Sierra Leone Sees Gains in Malaria Prevention for pregnant Women, But Regional Disparities Widen
Freetown, Sierra Leone – Intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) coverage among pregnant women in Sierra Leone rose substantially between 2008 and 2019, but a new study reveals increasing inequalities in access based on geographic location, raising concerns about equitable maternal health outcomes. While national coverage climbed from 5.2% to 35.7% over the 11-year period, disparities between provinces have grown, highlighting the need for targeted interventions.
The research, utilizing data from the Sierra Leone Demographic Health survey in 2008, 2013, and 2019, underscores a complex picture of progress and persistent challenges. IPTp-SP is a crucial intervention for preventing malaria during pregnancy, a major contributor to maternal and infant mortality. Understanding the factors driving uneven uptake is vital for maximizing the impact of this preventative measure. The study employed inequality measures – including simple difference, ratio, population-attributable risk, and population-attributable fraction – to assess disparities across economic status, education level, place of residence, and sub-national province.
Key findings indicate that economic inequalities widened, with a gap of -5.2 percentage points in 2019 between the richest (Quintile 5) and poorest (Quintile 1) pregnant women, compared to -1.4 percentage points in 2008. Though, inequalities related to education and place of residence decreased; the difference between women with secondary or higher education and those with no education fell from 4.4 to -3.8 percentage points, while the urban-rural gap narrowed from 1.4 to -6.3 percentage points. Conversely, provincial inequalities increased substantially, from a 4.1 percentage point difference in 2008 to 18.4 percentage points in 2019.
Researchers conclude that while overall IPTp-SP coverage is improving and some inequalities are lessening, the growing disparities at the provincial level demand tailored strategies. The study recommends a multifaceted approach encompassing health system strengthening, targeted behaviour change communication, and addressing underlying social determinants of health to achieve global and equitable coverage of IPTp-SP in Sierra Leone.
Keywords: Intermittent preventive treatment in pregnancy (IPTp); Malaria prevention; Maternal health; Sierra Leone; Sulfadoxine-Pyrimethamine (SP).
