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Background <p>Anaemia in pregnancy remains a major public health challenge in sub-Saharan Africa, contributing to adverse birth outcomes, including low birth weight and neonatal mortality. The World Health Organization (WHO) recommends the uptake of intermittent preventive treatment during pregnancy with at least three doses of sulfadoxine-pyrimethamine (IPTp-SP3) to reduce these adverse outcomes. Achieving equitable distribution of IPTp-SP3 is essential for advancing Sustainable Development Goal 3 (SDG3), which aims to achieve universal health coverage and equitable access to healthcare services for all men and women. However, continued disparities in the uptake of IPTp3 across socioeconomic groups are evident in many African countries. This study, therefore, investigates wealth-based inequalities in IPTp-SP3 coverage across 15 West African countries.</p> Methods <p>Using the WHO Health Equity Assessment Toolkit (HEAT), the study analysed secondary data drawn from the Demographic and Health Surveys (DHS), Malaria Indicator Surveys (MIS) and Multiple Indicator Cluster Surveys (MICS) conducted from 2015 to 2021, across 15 West African countries. Four measures of inequalities: Absolute Difference (D), Prevalence Ratio(R), Population Attributable Risk(PAR) and Population Attributable Fraction(PAF) were used to assess wealth-related inequalities in IPTp-SP3 coverage.</p> Results <p>The lowest IPTp-SP3 coverage, 11.2% was recorded in Mauritania, whilst Burkina Faso recorded the highest coverage of 57.7%. The results revealed substantial wealth-related inequalities. IPTp-SP3 coverage was high among the population's richest quintiles in Guinea (D = 30.3%), Togo (D = 27.6%) and Benin (D = 17.6%). Paradoxically, in Liberia (D = −&#xa0;4.5%), Nigeria (D = −&#xa0;4.4%), and Sierra Leone (D = −&#xa0;3.1%), the poorest quintiles experience the highest IPTp-SP3 coverage compared to the richest quintiles. Countries with the greatest potential national increase in IPTp-SP3 coverage if the poorer quintiles had the same level of access as the richest were Togo (17.3), Guinea (17.2) and Senegal (6.3) percentage points. However, near-equitable access to IPTp-SP3 was observed in Liberia, Nigeria and Sierra Leone.</p> Conclusion <p>Wealth-based inequalities continue to hinder IPTp-SP3 uptake in West Africa. Addressing these disparities require targeted equity-driven strategies to improve coverage among pregnant women and towards achieving the objectives of SDG 3.</p>

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Wealth-based inequalities in the uptake of three or more doses of intermittent preventive treatment in pregnancy in West Africa, 2015–2021

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  • 发表日期：

    2025年12月9日

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  • Abdul-Wahab Inusah,
  • Temple O. Jagha,
  • Abdul‑Aziz Seidu,
  • Shamsu-Deen Ziblim

摘要

Background

Anaemia in pregnancy remains a major public health challenge in sub-Saharan Africa, contributing to adverse birth outcomes, including low birth weight and neonatal mortality. The World Health Organization (WHO) recommends the uptake of intermittent preventive treatment during pregnancy with at least three doses of sulfadoxine-pyrimethamine (IPTp-SP3) to reduce these adverse outcomes. Achieving equitable distribution of IPTp-SP3 is essential for advancing Sustainable Development Goal 3 (SDG3), which aims to achieve universal health coverage and equitable access to healthcare services for all men and women. However, continued disparities in the uptake of IPTp3 across socioeconomic groups are evident in many African countries. This study, therefore, investigates wealth-based inequalities in IPTp-SP3 coverage across 15 West African countries.

Methods

Using the WHO Health Equity Assessment Toolkit (HEAT), the study analysed secondary data drawn from the Demographic and Health Surveys (DHS), Malaria Indicator Surveys (MIS) and Multiple Indicator Cluster Surveys (MICS) conducted from 2015 to 2021, across 15 West African countries. Four measures of inequalities: Absolute Difference (D), Prevalence Ratio(R), Population Attributable Risk(PAR) and Population Attributable Fraction(PAF) were used to assess wealth-related inequalities in IPTp-SP3 coverage.

Results

The lowest IPTp-SP3 coverage, 11.2% was recorded in Mauritania, whilst Burkina Faso recorded the highest coverage of 57.7%. The results revealed substantial wealth-related inequalities. IPTp-SP3 coverage was high among the population's richest quintiles in Guinea (D = 30.3%), Togo (D = 27.6%) and Benin (D = 17.6%). Paradoxically, in Liberia (D = − 4.5%), Nigeria (D = − 4.4%), and Sierra Leone (D = − 3.1%), the poorest quintiles experience the highest IPTp-SP3 coverage compared to the richest quintiles. Countries with the greatest potential national increase in IPTp-SP3 coverage if the poorer quintiles had the same level of access as the richest were Togo (17.3), Guinea (17.2) and Senegal (6.3) percentage points. However, near-equitable access to IPTp-SP3 was observed in Liberia, Nigeria and Sierra Leone.

Conclusion

Wealth-based inequalities continue to hinder IPTp-SP3 uptake in West Africa. Addressing these disparities require targeted equity-driven strategies to improve coverage among pregnant women and towards achieving the objectives of SDG 3.