Factors associated with intermittent preventive treatment (IPTp-SP) use for malaria during pregnancy in Somalia: a multilevel analysis of the 2020 demographic and health survey

The overall reported use of SP/Fansidar in Somalia is critically low, indicative of significant gaps in maternal healthcare delivery and falling far short of WHO coverage goals. This is fundamentally driven by the very low overall ANC attendance rate (31.0%) and further exacerbated by paradoxical findings, such as lower reported SP use among those who do attend, despite higher ANC attendance, which suggest severe systemic barriers and potential issues with service quality or SP availability. Interventions are needed to improve both initial access to ANC and the quality of ANC delivery, ensure SP availability and administration during visits, address regional inequities, and strengthen the health system to protect pregnant women and newborns from malaria.