Factors associated with the optimal uptake of intermittent preventive treatment in pregnancy with sulfadoxine–pyrimethamine: The experiences of postpartum women attending child welfare clinics in three rural districts in the Western Region of Ghana

BACKGROUND: Intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) is a key preventive strategy. However, optimal uptake remains inconsistent despite high antenatal care (ANC) attendance. This study assessed factors associated with optimal IPTp-SP uptake and explored the experiences of postpartum women in rural Ghana. METHODS: A convergent parallel mixed-method study was conducted among 1,155 postpartum women attending child welfare clinics in Jomoro, Prestea-Huni Valley and Ellembelle districts of the Western Region of Ghana. Quantitative data were collected using structured questionnaires and analysed using descriptive statistics and chi-square tests. Qualitative data from in-depth interviews and focus group discussions were analysed thematically to explore women's experiences and perceptions. RESULTS: Among the 1,155 women enrolled, 812 (70.3%) took three or more doses of IPTp-SP (IPTp3-SP). Knowledge of malaria in pregnancy was high, with 92.7% correctly identifying its mode of transmission and 91.7% identifying ways of preventing malaria during pregnancy. Factors independently associated with IPTp3-SP included age 10-19 years compared with 20-29 years (aOR 2.17, 95% CI 1.21-3.88), gravidity of three compared with one (aOR 2.67, 95% CI: 1.58-4.50), and gravidity of four compared with one (aOR 1.83, 95% CI: 1.02-3.28). Lower odds were observed among uninsured women (aOR 0.36, 95% CI: 0.20-0.64), single women (aOR 0.64, 95% CI: 0.42-0.97), and cohabiting women (aOR 0.52, 95% CI: 0.34-0.79). ANC attendance showed a strong association with IPTp3-SP: women attending <4 ANC visits had lower odds of receiving IPTp3-SP than those attending 10 or more visits (aOR 0.08, 95% CI: 0.04-0.15). Nausea, dizziness, weakness, abdominal discomfort, vomiting and difficulty chewing the tablets affected their experiences and, for some women, willingness to continue treatment. CONCLUSIONS: IPTp-SP uptake was relatively high. Predictors of optimal uptake include age, education, marital status, gravidity, health insurance status, and number of ANC visits. Women with fewer ANC visits were less likely to receive three or more doses. Reported side effects posed barriers to adherence. Strengthening ANC attendance and counselling on IPTp-SP expected side effects may improve completion of recommended doses.