Antenatal care contact and optimal IPTp-SP uptake among pregnant women in a district hospital in Ghana: multivariable regression and exploratory decomposition analysis

This study examined the factors associated with optimal IPTp-SP uptake and explored whether antenatal care (ANC) contacts statistically mediated the association between parity and IPTp-SP uptake among pregnant women attending ANC in Juaben, Ghana. This cross-sectional analysis utilised retrospective data of 2,301 pregnant women who delivered at Juaben Government Hospital between January 2021 and December 2023. Modified Poisson regression with a log link and robust (HC0) standard errors was used to estimate adjusted prevalence ratio (aPR) for optimal IPTp-SP uptake. An exploratory decomposition analysis was conducted to determine whether ANC contacts statistically accounted for part of the association between parity and optimal IPTp-SP uptake. Of the 2,301 women included in the analysis, approximately 74.7% received optimal IPTp-SP uptake. In the primary multivariable analysis, completing ≥ 8 ANC contacts was associated with a higher prevalence of optimal IPTp-SP uptake (aPR: 1.31, 95% CI: 1.23–1.40). In the exploratory decomposition analysis, among nulliparous women compared with multiparous mothers, the average indirect component through ≥ 8 ANC contacts was 0.03 (95% CI: 0.01–0.05), while the average direct component was − 0.07 (95% CI: −0.13 to − 0.02). Among primiparous mothers compared with multiparous women, the average indirect component through ≥ 8 ANC contacts was 0.03 (95%CI: 0.01–0.04), whereas the average direct component was − 0.01 (95%CI: −0.08 to 0.04). This study demonstrated a high prevalence of optimal IPTp-SP uptake, which was associated with completing at least eight ANC contacts, reflecting progress in malaria prevention during pregnancy. The findings underscore the important role of ANC contacts as the main platform for delivering preventive maternal health interventions. Strengthening ANC engagement and ensuring consistent IPTp-SP availability at health facilities are essential to achieve optimal maternal health outcomes.