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Background <p>Malaria is a significant public health issue in sub-Saharan Africa, accounting for 96% of global malaria-related deaths. Malaria during pregnancy can lead to maternal morbidity and death, stillbirths, and newborn deaths. Prevention and control policies in areas of stable transmission emphasize a combination of intermittent preventive treatment during pregnancy (IPTp) and use of insecticide-treated nets (ITNs), along with effective case management. Neither ITNs nor IPTp provide complete protection alone, and since IPTp and ITNs work synergistically, combining these interventions could be highly effective. The World Health Organization (WHO) recommends that pregnant women receive IPTp, starting early in the second trimester, with at least three doses, regardless of ITN use. Therefore, this study aims to assess the utilization of ITNs and IPTp and the factors influencing their use among pregnant women in sub-Saharan Africa.</p> Methods <p>We used the most recent Malaria Indicator Survey (MIS) or Demographic and Health Survey (DHS) data from 18 sub-Saharan African (SSA) countries, conducted between 2018 and 2024. A weighted sample of 63,561 women who had given birth in the 3&#xa0;years preceding the survey was included in this analysis. Pooled estimates for the utilization of both insecticide-treated nets (ITN) and IPTp were reported with 95% confidence intervals (CI). To determine factors associated with utilization, we performed a multilevel multinomial regression analysis. Variables with a p-value &lt; 0.05 or whose ARRR confidence interval did not include one were considered significant factors associated with malaria preventive measures utilization among pregnant women.</p> Results <p>Among our weighted sample of 63,561 pregnant women, the following utilization rates of malaria preventive measures were observed: 28.9% (95% CI 28.4, 29.3%) used both an ITN (slept under one the previous night) and IPTp (3 or more doses), and 17.6% (95% CI 17.2, 18.0%) used neither ITN nor IPTp. Multilevel multinomial regression analysis revealed that age, educational status, sex of household head, wealth index, mass media exposure, residence and sub-region of SSA were significant factors associated with ITN and IPTp utilization.</p> Conclusion <p>Fewer than one-third of expectant mothers took advantage of combined ITN and IPTp malaria prevention strategies. Both community-level and individual-level predictors should be considered when developing strategies and implementing programs run by both governmental and non-governmental organizations in order to achieve the global goal of reducing malaria by 90% by 2030.</p>

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Use of insecticide-treated nets (ITN) and intermittent preventive treatment (IPTp) for malaria prevention and its associated factors among pregnant women in Sub-Sahara Africa

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月2日

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  • Eyob Akalewold Alemu,
  • Mahlet Alehegn Tesfa,
  • Solomon Gedlu Nigatu,
  • Tilahun Yemanu Birhan,
  • Gelila Yitageasu,
  • Lidetu Demoze,
  • Assefa Admassu Tadesse

摘要

Background

Malaria is a significant public health issue in sub-Saharan Africa, accounting for 96% of global malaria-related deaths. Malaria during pregnancy can lead to maternal morbidity and death, stillbirths, and newborn deaths. Prevention and control policies in areas of stable transmission emphasize a combination of intermittent preventive treatment during pregnancy (IPTp) and use of insecticide-treated nets (ITNs), along with effective case management. Neither ITNs nor IPTp provide complete protection alone, and since IPTp and ITNs work synergistically, combining these interventions could be highly effective. The World Health Organization (WHO) recommends that pregnant women receive IPTp, starting early in the second trimester, with at least three doses, regardless of ITN use. Therefore, this study aims to assess the utilization of ITNs and IPTp and the factors influencing their use among pregnant women in sub-Saharan Africa.

Methods

We used the most recent Malaria Indicator Survey (MIS) or Demographic and Health Survey (DHS) data from 18 sub-Saharan African (SSA) countries, conducted between 2018 and 2024. A weighted sample of 63,561 women who had given birth in the 3 years preceding the survey was included in this analysis. Pooled estimates for the utilization of both insecticide-treated nets (ITN) and IPTp were reported with 95% confidence intervals (CI). To determine factors associated with utilization, we performed a multilevel multinomial regression analysis. Variables with a p-value < 0.05 or whose ARRR confidence interval did not include one were considered significant factors associated with malaria preventive measures utilization among pregnant women.

Results

Among our weighted sample of 63,561 pregnant women, the following utilization rates of malaria preventive measures were observed: 28.9% (95% CI 28.4, 29.3%) used both an ITN (slept under one the previous night) and IPTp (3 or more doses), and 17.6% (95% CI 17.2, 18.0%) used neither ITN nor IPTp. Multilevel multinomial regression analysis revealed that age, educational status, sex of household head, wealth index, mass media exposure, residence and sub-region of SSA were significant factors associated with ITN and IPTp utilization.

Conclusion

Fewer than one-third of expectant mothers took advantage of combined ITN and IPTp malaria prevention strategies. Both community-level and individual-level predictors should be considered when developing strategies and implementing programs run by both governmental and non-governmental organizations in order to achieve the global goal of reducing malaria by 90% by 2030.