This study was conducted in Ebonyi State which is one the five states that make up the South East geopolitical zone in Nigeria. Ebonyi State has 13 Local Government Areas (LGA) and 142 communities. The 2019 projected population of Ebonyi State and population of women of reproductive age were 3,112,220 and 684,688 respectively as obtained from the State Ministry of Health. Presently there are 556 health facilities both public and private in Ebonyi State comprising one tertiary health facility, 13 general hospitals, 6 mission hospitals, 417 primary health centers and 119 private hospitals/clinics . Most of these health facilities offer maternal and child health related services such as ante natal care (ANC) and immunization services. The ANC attendance at health facilities with skilled providers was 70.3% . Ebonyi State is one of the states supported by the Presidential Malaria Initiative project. The project provides training for health workers, provides malaria preventive commodities including SP. During ANC clinics, SP is prescribed and dispensed at the health facility at no cost to the pregnant.
The predominant occupations in the state are farming and trading. Most communities in Ebonyi State engage in farming activities which increases the man-vector contact aiding malaria transmission. More so, the limestone excavations and quarrying activities in many of the communities create enabling environments for water accumulation and breeding of mosquitoes that transmit malaria.
Study design and population
We conducted a cross-sectional study among women of reproductive age (N = 340). We included women who had been residing in selected communities and had given birth in the past year prior to the survey. The women who were incapacitated or not disposed to respond to the interview were excluded.
Multistage sampling technique was used to recruit respondents for the study. Two LGAs (Abakaliki and Ebonyi) were selected by balloting from a list of 13 LGAs in the state. In each of the LGAs, four communities were selected by balloting from Abakaliki LGA (Izziunuhu, Azuiyiokwu, Okpaugwu, and Timber Communities) and Ebonyi LGA (Aboffia, Kpirikpiri, Abakpa, and New Layout). The list of households in these communities were obtained from the immunization department of the selected LGAs. A total of 1041 households from the eight communities were obtained to serve as sampling frame. Eligible women were selected from each of the sampled households in the communities using systematic sampling technique until the allocated sample size was achieved. However, in any household where there was more than one eligible woman, the respondent was selected by balloting.
Measurement of variables
The dependent variable was IPTp uptake which was categorized based on the number of doses of IPTp they took during the pregnancy in the year preceding the survey. Those who did not take any IPTp were categorized as none, those who took less than three doses were categorized as inadequate uptake and those who took three doses and or more were categorized as having adequate uptake. To examine the determinants of IPTp uptake, we re-categorize the variable into two groups. None IPTp uptake and inadequate uptake were merged and categorized as inadequate while adequate uptake remained as ≥3 doses.
Data collection and analysis
A semi-structured interviewer administered questionnaire was used to collect data on socio-demographic characteristics of respondents, uptake of intermittent preventive treatment for malaria in pregnancy, health facility type and spouse information. The data collection was conducted by trained research assistants. Data were analyzed with Statistical Package for Social Science (IBM SPSS) version 20. We examined the association between uptake of IPTp and sociodemographic characteristics using Chi Squared test. The variables that were significant at 10% in the bivariate analysis were included in the multiple logistic regression. We identified the predictors of IPTp uptake at 5% level of significance.
We obtained ethical approval from the Research and Ethics Committee of Ebonyi State Ministry of Health (approval reference number: SMOH/ERC/054/19). Written informed consents were obtained from all respondents after explaining the details of the study. Participation in the study was voluntary and the information obtained were handled with strict confidentiality.