Increased uptake of intermittent preventive treatment for malaria in pregnant women in Zambia (2006–2012): Potential determinants and highlight of lessons learnt

Abstract Objective To assess potential determinants of uptake and highlight lessons learnt from the implementation of intermittent preventive treatment (IPTp), given to pregnant women as early as possible during the second trimester in Zambia. Methods Data from four national malaria surveys (2006, 2008, 2010, 2012) were reviewed, and proportions of pregnant women attending antenatal clinics (ANCs) who received two or more doses of sulfadoxine–pyrimethamine (IPTp2) were compared by place of residence, education level, and wealth status. Malaria cases and deaths in pregnant women, from Health Information Management System 2011–2013, were analyzed to determine malaria burden in pregnancy in Zambia. A multiple logistic regression model was applied to identify potential determinants of IPTp uptake. Results The proportion of pregnant women who took IPTp at ANCs increased from near zero at inception in 2001 to 61.9% in 2006; and to 72% by 2012 ( P P P  = 0.05). Incidence of malaria cases, hospital admissions and mortality during pregnancy decreased between 2011 and 2013. Overall, increased IPTp uptake was associated with being in urban areas (OR = 1.56, 95% CI : 1.39–1.74), having college (OR = 1.83, 95% CI : 1.25–2.75) or secondary education (OR = 1.68, 95% CI : 1.44–1.96) or of being of higher wealth status (OR = 1.86, 95% CI : 1.60–2.17). Conclusions Zambia has increased IPTp uptake through ANC for all women. The malaria control program has contributed to increasing access to health services and reducing demographic and socioeconomic disparities.