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Perceptions of Intermittent Preventive Treatment in Pregnancy (IPTp) Among Pregnant Women in the Western Area Urban District, Sierra Leone: A Mixed-Methods Study

Irene Mabinty Sesay
Bachelor of Nursing Education Student, Tonkolili District College of Health Sciences, Masanga, Sierra Leone
DOI Crossref DOI 10.37547/tajmspr/Volume08Issue10-03
tajmspr 2026
VOL. 8 / NO. 10 OCTOBER
FULL TEXT PP. 17-23
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VOLUME 8
ISSUE 10
YEAR 2026
PAGES 17-23
RESEARCH OVERVIEW

Abstract

Background: Malaria in pregnancy remains a major public health challenge in Sierra Leone, contributing significantly to maternal and neonatal morbidity and mortality. While Intermittent Preventive Treatment in Pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) is a proven intervention, adherence remains suboptimal. Perceptions of IPTp including beliefs about benefits, risks, and acceptability are critical determinants of uptake. However, limited research has explored these perceptions among pregnant women in urban Sierra Leone, particularly in the Western Area Urban District.

Objective: To examine the perceptions of pregnant women attending antenatal clinics in the Western Area Urban District regarding IPTp, including perceived benefits, risks, safety concerns, and acceptability.

Methods: A mixed-methods study was conducted among 422 pregnant women attending six selected ANC facilities in Freetown between July and September 2025. Quantitative data were collected using structured questionnaires assessing perceptions of IPTp benefits, risks, and acceptability. Qualitative data were collected through semi-structured in-depth interviews (n=12) and focus group discussions (n=5 groups, 6–10 women each) to explore lived experiences, beliefs, and social norms. Quantitative data were analysed using descriptive statistics and chi-square tests; qualitative data were analysed thematically using a framework approach.

Results: Among 422 participants, 68.5% (n=289) perceived IPTp as beneficial for preventing malaria in pregnancy, and 62.1% (n=262) believed it was safe for both mother and baby. However, 37.4% (n=158) expressed concerns about side effects, and 28.7% (n=121) reported fear of harm to the unborn baby. Only 54.3% (n=229) perceived IPTp as highly acceptable. Perceptions were significantly associated with knowledge level (p<0.001), provider counselling (p=0.002), and previous experience with IPTp (p=0.008). Qualitative analysis revealed three major themes: (1) trust and acceptance grounded in provider confidence and awareness of malaria risks; (2) fear and scepticism driven by side effects, misinformation, and cultural beliefs; and (3) social influences, including partner and community norms, shaping acceptability.

Conclusion: Perceptions of IPTp among pregnant women in the Western Area Urban District are mixed, with significant proportions expressing safety concerns and fear of side effects. Addressing these perceptions through culturally sensitive health education, improved provider communication, and community engagement is essential to improve IPTp acceptability and adherence. Interventions should target both individual beliefs and broader social norms.

RESEARCH TOPICS

Keywords

Intermittent Preventive Treatment in Pregnancy (IPTp) perceptions acceptability malaria in pregnancy mixed-methods Sierra Leone

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References

  1. Asem, L., Abdulia, G., Assuming, P. O., & Abeka-Nkrumah, G. (2024). Knowledge and attitude of service users of intermittent preventive treatment of malaria in pregnancy using sulfadoxine-pyrimethamine in the Volta Region of Ghana. PLOS ONE, 19(9), e0309340. https://doi.org/10.1371/journal.pone.0309340
  2. Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory. Prentice-Hall.
  3. Boene, H., González, R., Valá, A., Rupérez, M., Velasco, C., Machevo, S., Sacoor, C., Sevene, E., Macete, E., Menéndez, C., & Munguambe, K. (2014). Perceptions of Malaria in Pregnancy and Acceptability of Preventive Interventions among Mozambican Pregnant Women: Implications for Effectiveness of Malaria Control in Pregnancy. PLOS ONE, 9(2), e86038. https://doi.org/10.1371/journal.pone.0086038
  4. Diala, C. C., Pennas, T., Marin, C., & Belay, K. A. (2013). Perceptions of intermittent preventive treatment of malaria in pregnancy (IPTp) and barriers to adherence in Nasarawa and Cross River States in Nigeria. Malaria Journal, 12, 342. https://doi.org/10.1186/1475-2875-12-342
  5. Kaya, M. (2020). Barriers to malaria preventive treatment among pregnant women in Sierra Leone. Journal of Public Health, 28(3), 345–356.
  6. Koh, L., Ssekamatte, T., & Nakiyingi, J. (2020). Community-based interventions to improve IPTp adherence in Uganda. BMC Pregnancy and Childbirth, 20, 123.
  7. Kumbani, L. C., Mhango, W., & Chirwa, E. (2017). Women's experiences with antenatal care and IPTp in Malawi. BMC Pregnancy and Childbirth, 17, 132.
  8. National Malaria Control Programme [NMCP]. (2022). Annual Report. Sierra Leone Ministry of Health & Sanitation.
  9. Sierra Leone Ministry of Health & Sanitation. (2021). National Malaria Control Programme Annual Report.
  10. Smith, J., et al. (2024). Acceptability of intermittent preventive treatment of malaria in pregnancy with sulfadoxine-pyrimethamine plus dihydroartemisinin-piperaquine in Papua New Guinea: a qualitative study. Malaria Journal.
  11. Tatem, A. J., et al. (2020). The effects of malaria prevention on pregnancy outcomes. The Lancet Global Health, 8(3), e123–e134.
  12. Wanjala, C., Mumo, M., & Shann, L. (2020). Side effects and adherence to IPTp in Kenya. Malaria Journal, 19, 156.
  13. World Health Organization. (2021). World Malaria Report 2021. WHO.