Health System Strengthening and Uptake of IPTp-SP during Antenatal Care: A Quasi-Experimental Study in Osun State, Nigeria

Abstract

Background: Malaria in pregnancy remains a major public health problem in Nigeria, contributing significantly to maternal and neonatal morbidity and mortality. Despite the effectiveness of Intermittent Preventive Treatment in pregnancy with Sulfadoxine-Pyrimethamine (IPTp-SP), its uptake remains low due to weak antenatal care (ANC) systems and inadequate health education. Aim: This study aims to assess the effect of health system strengthening on IPTp-SP uptake in Osun State, Nigeria. Methods: A non-equivalent control-group quasi-experimental design was employed, with baseline and endline facility-based surveys conducted in three secondary health facilities across Osun State. The intervention was implemented at State Specialist Hospital, Asubiaro, while State Hospital Ede and State Hospital Ilesa served as control sites. A total of 250 pregnant women aged 18–49 years who had received at least one dose of IPTp-SP were recruited using systematic sampling. The intervention, conducted over eight weeks, included structured health education, provider training, improved data documentation using NHMIS registers, WhatsApp-based reminders, and logistical support for SP administration. Data were collected using interviewer-administered questionnaires via KoboCollect and analyzed using SPSS version 23. Descriptive and comparative analyses were performed, with statistical significance set at p < 0.05. Results: At baseline, both groups showed poor knowledge of malaria and IPTp-SP. Following the intervention, the intervention group demonstrated a marked improvement in knowledge of malaria causation, risk during pregnancy, and IPTp-SP use, reaching 100% correct responses in key domains, while the control group showed minimal change. Conclusion: Health system strengthening through structured ANC education improves knowledge of malaria and IPTp-SP. Integrating such education into routine ANC is essential for improving IPTp-SP uptake and reducing malaria in pregnancy.