statistically significant association (p<0.05) S-P: Sulphadoxine-Pyrimethamine
Table 4: Assessment of adherence to IPT guidelines based on Sulphadoxine-Pyrimethamine intake interval
Variables Categories S-P Intake Interval Chi-square p-value
1 Month 2 Months 3 Months
Age Groups 16-20 (n = 232) 70 (30.2) 95 (40.9) 67 (28.9) 7.90 0.25
21-30 (n = 1158) 349 (30.1) 462 (39.9) 347 (30.0)
31-40 (n = 579) 181 (31.3) 241 (41.6) 157 (27.1)
41-50 (n = 347) 95 (27.4) 128 (36.9) 124 (35.7)
Total (N = 2316) 695 (30.0) 926 (40.0) 695 (30.0)
Marital Status Single (n = 232) 78 (33.6) 76 (32.8) 78 (33.6) 9.87 0.13
Married (n = 1505) 460 (30.6) 609 (40.5) 436 (29.0)
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Divorced (n = 232) 70 (30.2) 93 (40.1) 69 (29.7)
Widowed (n = 347) 87 (25.1) 148 (42.7) 112 (32.3)
Total (N = 2316) 695 (30.0) 926 (40.0) 695 (30.0)
Educational
Status
None (n = 237) 71 (30.0) 95 (40.1) 71 (30.0) 6.64 0.36
Primary (n = 458) 123 (26.9) 180 (39.3) 155 (33.8)
Secondary (n = 1042) 319 (30.6) 410 (39.3) 313 (30.0)
Tertiary (n = 579) 182 (31.4) 241 (41.6) 156 (26.9)
Total (N = 2316) 695 (30.0) 926 (40.0) 695 (30.0)
Occupation Unemployed (n = 347) 54 (33.3) 73 (45.1) 35 (21.6) 28.51 0.001*
Private Business (n =
1158)
52 (32.1) 77 (47.5) 33 (20.4)
Civil Servant (n = 162) 160 (32.9) 173 (35.5) 154 (31.6)
Medical Staff (n = 162) 351 (30.3) 460 (39.7) 347 (30.0)
Other Hospital Staff (n =
487)
78 (22.5) 143 (41.2) 126 (36.3)
Total (N = 2316) 695 (30.0) 926 (40.0) 695 (30.0)
Residence Rural (n = 463) 153 (33.0) 200 (43.2) 110 (23.8) 10.81 0.01*
Urban and Periurban (n =
1853)
542 (29.2) 726 (39.2) 585 (31.6)
Total (N = 2316) 695 (30.0) 926 (40.0) 695 (30.0)
Religion Christianity (n = 926) 311 (33.6) 350 (37.8) 265 (28.6) 9.42 0.01*
Islam (n = 1390) 384 (27.6) 576 (41.4) 430 (30.9)
Total (N = 2316) 695 (30.0) 926 (40.0) 695 (30.0)
Parity Primigravida (n = 579) 172 (29.7) 232 (40.1) 175 (30.2) 3.89 0.42
Secondigravida (n = 695) 214 (30.8) 291 (41.9) 190 (27.3)
Multigravida (n = 1042) 309 (29.7) 403 (38.7) 330 (31.7)
Total (N = 2316) 695 (30.0) 926 (40.0) 695 (30.0)
Time of
Antenatal
Registration
1st Trimester (n = 232) 71 (30.6) 90 (38.8) 71 (30.6) 3.92 0.42
2nd Trimester (n = 1389) 409 (29.4) 545 (39.2) 435 (31.3)
3rd Trimester (n = 695) 215 (30.9) 291 (41.9) 189 (27.2)
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Total (N = 2316) 695 (30.0) 926 (40.0) 695 (30.0)
Monthly
Income (₦)
Below N50,000 (n = 1158) 348 (30.1) 463 (40.0) 347 (30.0) 6.72 0.15
50,000-100,000 (n = 811) 232 (28.6) 344 (42.4) 235 (29.0)
100,000-500,000 (n = 347) 115 (33.1) 119 (34.3) 113 (32.6)
Total (N = 2316) 695 (30.0) 926 (40.0) 695 (30.0)
*Statistically significant association (p<0.05) S-P: Sulphadoxine-Pyrimethamine
Impact of IPT Adherence on Febrile Illness Occurrence and Malaria Parasitemia
As shown in Table 5, among women who commenced IPTp-SP in the second trimester, 96.5% reported an
absence of febrile illness, compared to 95.1% among third-trimester starters, although this difference was not
statistically significant. However, malaria parasite microscopy showed a significant association, with 73.9% of
second-trimester initiators testing negative for malaria parasites compared to 30.4% of third-trimester initiators
(χ²=22.2, p<0.0001). While completion of two SP doses was associated with higher febrile illness-free rates
(96.6% compared to 95.0% among one-dose recipients), and higher malaria microscopy negativity rates
(55.6% compared to 48.9% among one-dose recipients), the observed differences were not statistically
significant. SP intake intervals also did not significantly affect febrile illness occurrence or malaria microscopy
outcomes.
Table 5: Impact of adherence to intermittent preventive treatment and usage of insecticide-treated net among
study participants
Adherence Measures Categories Absence of Febrile Illness (N = 2,316) Negative MP Microscopy (n = 92)+
Percentage
(%)
Chi-
square
p-value Percentage
(%)
Chi-
square
p-value
Commencement of IPT 2nd Trimester 96.5 2.88 0.09 73.9 22.2 0.0001*
3rd Trimester 95.1 30.4
Total 96.0 52.2
Number of S-P Doses One 95.0 3.63 0.06 48.9 5.34 0.07
Two 96.6 55.6
Total 96.0 52.2
S-P Intake Interval 1 Month 95.7 1.29 0.53 53.3 4.78 0.31
2 Months 95.7 40.5
3 Months 96.7 68.0
Total 96.0 52.2
+Percentage were estimated for few participants with MP microcopy results MP: Malaria Parasite
*Statistically significant association (p<0.05)
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DISCUSSION
This study assessed adherence to intermittent preventive treatment in pregnancy (IPTp) using Sulphadoxine-
Pyrimethamine (SP) among pregnant women and its association with key socio-demographic characteristics
and malaria-related outcomes in a tertiary healthcare facility in Jos, Northcentral Nigeria. The findings provide
important insights into the patterns of IPTp uptake and highlight significant disparities related to occupation,
parity, residence, and timing of antenatal care registration.
Overall adherence to IPTp, based on initiation in the second trimester and uptake of at least two doses, was
approximately 60.0%. This figure, which is relatively higher than some previous reports from sub-Saharan
Africa [18, 19], still falls below the World Health Organization’s recommendation that all eligible pregnant
women should receive at least three doses of SP at monthly intervals starting from the second trimester [4, 5].
The suboptimal adherence observed underscores ongoing challenges in achieving IPTp coverage targets in
sub-Saharan Africa, even within tertiary health facilities.
Adherence was significantly associated with several sociodemographic factors, including occupation,
residence, parity, and timing of ANC registration. Occupation was a significant determinant of adherence
(p<0.001), with higher proportions of unemployed women, those categorized under “other hospital staff”, and
those in private business initiating IPTp in the second trimester and completing two doses, in contrast to civil
servants and medical staff, who demonstrated lower adherence. This unexpected trend may reflect
occupational barriers, such as inflexible working hours or perceived lower vulnerability due to medical
knowledge or advanced literacy levels. This is similar to previous studies which reported higher IPTp-SP
uptake positively correlayed with engagement in gfarming or business [20], suggesting that structural and
occupational constraints may hinder optimal ANC attendance and IPTp uptake [21, 22]. It is however different
from findings in a previous report from Cameroon where illiterate participants were had a significantly
lower IPTp-SP uptake compared to literate women [23].
Residence was also found to significantly influence adherence during this study. Women from urban and peri-
urban areas demonstrated higher adherence rates, with respect to initiation of IPTp in the second trimester and
completion of two doses, compared to their rural counterparts. This finding aligns with previous studies that
associate urban residence with better access to healthcare, more frequent ANC visits, and higher IPIp-SP
uptake [24-26]. This suggests that the persistent urban-rural divide in healthcare access remains a key concern
in malaria prevention efforts.
Parity and timing of ANC registration were also significantly associated with adherence. Similar to some
previous reports, multigravida women showed significantly higher compliance with IPTp recommendations
than primigravida counterparts [27]. This may be attributed to increased awareness and experience gained from
previous pregnancies. In the present study, women who registered in the second trimester were more likely to
initiate IPTp early and receive the recommended two doses, compared to late registrants. This supports
existing literature emphasizing early ANC initiation as a determinant of IPTp adherence [28-30].
Furthermore, the study evaluated the clinical impact of IPTp adherence. Commencement of SP in the second
trimester and receiving two doses were associated with a higher absence of febrile illness and increased
likelihood of negative malaria microscopy at delivery, although only the timing of IPTp commencement
showed a statistically significant association with malaria test results. This reinforces evidence that IPTp-SP
effectively reduces malaria parasitemia and febrile episodes during pregnancy, thereby contributing to
improved maternal and fetal outcomes [4, 5]. Interestingly, SP intake intervals [one, two, or three months] did
not significantly affect outcomes, suggesting that timing of initiation and total dose count may be more critical
than spacing alone. However, this may also be attributed to limitations associated with self-reporting and non-
specific nature of febrile illness, and the small sample size of participants tested for malaria parasite burden.
CONCLUSION AND RECOMMENDATIONS
Adherence to IPTp-SP among pregnant women attending the tertiary healthcare facility was moderate, with
only about 60.0% initiating treatment in the second trimester and receiving at least two doses. Key
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determinants of adherence included occupation, residence, parity, and timing of antenatal care registration.
Improved adherence was associated with better clinical outcomes, notably reduced febrile episodes and lower
malaria parasitemia. These findings highlight the need for targeted interventions addressing socio-demographic
barriers to optimize IPTp uptake and improve maternal health outcomes in malaria-endemic settings. Early
antenatal care registration should be prioritized through targeted health education campaigns. Workplace-
friendly ANC services can help boost uptake among employed women, especially civil servants and healthcare
staff. Rural access must also be enhanced via mobile clinics and stronger primary care systems. Further
research, particularly using more robust statistical analysis, is needed to explore the benefits of additional SP
doses and optimal dosing intervals.
Limitations of the Study
Limitations of the study includes its cross-sectional design, which precludes causal inferences between
adherence and outcomes, and non-consideration of the seasonality of malaria in Nigeria and its impact on
IPTp-SP adherence. The study was also conducted at a single tertiary healthcare facility, which may limit the
generalizability of the findings to other settings, particularly primary healthcare centers. In addition, the data
used for the study relied on hospital records and participant self-reporting, which may introduce recall or
reporting bias, and malaria microscopy results were available for only a small subset of participants, limiting
the strength of statistical associations with parasitemia.
Conflicts of Interest: None
Acknowledgements
The authors sincerely appreciate the Head of Department of Obstetrics and Gynaecology Department,
Bingham University Teaching Hospital, Dr. Edugbe for granting access to the ANC records. We also
appreciate the matron in charge of the ANC clinic for her cooperation. Lastly, we thank the research assistants
who helped in data entry.
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