Coverage and factor associated to the uptake of Intermittent preventive treatment for malaria during pregnancy (IPTp) in Cameroun in 2018: an analysis from the 2018 Cameroon Demographic Health Survey data

Malaria in pregnancy is a major public health issue, contributing to significantly increasing mother and children mortality and morbidity. Intermittent preventive treatment of malaria using Sulfadoxine-Pyrimethamine (IPTp-SP) is one of the key interventions recommended by WHO and in Cameroon to reduce the morbidity of Malaria in Pregnancy. The present study aims to assess the distribution and determinants of poor uptake of IPTp-SP (< 3 doses) among pregnant women in Cameroon. We conducted a secondary analysis of data extracted from the Cameroun Demographic Health Survey conducted in 2018. Data were collected using a questionnaire administered in face to face to mothers with at least one child under 5, selected using a 2-stage stratified sampling process. Frequencies of mothers exposed to less than 3 doses of IPTp-SP were estimated with a 95% CI. A case-control design was used to assess the association between key suspected determinants and being exposed to less than 3 doses of IPTp-SP. This was measured by estimating crude and adjusted Odd-Ratios (ORs). A total of 13527 childbearing age women were interviewed, of which 5528 (40.9%) met our selection criteria. Among those, 845 (15.3%) had not attended any Antenatal care (ANC) visit, 1109 (20%) had attended 1 to 3 visits, 3379 (61.1%) had attended 4 to 7 visits and only 195 (3.5%) had attended at least 8 visits. In all, 3398 (61.5%, CI: 60.2-62.8) had received less than 3 doses of IPTp-SP. Maternal age below 26 years (aOR=1.17, CI: 1.01-1.35), residence in an area of lower malaria endemicity (aOR=1.26, CI: 1.00-1.58), residence in the Sahelian regions (aOR=5.81, CI: 2.46-13.69), and having attended less than 4 ANC visits (aOR=1.30, CI: 1.08-1.57) were predictors of poor uptake of IPTp-SP. Conversely, residence in major cities (aOR=0.65, CI: 0.50-0.84), having attended a first ANC visit at 3 months or less of pregnancy (aOR=0.66, CI: 0.57-0.78) and having been followed on ANC by a medical doctor (aOR=0.22, CI: 0.13-0.35), were preventing factors for poor uptake of IPTp3+. Highest level of education (aOR= 1.10, CI: 0.90-1.32) was not found associated with the uptake of IPTp-SP. Therefore, only a third of pregnant women in Cameroon take an optimal dose of IPTp-SP. This proportion vary widely with the place of residence, being significantly low in the Sahelian regions. Interventions to address identified determinants of low coverage of IPTp-SP like maternal age below 26 years, ANC characteristics or being resident of area with lower malaria endemicity ought to be tested.