Individual and community-level correlates of optimal doses of sulfadoxine-pyrimethamine for intermittent preventive treatment of malaria during pregnancy in Tanzania: a multilevel analysis of the 2022 national survey.

Background: Malaria during pregnancy remains a significant public health challenge in sub-Saharan Africa, where approximately 32 million pregnant women are at risk. Despite the progress made in the coverage of Intermittent Preventive Treatment of malaria during pregnancy using sulfadoxine-pyrimethamine (IPTp-SP), notable gaps persist in understanding the individual and community-level factors that correlate with optimal dosing adherence. This study aims to assess these correlates in Tanzania using recent Tanzania Demographic and Health Survey (TDHS) data.

Methods: This study employed an analytical cross-sectional design, utilizing data from the 2022 TDHS. This study's analysis included 4497 women who had given birth within two years before the survey. The data were analzed using multilevel mixed-effects logistic regression, employing four models to identify factors associated with optimal IPTp-SP dose uptake.

Results: The overall uptake of optimal (≥ 3 doses) IPTp-SP was 31.2% (95% CI 29.1-33.3). In the adjusted analysis, individual correlates were women aged 25-34 years (AOR = 1.52, 95% CI 1.21-1.90) and 35-49 years (AOR = 1.47, 95% CI 1.10-1.96) compared to women aged 15-24 years. Women with primary education (AOR = 1.34, 95% CI 1.07-1.68) were more likely to achieve optimal uptake than those with no formal education. Furthermore, women with one child (AOR = 1.65, 95% CI 1.26-2.17) and two children (AOR = 1.37, 95% CI 1.09-1.74) showed higher odds of optimal uptake compared to women with no children. Having more than three antenatal care (ANC) visits (AOR = 1.77, 95% CI 1.47-2.12) increased the likelihood of optimal uptake compared to those with fewer than three visits. Community-level correlates of optimal IPTp-SP uptake included communities with higher ANC visit rates (AOR = 1.49, 95% CI 1.13-1.97), which showed higher odds of optimal uptake than those with low ANC visit rates. Residing in the Northern (AOR = 1.61, 95% CI 1.01-2.59) and Lake zones (AOR = 1.68, 95% CI 1.12-2.53) was also associated with higher odds of optimal uptake compared to women in the Western zone. Conversely, women in Zanzibar (AOR = 0.01, 95% CI 0.01-0.06) had low uptake because IPTp-SP is no longer recommended.

Conclusion: This study revealed low uptake of optimal doses of IPTp-SP influenced by several individual and community factors. Future malaria prevention in pregnancy requires integrating control programs with reproductive health services, overcoming socio-cultural barriers, and utilizing community engagement to enhance IPTp-SP coverage.