Factors influencing low coverage of optimal dose of intermittent preventive treatment with sulfadoxine-pyrimethamine among pregnant women in Farafangana, Madagascar, 2024

Introduction: In Madagascar, coverage of the optimal dose (three doses or more) of Intermittent Preventive Treatment with Sulfadoxine-Pyrimethamine during pregnancy (IPTp-SP) remains low, reaching only 31% in 2021. This study aimed to investigate the factors influencing this low coverage in a particularly affected community. Methods: This was a cross-sectional study using a mixed-methods approach, conducted among mothers with a child under 12 months and healthcare personnel in Farafangana from November 19, 2024, to January 10, 2025. A descriptive analysis, a bivariate and multivariate logistic regression, were conducted. The odds ratio with a 95% confidence interval was used as the measure of association. Qualitative data analysis was conducted manually based on predefined themes and sub-themes. Results: The coverage of the optimal dose of IPTp-SP was 28.9%. Factors significantly associated with the non-receipt of the optimal dose included women under 25 years of age (adjusted odds ratios (AOR) [95% confidence intervals (CI)] = 0.47 [0.26 – 0.83]), being multigravida (AOR [95% CI] = 1.66 [1.08 – 3.14]), multiparity (AOR [95% CI] = 1.62 [1.13 – 3.18]), poor knowledge of the recommended dose (AOR [95% CI] = 6.82 [3.21 – 14.49]), late initiation of intake (AOR [95% CI] = 2.28 [1.41 – 3.67]), and SP-related side effects (AOR [95% CI] = 1.58 [1.02 – 2.46]). The qualitative approach corroborated these findings and identified the influence of women’s social surroundings. Conclusion: Factors related to women, sociocultural aspects, and the health system influence the low coverage of the optimal IPTp-SP dose in Farafangana. An implementation approach addressing all these factors would be essential to improve coverage.