Determinants of suboptimal IPTp-SP uptake for malaria prevention during pregnancy in Kissidougou, Guinea

Introduction: Malaria in pregnant women is a major public health issue. Despite the adoption of sulfadoxine-pyrimethamine (SP) as chemoprevention for malaria during pregnancy in Guinea, its use remains insufficient. The objective of this study was to evaluate the factors associated with suboptimal IPTp-SP uptake in Kissidougou. Methods: A cross-sectional analytical study was conducted in the Kissidougou health district from November 2024 to March 2025 among 532 women who had given birth in the previous 12 months. The analysis was performed using SPSS version 25 software. In order to identify factors associated with inadequate intermittent preventive treatment of sulfadoxine pyrimethamine (IPTp-SP) dosage, binary logistic regression was performed with a significance threshold set at 5% and a confidence interval of 95%. Results: Among the 532 participants surveyed in our study, the average age was 25.9 (± 6.3) years, and most of them (72.0%) lived in rural areas. Almost all of our participants (97.6%) were married, and 61.8% had no formal education. Overall, 54.9% of women had inadequate uptake of the recommended minimum of three IPTp-SP doses during pregnancy. Factors associated with suboptimal IPTp-SP uptake included fewer than three antenatal care visits (aOR=13.05, 95% CI: 4.86-35.03), poor knowledge of the interval between SP doses (aOR = 45.24, 95% CI: 23.99-85.34), poor knowledge of the dangers of malaria during pregnancy (aOR = 0.36, 95% CI: 0.19 – 0.65), and means of transportation (aOR = 0.26, 95% CI: 0.15-0.47). Conclusion: Achieving optimal coverage of IPTp-SP in Kissidougou requires going beyond an approach focused solely on drug availability. An effective strategy must systematically address the economic (cost of consultations) and geographical (transport) determinants that limit access to antenatal care, while filling critical knowledge gaps.