Missed opportunities in IPTp-SP delivery during antenatal care in Osun State, Nigeria
5 affiliations
- 1African Field Epidemiology Network, Abuja, Nigeria; Department of Public Health, Adeleke University, Ede, Osun State, Nigeria
- 2Department of Public Health, Adeleke University, Ede, Osun State, Nigeria
- 3UNICEF Nigeria
- 4Malaria Unit, Department of Public Health, Osun State Ministry of Health, Nigeria
- 5Department of Public Health, University of Ilorin, Ilorin, Nigeria
Abstract
Introduction: Intermittent preventive treatment of malaria in pregnancy with sulfadoxine -pyrimethamine (IPTp-SP) is a World Health Organization (WHO) recommended intervention delivered primarily through antenatal care (ANC) platforms. Nigeria continues to report a persistent gap between ANC attendance and IPTp-SP completion, suggesting missed opportunities at the point of service. This baseline assessment quantified implementation gaps in IPTp-SP delivery and explored socioeconomic differentials that may lead to deficiencies in effective coverage. Methods: A cross-sectional baseline survey was conducted among 250 pregnant women (18-49 years) attending ANC in three secondary facilities across Osun State (State Specialist Hospital Asubiaro; State Hospital Ede; State Hospital Ilesa). Eligible women had received at least one SP dose in the current pregnancy. Data were collected using an interviewer-administered questionnaire configured in KoBoCollect. Key implementation outcomes included SP availability, directly observed therapy (DOT), and provider counselling. Knowledge was assessed using an 11-item composite score and classified as good knowledge at ≥7/11. Socioeconomic position was proxied by self-reported monthly income categories and autonomy indicators. Descriptive statistics and multivariable logistic regression were used to identify correlates of DOT. Results: The mean age of the participants was 29.7±5.1 years; mean booking gestational age was 18.5±6.8 weeks; and mean ANC visits were 3.6±2.0. While SP was reported as “always available” by 71.6% and available on the day of visit by 74.0%, DOT was reported by only 24.0% and provider explanation by 7.6%. Facility-level variation was substantial: DOT ranged from 10.2% to 65.2%. Socioeconomic constraints were evident: only 47.6% could afford SP and 36.8% met criteria for high autonomy. Conclusion: Findings indicate major implementation failures, particularly in DOT and counselling, despite a moderate level of reported SP availability. These gaps are likely to sustain inequities and limit effective coverage. Interventions should prioritise standardised DOT workflows, supervision and job aids, commodity/security mechanisms, and equity-oriented support for women facing cost and autonomy constraints.
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BibTeX
@article{orhorhamreru2026missed,
title = {{Missed opportunities in IPTp-SP delivery during antenatal care in Osun State, Nigeria}},
author = {Tosin Orhorhamreru and Opeyemi Oladunni and Adefunke Busola Ogunleye and Moronke Rachael Orhorhamreru and Braimah Rasheed Oyeyemi and Olufemi Oroge and Adekunle Ganiyu Salawudeen},
journal = {Journal of Interventional Epidemiology and Public Health},
year = {2026},
month = aug,
doi = {10.37432/jieph-d-26-00098},
url = {https://doi.org/10.37432/jieph-d-26-00098},
note = {CC BY},
}
RIS
TY - JOUR
TI - Missed opportunities in IPTp-SP delivery during antenatal care in Osun State, Nigeria
AU - Tosin Orhorhamreru
AU - Opeyemi Oladunni
AU - Adefunke Busola Ogunleye
AU - Moronke Rachael Orhorhamreru
AU - Braimah Rasheed Oyeyemi
AU - Olufemi Oroge
AU - Adekunle Ganiyu Salawudeen
PY - 2026
DA - 2026/08/01
JO - Journal of Interventional Epidemiology and Public Health
DO - 10.37432/jieph-d-26-00098
UR - https://doi.org/10.37432/jieph-d-26-00098
AB - Introduction: Intermittent preventive treatment of malaria in pregnancy with sulfadoxine -pyrimethamine (IPTp-SP) is a World Health Organization (WHO) recommended intervention delivered primarily through antenatal care (ANC) platforms. Nigeria continues to report a persistent gap between ANC attendance and IPTp-SP completion, suggesting missed opportunities at the point of service. This baseline assessment quantified implementation gaps in IPTp-SP delivery and explored socioeconomic differentials that may lead to deficiencies in effective coverage. Methods: A cross-sectional baseline survey was conducted among 250 pregnant women (18-49 years) attending ANC in three secondary facilities across Osun State (State Specialist Hospital Asubiaro; State Hospital Ede; State Hospital Ilesa). Eligible women had received at least one SP dose in the current pregnancy. Data were collected using an interviewer-administered questionnaire configured in KoBoCollect. Key implementation outcomes included SP availability, directly observed therapy (DOT), and provider counselling. Knowledge was assessed using an 11-item composite score and classified as good knowledge at ≥7/11. Socioeconomic position was proxied by self-reported monthly income categories and autonomy indicators. Descriptive statistics and multivariable logistic regression were used to identify correlates of DOT. Results: The mean age of the participants was 29.7±5.1 years; mean booking gestational age was 18.5±6.8 weeks; and mean ANC visits were 3.6±2.0. While SP was reported as “always available” by 71.6% and available on the day of visit by 74.0%, DOT was reported by only 24.0% and provider explanation by 7.6%. Facility-level variation was substantial: DOT ranged from 10.2% to 65.2%. Socioeconomic constraints were evident: only 47.6% could afford SP and 36.8% met criteria for high autonomy. Conclusion: Findings indicate major implementation failures, particularly in DOT and counselling, despite a moderate level of reported SP availability. These gaps are likely to sustain inequities and limit effective coverage. Interventions should prioritise standardised DOT workflows, supervision and job aids, commodity/security mechanisms, and equity-oriented support for women facing cost and autonomy constraints.
SN - 2664-2824
ER -