Impact of eight or more antenatal care visits on intermittent preventive treatment of malaria uptake during pregnancy and facility-based delivery in Ghana: a propensity score matched analysis

Abstract

Maternal and malaria-related morbidity remain major public health challenges in sub-Saharan Africa, particularly in Ghana. The World Health Organization (WHO) recommends eight or more antenatal care (ANC8+) contacts to enhance maternal and child health, but its effect on malaria prevention and delivery outcomes is not well established. This study examined the impact of ANC8 + visits on facility-based delivery and optimal uptake of intermittent preventive treatment for malaria during pregnancy (IPTp-SP). Data were drawn from the 2022 Ghana Demographic and Health Survey, including women aged 15–49 years who had given birth within the three years preceding the survey. Propensity score matching was applied to estimate the effect of ANC8 + visits on facility-based delivery and uptake of at least three IPTp-SP doses. Only 38.7% of women met the ANC8 + threshold. Among all respondents, 85.4% delivered in a health facility, and 66.5% received three or more IPTp-SP doses. After matching, ANC8 + attendance increased the likelihood of facility delivery by 8.2% points (ATT = 8.2, 95% CI: 4.6–11.9) and optimal IPTp-SP uptake by 11.1% points (ATT = 11.1, 95% CI: 6.8–15.4). Adherence to WHO’s ANC8 + recommendation significantly improves facility-based delivery and malaria prevention during pregnancy. Strengthening policies that enhance ANC attendance, particularly among socioeconomically and geographically disadvantaged groups, is essential for advancing maternal and child health in Ghana.