Spatial distribution and determinants of uptake of intermittent preventative treatment for malaria during pregnancy in the democratic republic of congo between 2017 and 2018
1
Epidemiology and Biostatistics, The University of the Witwatersrand, Johannesburg, South Africa
Popul. Med. 2026;8(Supplement Supplement 1):A2303
ABSTRACT
BACKGROUND:
The Democratic Republic of Congo (DRC) bears the second highest burden of malaria in Sub-Saharan Africa, with a significant proportion of pregnant women affected. Despite targeted efforts, the uptake of Intermittent Preventative Treatment with Sulfadoxine and Pyrimethamine (IPTp-SP) during pregnancy remains sub-optimal. The aim of this study is to determine the spatial distribution and determinants of the uptake of Intermittent Preventative Treatment for malaria during pregnancy among women aged 15 to 49 years in the DRC between 2017 and 2018.
METHODS:
This cross-sectional study draws from the 2017–2018 UNICEF Multiple Indicator Cluster Survey, including 4,249 women who were pregnant two years prior to the primary study. Multi-level logistic regression, conditional and simultaneous autoregressive modelling were used to identify individual- and ecological-level factors associated with IPTp-SP optimal uptake.
RESULTS:
Only 23.2% (n=987) of women achieved optimal (3 doses) IPTp-SP uptake. Key predictors included primiparity (aOR: 1.49, 95% CI: 1.10-2.10) and early antenatal care (ANC) initiation (aOR: 0.46, 95% CI: 0.24-0.88 for visits >12 weeks). A significant dose-response relationship was observed; fewer ANC visits drastically reduced uptake odds. Notably, provinces with medium-to-high conflict intensity showed higher uptake (aOR: 2.9, 95% CI: 1.4-7). Environmental factors, including high humidity and temperatures >25 degree Celsius, were positive predictors, while high evaporation was a negative predictor. Spatial modeling confirmed religion, ANC timing and frequency, and residential area were the most robust determinants of uptake across the DRC.
CONCLUSIONS:
IPTp-SP uptake in the DRC remains sub-optimal, with both individual and contextual factors contributing to low uptake. Early attendance of ANC and climate variability emerged as consistent determinants, suggesting that strengthening pregnancy services and addressing rising concerns of climate and political instability may improve IPTp-SP coverage. A multi-sectoral strategy that integrates environmental and health system dimensions is critical to enhance malaria prevention in pregnancy.
The Democratic Republic of Congo (DRC) bears the second highest burden of malaria in Sub-Saharan Africa, with a significant proportion of pregnant women affected. Despite targeted efforts, the uptake of Intermittent Preventative Treatment with Sulfadoxine and Pyrimethamine (IPTp-SP) during pregnancy remains sub-optimal. The aim of this study is to determine the spatial distribution and determinants of the uptake of Intermittent Preventative Treatment for malaria during pregnancy among women aged 15 to 49 years in the DRC between 2017 and 2018.
METHODS:
This cross-sectional study draws from the 2017–2018 UNICEF Multiple Indicator Cluster Survey, including 4,249 women who were pregnant two years prior to the primary study. Multi-level logistic regression, conditional and simultaneous autoregressive modelling were used to identify individual- and ecological-level factors associated with IPTp-SP optimal uptake.
RESULTS:
Only 23.2% (n=987) of women achieved optimal (3 doses) IPTp-SP uptake. Key predictors included primiparity (aOR: 1.49, 95% CI: 1.10-2.10) and early antenatal care (ANC) initiation (aOR: 0.46, 95% CI: 0.24-0.88 for visits >12 weeks). A significant dose-response relationship was observed; fewer ANC visits drastically reduced uptake odds. Notably, provinces with medium-to-high conflict intensity showed higher uptake (aOR: 2.9, 95% CI: 1.4-7). Environmental factors, including high humidity and temperatures >25 degree Celsius, were positive predictors, while high evaporation was a negative predictor. Spatial modeling confirmed religion, ANC timing and frequency, and residential area were the most robust determinants of uptake across the DRC.
CONCLUSIONS:
IPTp-SP uptake in the DRC remains sub-optimal, with both individual and contextual factors contributing to low uptake. Early attendance of ANC and climate variability emerged as consistent determinants, suggesting that strengthening pregnancy services and addressing rising concerns of climate and political instability may improve IPTp-SP coverage. A multi-sectoral strategy that integrates environmental and health system dimensions is critical to enhance malaria prevention in pregnancy.
| eISSN: | 2654-1459 |
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