Coverage and Determinants of Malaria Preventive Measures During Pregnancy in Urban Gabon: A Cross-Sectional Study of IPTp-SP Uptake and ITN Use in Owendo

Coverage and Determinants of Malaria Preventive Measures During Pregnancy in Urban Gabon: A Cross-Sectional Study of IPTp-SP Uptake and ITN Use in Owendo | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Coverage and Determinants of Malaria Preventive Measures During Pregnancy in Urban Gabon: A Cross-Sectional Study of IPTp-SP Uptake and ITN Use in Owendo Bridy Chesly Moutombi Ditombi, Sidi Gerard Mba Edou, Dimitri Ardain Moussavou Mabicka, and 9 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6649416/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 15 You are reading this latest preprint version Abstract Background Malaria in pregnancy remains a major public health challenge in sub-Saharan Africa. This study assessed the coverage and determinants of intermittent preventive treatment with sulfadoxine–pyrimethamine (IPTp-SP) and the use of insecticide-treated nets (ITNs) among postpartum women in a large urban maternity facility in Owendo, Gabon. Methods A cross-sectional study was conducted among postpartum women attending a public tertiary hospital in Gabon. Data were collected through structured interviews and clinical records. The main outcomes were receipt of at least three doses of IPTp-SP and consistent ITN use during pregnancy. Multivariable logistic regression was performed to identify factors associated with IPTp-SP uptake and ITN use. Results Among 302 participants, 77.1% received at least three doses of IPTp-SP, whereas ITN ownership was 40.6%, and only 28.1% achieved full preventive coverage (defined as ≥ 3 IPTp-SP doses and regular ITN use). Overall, 34.8% had 8 antenatal care (ANC) visits. IPTp-SP uptake was strongly associated with ANC attendance: women with more at least four visits were 22 times more likely to complete the recommended regimen (22.13[7.27-108-96]; p < 0.001 ). Employment status and gravidity also influenced adherence. ITN use was significantly associated with secondary (aOR: 15.91[1.30-47.57]; p = 0.049 ) or higher education (aOR: 27.26[2.14–82.30]; p = 0.021 ) and single (OR: 4.05[1.50-11.76]; p = 0.007 ) marital status. None of the IPTp-SP doses were administered under direct observation. Conclusions While IPTp-SP coverage was promising and approaching target levels, gaps remain in the delivery of comprehensive malaria prevention. Strengthening ITN distribution, ensuring supervised IPTp-SP administration, and addressing educational and behavioural barriers are essential to improving maternal protection against malaria in Gabon Antenatal care IPTp-SP ITN pregnancy malaria Introduction Malaria remains a significant public health challenge, particularly in sub-Saharan Africa (SSA), where it continues to be one of the leading causes of morbidity and mortality among pregnant women and young children. According to the World Health Organization (WHO), approximately 263 million cases of malaria and 597,000 malaria-related deaths were reported globally in 2023, with the majority of these cases occurring in the African region [ 1 ]. In 2022, an estimated 12.4 million pregnant women in Africa were affected by malaria, exposing both mothers and their unborn children to a range of adverse outcomes, including maternal anaemia, stillbirth, preterm birth, and low birth weight [ 1 , 2 ]. To mitigate these risks, the WHO recommends a combination of preventive measures, including the use of long-lasting insecticidal nets (LLINs), prompt diagnosis and treatment, and intermittent preventive treatment during pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) [ 3 , 4 ]. IPTp-SP has proven particularly effective in reducing placental malaria, maternal anaemia, and poor neonatal outcomes when administered in three or more doses during antenatal care (ANC) visits [ 5 , 6 ]. While WHO initially recommended two doses of IPTp-SP in 2004, this guideline was updated in 2012 to recommend at least three doses during pregnancy [7; 3]. These SP doses should be administered at least one month apart, starting at 13 weeks of gestation until the final ANC visit, under directly observed therapy [3;8]. The uptake of three or more doses of IPTp-SP is significantly associated with lower rates of pregnancy outcomes [6; 9,10]. Despite the adoption of these policy guidelines, coverage remains suboptimal in many malaria-endemic countries. Two meta-analyses have reported IPTp-SP coverage rates ranging from 5.3–98.9%, with an average of 30.7% across sub-Saharan Africa, highlighting significant variation between countries [ 11 , 12 ]. Insecticide-treated nets (ITNs) are another key preventive strategy recommended by the WHO, significantly reducing the burden of malaria. Although global and national funding for malaria control primarily focuses on the procurement of drugs and LLINs, numerous studies have pointed out the persistently low utilisation of ITNs among pregnant women and children under five in SSA [ 13 , 14 ]. A recent survey in East Africa revealed that only 47.05% of pregnant women reported sleeping under an ITN, with coverage ranging from 6.08% in Zimbabwe to 64.13% in Uganda [ 15 ]. In SSA, only about half of net owners sleep under an ITN [ 1 ]. The factors influencing IPTp-SP uptake and ITN adherence among pregnant women are multifactorial, involving a combination of sociodemographic factors, education, insufficient knowledge, cultural beliefs, healthcare service quality, ANC attendance, as well as concerns related to side effects of IPTp-SP [ 16 – 20 ]. In Gabon, a Central African country with perennial malaria transmission, data on the use of malaria prevention strategies during pregnancy are limited. A 2013 study in Libreville found that 57.4% of pregnant women received at least two doses of IPTp-SP, while only 49.5% had full preventive coverage [ 21 ]. More recently, Bitheghe et al . (2022) found that in southern Gabon, only 58.8% of women received three or more doses of IPTp-SP [ 22 ]. These coverage rates remain below both the national and WHO targets of 80%. Information from Estuaire province, where nearly half of the country’s population resides, is outdated, despite improved access to maternal and child health services since the implementation of universal health coverage. Moreover, there has been limited research into the combined coverage of IPTp-SP and ITN use among pregnant women in Gabon, and factors influencing their uptake have not been fully explored. This gap hampers the ability of health authorities to assess the effectiveness of malaria control programmes and adjust strategies accordingly. The present study aims to address this gap by assessing the levels of IPTp-SP and ITN use, and identifying the associated determinants, among postpartum women in an urban maternity setting in Owendo located in the Estuaire province of Gabon. The findings of this study will contribute to the development of context-specific, evidence-based interventions to enhance malaria prevention during pregnancy. Methods Study design, setting, and population This analytical cross-sectional study was conducted over a four-month period, from February to May 2024, in the maternity ward of the Owendo University Hospital Centre (CHUO). Owendo is an industrial district located in the Estuaire province approximately 20 kilometres south of Libreville, the capital city of Gabon. It hosts the country’s first and largest seaport. The CHUO maternity unit is the second most utilised maternity service in the country and the only public facility in the municipality offering comprehensive and free maternal healthcare services, including antenatal care (ANC) and delivery. The study population comprised volunteers women during their immediate postpartum seen when they were placed under observation in the maternity ward of the CHUO, who provided verbal informed consent. Exclusion criteria included: women receiving cotrimoxazole prophylaxis, those admitted for unrelated medical conditions, and those who declined to participate in the interview. Sample size calculation The sample size was calculated based on a 15% estimated prevalence of three-dose IPTp-SP coverage, as reported by the Gabonese Malaria National Control Programme (MNCP) in 2020 (Data from the MNCP). The sample size was determined using the standard formula for prevalence studies: n=(Z 2 x P(1 − P))/e 2 Where: n = minimum required sample size Z = 1.96 (standard normal deviate for 95% confidence level) p = estimated prevalence (0.15) e = margin of error (0.05) The minimum calculated sample size was 196. To account for a potential 10% non-response rate, the final sample size was increased to 216 women. Data collection procedure Participants were recruited using a convenience systematic approach. Prior to participation, women were informed of the study objectives, procedures, and their rights. Those who consented orally were enrolled. Data were collected via structured, face-to-face interviews complemented by a review of ANC booklets and the delivery registry. The questionnaire was developed based on existing scientific literature, pre-tested among ten postpartum women for clarity and completeness and adjusted accordingly. Data were entered directly into REDCap (Research Electronic Data Capture) using tablet-based forms. Collected variables included: identification (anonymous ID, age); sociodemographic data (residence, marital status, education, employment status of the woman and her partner) ; obstetric history (gravidity, parity, number of ANC visits) ; malaria prevention measures: number of IPTp-SP doses received, ITN ownership and regular use, and reasons for lack of ITN use. Correct or full preventive coverage was defined as uptake of three or more doses of IPTp-SP combined with regular use of an IITN. Data management and statistical analysis All data were reviewed weekly by the Parasitology Department’s data management team for completeness and consistency. The final database was cleaned and exported to Excel, then analysed using Statview version 5.0 and R software for advanced statistical modelling. Descriptive statistics were used to summarise participant characteristics and estimate coverage rates. Categorical variables were compared using the Chi-square or Fisher’s exact test. Continuous variables were analysed using the non-parametric Mann–Whitney U test or Kruskal–Wallis test, as appropriate. Multivariable analyses were performed using a two-level logistic regression model in R to identify individual- and context-level factors associated with IPTp-SP and ITN uptake. A p-value of < 0.05 was considered statistically significant. Ethical considerations This study is part of the routine malaria surveillance activities conducted by the Department of Parasitology and Mycology, in collaboration with the National Malaria Control Programme. Ethical clearance was granted by the Ministry of Health. Administrative authorisation was obtained from the CHUO Medical Director and the Head of the Obstetrics and Gynaecology Department. All participants were informed of the study’s objectives, voluntary participation, and confidentiality assurances. Verbal informed consent was obtained before enrolment. Each participant was assigned a unique anonymous identifier, and all data were handled in compliance with the principles outlined in the Declaration of Helsinki. Results General characteristics of study population A total of 302 postpartum women were enrolled. The majority (84.4% ; n = 255/302) were under 35 years of age, with a median age of 28 [ 24 – 33 ] years, and most were single. Educational attainment was relatively high, with 93.4% (n = 382) of participants having completed at least secondary school and nearly one in four (24.2%) participants were unemployed. Regarding obstetric history, 60.9% were either primiparous or secondiparous, and 58.3% (n = 176) were primigravidae or secundigravidae. The median number of ANC visits was 7[ 5 – 8 ], 47% of women attended between five (5) and seven (7) ANC visits and 34.8% had eight (8). Among the 252 participants who reported on their partner’s occupation, 73.9% stated that their partner was engaged in an income-generating activity. Participants characteristics are summarised in Table 1 . Table 1 General characteristics of participants Variables n % Age group, years 34 47 15.6 Education None 6 2.0 Primary 14 4.6 Secondary 153 50.7 High school 129 42.7 Parity Primiparous 101 33.4 Secondiparous 83 27.5 Multiparous 118 39.1 Gravidity Primigravidae 97 32.1 Secundigravidae 79 26.2 Multigravida 126 41.7 Matrimonial status Single 259 86.0 Married 42 14.0 Occupation Worker 106 35.1 Middle management 105 34.8 Senior executive 18 6.0 Unemployed 73 24.1 Number of ANC < 4 21 7.0 ≥ 4 281 93.0 Husband’s sector activity Unemployed 41 16.3 Student 25 9.9 Private sector 43 17.1 Public sector 73 29.0 Self-employed 70 27.8 ITN use Yes 85 65.4 No 45 34.6 SP doses received < 3 69 22.9 ≥ 3 233 77.1 Malaria prevention during pregnancy Ownership of ITNs was reported by 40.6% (n = 130) of participants. Among these, 65.4% (n = 85) declared regular use. Common reasons cited for not owning or using an ITN included discomfort due to heat (n = 11), financial constraints (n = 28), personal dislike of the net (n = 120), and preference for alternative prevention methods (n = 13). The mean number of sulfadoxine-pyrimethamine (SP) doses received during pregnancy was 3.0 (± 3.3). Among, the 233 women who had received at least three doses of IPTp-SP, 32.5% received three doses, 29.5% received four, 9.3% received five, and 5.6% received six doses. None of the reported SP doses had been administered under direct observation by healthcare personnel. Combined preventive coverage Despite the high level of IPTp-SP uptake, the proportion of women who achieved correct preventive coverage defined as receipt of at least three doses of IPTp-SP combined with regular ITN use was much lower. Only 85 (28.1%) women met this definition; 148 (49.0%) received at least three doses of IPTp-SP but did not regularly use an ITN. Additionally, 69 (22.8%) participants received fewer than three doses of IPTp-SP and did not regularly use an ITN whereas none of those who received fewer than three IPTp-SP doses regularly used an ITN. Determinants of optimal IPTp-SP uptake (≥ 3 doses) Optimal uptake of IPTp-SP was observed in over three-quarters of participants (Table III). Bivariate analyses showed no significant association with age, level of school attended or marital status. However, a woman’s employment status was significantly associated with IPTp-SP adherence. Compared to unemployed women, those in the worker and middle-management categories were respectively 1.96 (p = 0.049) and 2.52 (p = 0.010) times more likely to receive at least three doses (Table 2 ). Partner’s employment status also influenced SP uptake. Women whose partners were employed in the public sector had a higher chance to complete the recommended regimen compared to those whose partners were unemployed (Table 2 ). In the multivariable logistic regression model, two factors remained significantly associated with optimal IPTp-SP uptake. Attending fewer than four ANC visits was strongly associated with inadequate SP coverage ( p < 0.001 ); primigravidae were significantly less likely to complete the regimen compared to secundigravidae (p = 0.006). (Table 2 ) Table 2 Predictive factors for optimal IPTp-SP use Variables crude OR [95%] p-value adjusted OR [95%] p-value ≥ 3 doses < 3 doses n % n % Age, years 34 34 72.3 13 27.7 0.79[0.34–1.87] 0.58 Education None 3 50.0 3 50.0 1 1 Primary 11 84.6 2 15.4 5.50[0.64–60.76] 0.13 0.55[0.031–9.38] 0.67 Secondary 115 75.2 38 24.8 3.02[0.54–16.90] 0.19 0.74[0.060–7.04] 0.80 High school 103 79.8 26 20.2 3.96[0.70-22.51] 0.1 0.92[0.072-9.20] 0.94 Gravidity Primigravidae 80 82.5 17 17.5 1 1 Secundigravidae 53 67.1 26 32.9 0.43[0.21–0.87] 0.019 0.30[0.13–0.70] 0.006 Multigravida 99 79.2 26 20.8 0.81[0.40–1.58] 0.54 0.72[0.30–1.69] 0.45 Marital status Married 34 82.9 7 17.1 1 Single 197 76.1 62 23.9 0.65[0.26–1.47] 0.33 Occupation Unemployed 46 66.7 23 33.3 1 1 Worker 66 77.6 19 22.4 1.96[1.01–3.88] 0.049 1.44[0.14–10.16] 0.73 Middle management 73 80.2 18 19.8 2.52[1.25–5.14] 0.010 3.14[0.28–24.41] 0.29 Senior executive 12 85.7 2 14.3 1.82[0.58–6.95] 0.33 1.98[0.14-25.00] 0.59 Number of ANC ≥ 4 4 19.0 17 81.0 1 1 < 4 228 81.4 52 18.6 18.6[6.58–66.8] < 0.001 22.13[7.27-108.96] < 0.001 Husband’s sector activity Unemployed 25 61.0 16 39.0 1 1 Student 17 68.0 8 32.0 1.36[0.84–2.98] 0.56 1.03[0.32–3.46] 0.95 Private sector 30 71.4 12 28.6 1.60[0.64–4.07] 0.31 0.74[0.089–8.66] 0.79 Public sector 59 80.8 14 19.2 2.70[1.15–6.44] 0.023 0.96[0.12–11.31] 0.97 Self-employed 56 80.0 14 20.0 2.56[1.09–6.12] 0.032 1.85[0.26–19.53] 0.56 Determinants of ITN use Among women who owned an ITN, 65.4% reported regular use. Multivariate analysis identified educational level and marital status as predictors of ITN use (Table III). Women with secondary and university-level education were respectively 1.91 and 22.26 times more likely to use ITNs than those with only primary education (p < 0.05). Single women were more likely to report ITN use than married women (aOR = 5.41 [1.53–22.83]; p = 0.012). (Table III). Other variables such as gravidity, parity, age group, number of ANC visits, and partner’s occupation showed no significant association with ITN use (Table 3 ). Table 3 Predictive factors for optimal ITN Use Variables ITN use crude OR [95%] p-value adjusted OR [95%] p-value No Yes n % n % Age group, years 34 17 85.0 3 15.0 2.27[0.59–11.22] 0.26 5.66[1.01–48.24] 0.069 Education Primary 1 20.0 4 80.0 1 1 Secondary 46 62.2 28 37.8 6.6[0.91–13.21] 0.10 15.91[1.30-47.57] 0.049 High school 35 72.9 13 27.1 10.8[1.43–22.14] 0.041 27.26[2.14–82.30] 0.021 None Gravidity 3 100.0 0 0.0 - 0.99 - 0.99 Primigravidae Secundigravidae 31 75.6 10 24.4 1 1 Multigravida 19 57.6 14 42.4 0.42[0.15–1.11] 0.10 0.40[0.13–1.17] 0.097 Marital status 35 62.5 21 37.5 0.43[0.17–1.04] 0.17 0.83[0.27–2.53] 0.75 Married Single 7 36.8 12 63.2 1 1 Occupation 78 70.3 33 29.7 4.05[1.50-11.76] 0.007 5.41[1.53–22.83] 0.012 Unemployed Worker 22 71.0 9 29.0 1 Middle management 22 73.3 8 26.7 0.92[0.34–2.49] 0.87 Senior management 27 62.8 16 37.2 0.76[0.53–3.33] 0.56 Number of ANC 7 100.0 0 0.0 - 0.99 ≥ 4 < 4 9 69.2 4 30.8 1 Husband’s sector activity 76 65.0 41 35.0 0.82[0.21–2.70] 0.76 Unemployed Student 15 71.4 6 28.6 1 Private sector 4 50.0 4 50.0 0.4[0.071–7.01] 0.28 Public sector 13 65.0 7 35.0 0.74[0.19–2.79] 0.66 Self-employed 20 58.8 14 41.2 0.57[0.17–1.79] 0.35 None of the studied variables were detected as factor significantly associated with the correct prevention. Discussion This study aimed to assess the coverage and determinants of malaria preventive measures, namely intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) and insecticide-treated net (ITN) use, among postpartum women in a large public maternity ward in Centre Hospitalier Universtaire d’Owendo, Gabon. While the uptake of IPTp-SP was relatively high, ITN ownership and usage were considerably lower, and only a small proportion of women received comprehensive malaria prevention during pregnancy. The proportion of women who received at least three doses of IPTp-SP (77.1%) exceeded the average reported in SSA (30.7%) the estimates of the last Demographic Health Survey (DHS) performed in 2019 (37.9%) and rate from southern Gabon in 2022 (58.8%) [11; 23; 22]. This variability may stem from differences in healthcare access, awareness, cultural beliefs, and provider practices [19; 24]. This encouraging figure likely reflects improvements in awareness in malaria prevention and ANC visit, as the vast majority of participants (93.0%) attended at least four visits. This reinforces the established role of ANC as a key platform for delivering IPTp-SP and disseminating preventive messages [5; 25]. This upward trend in our urban setting may be linked to improvement in ANC access, explained by the availability of free service at this facility under the universal health coverage program. Greater awareness could also be responsible, though ANC coverage likely remains heterogenous. In multivariable analysis, ANC attendance was a strong predictor of IPTp-SP adherence. Women who attended fewer than four ANC visits were significantly less likely to complete the recommended three-dose regimen, emphasising the importance of early and sustained engagement with maternal health services [ 26 – 28 ]. Though coverage likely remains heterogeneous across regions. Nevertheless, a notable gap remains in implementation quality, as none of the IPTp-SP doses were administered under direct observation, contrary to WHO recommendations, raising concerns about health staff adherence and drug efficacy [ 3 ]. Gravidity was also associated with SP uptake, with secundigravidae more likely to complete the regimen than primigravidae. This may reflect differences in health-seeking behaviour or prior experience with malaria prevention during earlier pregnancy. Socioeconomic factors also played a significant role. Women engaged in professional activity, and those whose partners were employed in the public sector or self-employed, were more likely to adhere to SP regimens. These findings support previous evidence that economic empowerment and household income positively influence maternal health outcomes [ 8 ]. By contrast, ITN ownership and use were low. While our findings are consistent with those from Ethiopia (47.1% and 39.9%) and Uganda (35%), they remain below the levels needed to ensure effective malaria prevention [15; 29]. In the most recent DHS 2019–2021 in Gabon, the proportion of pregnant women owning an ITN was 14% with a usage rate of 62% [ 22 ]. These figures are comparable those reported Mozambique (68.4%) and Ghana (61.0%) [ 30 , 31 ]. Both education level and marital status were significant predictors of net use. Women with secondary or higher education were more likely to use ITNs consistently, supporting the view that education attainment improves health literacy and fosters preventive behaviours [12; 32–34]. Conversely, lower education levels have been associated with limited awareness of malaria risks and reduced engagement with ANC services. Interestingly, single women in our cohort used more often ITNs than their married counterparts, possibly reflecting greater autonomy or decision-making power in health-related decisions among unmarried women [ 15; 35,36 ] . This observation is confirmed in some settings; data from DHS of SSA countries showed that women in male-headed household were more likely to use ITN than those in female-headed households [ 37 , 38 ]. Participants cited several barriers to ITN use, including discomfort due to heat, personal aversion, financial constraints, and a preference for alternative prevention methods such as mosquito insecticide spray. These challenges are consistent with findings from other contexts and reflect both behavioural and structural barriers to ITN use [ 39 – 41 ]. Crucially, only 85 women representing, less than one-third of the study population, achieved full malaria preventive coverage, defined as receiving at least three doses of IPTp-SP combined with regular ITN use. Almost half of study participants received ≥ 3 IPTp-SP doses but did not use an ITN regularly, while 22.8% received neither adequate chemoprevention nor consistent vector protection. This highlights a significant implementation gap: despite effective ANC-based SP delivery, household-level preventive practices remain insufficient. Similar disparities have been documented in other malaria-endemic settings [20; 24]. Despite the strengths of the study, including a robust sample size and integration of clinical records with interviews, some limitations must be acknowledged. First, the cross-sectional design precludes causal inference. Second, self-reported ITN use, and SP uptake may be affected by recall and social desirability bias. The findings underscore the need to reinforce community-level malaria prevention, particularly through improved ITN distribution and promotion. While IPTp-SP coverage appears encouraging, ensuring supervised administration during ANC visits and tackling behavioural barriers to ITN use remain essential. Future studies should further explore qualitative determinants of ITN non-use and assess the effectiveness of free ITN distribution campaigns in other Gabonese settings. Conclusion This study highlights both progress and persistent gaps in the implementation of malaria prevention strategies among pregnant women in urban Gabon. Although IPTp-SP coverage was relatively high, consistent with improvements in ANC utilisation, the lack of directly observed therapy and the low uptake of ITNs underscore significant shortcomings in achieving comprehensive protection. Socioeconomic status, education, and ANC attendance emerged as key determinants of preventive behaviour, while disparities in ITN use suggest a need for targeted behavioural and structural interventions. To close the prevention gap, policy efforts should prioritise supervised IPTp-SP delivery during ANC, strengthen ITN distribution and education campaigns, and tailor strategies to reach vulnerable subgroups, including primigravidae, low-income households, and less-educated women. Expanding community engagement and addressing contextual barriers to ITN use will be critical for enhancing malaria prevention during pregnancy and achieving national and regional targets in malaria control. Abbreviations • IPTp-SP • Intermittent Preventive Treatment in Pregnancy with Sulfadoxine–Pyrimethamine • ITN • Insecticide-Treated Net • LLIN • Long-Lasting Insecticidal Net • ANC • Antenatal Care • WHO • World Health Organization • SP • Sulfadoxine–Pyrimethamine • CHUO • Centre Hospitalier Universitaire d’Owendo • SSA • Sub-saharan Africa • RedCap • Research Electronic Data Capture Declarations Acknowledgements The authors would like to express their gratitude to the healthcare staff of the maternity ward of the Centre Hospitalier Universitaire d’Owendo for their collaboration and support during data collection. We also thank all the women who participated in the study and shared their experiences. Special thanks go to the research team of Department of Parasitology-Mycology of Université des Sciences de la Santé. Authors contribution BCMD and BAMK conceived and designed the study, interpreted the results and prepared the manuscript. SGME, DAMM, CM, CMB and BPN: performed the study methodology, interviewed and collected data, NPM and LNA: analysed data and interpreted results;BSO and DPMM: revised the manuscript; BAMK: correction of the final manuscript. All authors read and approved the manuscript. Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Data availability The datasets used and/or analysed during the current study are available from the corresponding author upon reasonable request. Conflicts of Interest The authors declare no conflicts of interest related to this work. Consent for publication Not applicable References World Health Organization. World malaria report 2023. Geneva: WHO; 2024. https://www.reuters.com/business/healthcare-pharmaceuticals/malaria-cases-up-again-2023-african-children-worst-hit-who-reports-2024-12-11/ . Disponible sur. Rogerson SJ, Desai M, Mayor A, Sicuri E, Taylor SM, van Eijk AM. 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Insecticide-treated net utilization and associated factors among pregnant women and under-five children in East Belessa District, Northwest Ethiopia: using the Health Belief model. Malar J. 2021;20(1):130. 10.1186/s12936-021-03666-6 . PMID: 33663516; PMCID: PMC7971121. Buh A, Kota K, Bishwajit G, Yaya S. Prevalence and associated factors of taking intermittent preventive treatment in pregnancy in Sierra Leone. Trop Med Infect Dis. 2019;4:32. 10.3390/tropicalmed4010032 . Vandy AO, Peprah NY, Jerela JY, Titiati P, Manu A, Akamah J, et al. Factors influencing adherence to the new intermittent preventive treatment of malaria in pregnancy policy in Keta District of the Volta region, Ghana. BMC Pregnancy Childbirth. 2019;19:424. 10.1186/s12884-019-2544-8 . Yoder PS, Nsabagasani X, Eckert E, Moran A, Yé Y. Perspectives of health care providers on the provision of intermittent preventive treatment in pregnancy in health facilities in Malawi. BMC Health Serv Res. 2015;15:354. 10.1186/s12913-015-0986-x . PMID: 26318623; PMCID: PMC4552981. Bouyou-Akotet MK, Mawili-Mboumba DP, Kombila M. Antenatal care visit attendance, intermittent preventive treatment and bed net use during pregnancy in Gabon. BMC Pregnancy Childbirth. 2013;13:52. 10.1186/1471-2393-13-52 . PMID: 23442536; PMCID: PMC3599563. Biteghe-Bi-Essone JC, Imboumy-Limoukou RK, Ekogha-Ovono JJ, Maghendji-Nzondo S, Sir-Ondo-Enguier PN, Oyegue LS, et al. Intermittent preventive treatment and malaria amongst pregnant women who give birth at the Centre Hospitalier Régional Paul Moukambi de Koula-Moutou in southeastern Gabon. Malar J. 2022;21:315. 10.1186/s12936-022-04305-4 . Direction Générale de la Statistique (DGS) et ICF. Enquête Démographique et de Santé au Gabon, 2019– 21. Libreville, Gabon et Rockville. Maryland, USA: DGS et ICF; 2023. Arinaitwe E, Ades V, Walakira A, Ninsiima B, Mugagga O, Patil TS, et al. Intermittent Preventive Therapy with Sulfadoxine-Pyrimethamine for Malaria in Pregnancy: A Cross-Sectional Study from Tororo, Uganda. PLoS ONE. 2013;8:6–11. 10.1371/journal.pone.0073073 . Mushi V, Mbotwa CH, Zacharia A, Ambrose T, Moshi FV. Predictors for the uptake of optimal doses of sulfadoxine-pyrimethamine for intermittent preventive treatment of malaria during pregnancy in Tanzania: Further analysis of the data of the 2015–2016 Tanzania demographic and health survey and malaria indicat. Malar J. 2021;20:75. 10.1186/s12936-021-03616-2 . Anto F, Agongo IH, Asoala V, Awini E, Oduro AR. Intermittent Preventive Treatment of Malaria in Pregnancy: Assessment of the Sulfadoxine-Pyrimethamine Three-Dose Policy on Birth Outcomes in Rural Northern Ghana. J Trop Med. 2019;2019:6712685. 10.1155/2019/6712685 . PMID: 31275401; PMCID: PMC6582795. Guimsop DK, Talla AFK, Kodji H, Ateudjieu J. Factors associated with the uptake of intermittent preventive treatment for malaria during pregnancy in Cameroon. PLOS Glob Public Health. 2024;4(3):e0001245. 10.1371/journal.pgph.0001245 . PMID: 38536856; PMCID: PMC10971583. : An analysis of data from the 2018 Cameroon Demographic and Health Survey. Azizi SC. Uptake of intermittent preventive treatment for malaria during pregnancy with Sulphadoxine-Pyrimethamine in Malawi after adoption of updated World Health Organization policy: an analysis of demographic and health survey 2015–2016. BMC Public Health. 2020;20(1):335. 10.1186/s12889-020-08471-5 . PMID: 32178658; PMCID: PMC7077170. Tesfaye T, Mengistie Alemu B, Egata G, Bekele H, Taye Merga B, Eshetu B, et al. Insecticide-Treated Nets Utilization and Associated Factors Among Pregnant Women in Miesso Woreda, Eastern Ethiopia: Observational Study. Int J Womens Health. 2022;14:445–53. Moon TD, Hayes CB, Blevins M, Lopez ML, Green AF. Factors associated with the use of mosquito bed nets: results from two cross-sectional household surveys in Zambézia Province, Mozambique. Malar J. 2016;15:196. https://doi.org/10.1186/s12936-016-1250-5 . Gonzalez-Calvo L., et al. Ernst KC, Erly S, Adusei C, Bell ML, Kessie DK, Biritwum-Nyarko A, et al. Reported bed net ownership and use in social contacts is associated with uptake of bed nets for malaria prevention in pregnant women in Ghana. Malar J. 2017;16:13. https://doi.org/10.1186/s12936-016-1660-4 . Zegeye AF, Mekonen EG, Gebrehana DA, et al. Spatial variation and multilevel determinants of malaria infection among pregnant women in Sub-Saharan Africa: using malaria indicator surveys. BMC Infect Dis. 2025;25:654. https://doi.org/10.1186/s12879-025-11037-8 . Choonara S, Odimegwu CO, Elwange BC. Factors influencing the usage of different types of malaria prevention methods during pregnancy in Kenya. Afr Health Sci. 2015;15(2):413–9. 10.4314/ahs.v15i2.14 . PMID: 26124786; PMCID: PMC4480458. Nguefack-Tsaguec -DefoTE, Tiotsa Tsapib G, Zogning Makemjiob A, Ethgena E, Sanou Sobzef O. M. Uso di Zanzariere Trattata con Insetticida nell’Africa Sub-Sahariana: Rivista Sistematica e Meta-analisi [Insecticide-Treated Net Use In Sub-Saharan Africa: Systematic Review and Meta-Analysis]. Ig Sanita Pubbl. 2021 Jul-Aug;78(4):564–582. Italian. PMID: 34525014. Nkoka O, Chuang TW, Chuang KY, Chen YH. Factors associated with insecticide-treated net usage among women of childbearing age in Malawi: a multilevel analysis. Malar J. 2018;17(1):372. 10.1186/s12936-018-2522-z . PMID: 30340640; PMCID: PMC6195758. Diallo OO, Ozodiegwu ID, Camara A, Galatas B, Gerardin J. Factors associated with the ownership and use of insecticide-treated nets in Guinea: an analysis of the 2018 Demographic and Health Survey. Malar J. 2023;22:29. https://doi.org/10.1186/s12936-023-04463-z . Ameyaw EK. Individual, community and societal correlates of insecticide treated net use among pregnant women in sub-Saharan Africa: a multi-level analysis. BMC Public Health. 2021;21(1):1592. 10.1186/s12889-021-11635-6 . PMID: 34445978; PMCID: PMC8394092. Barry I, Toure AA, Sangho O, Beavogui AH, Cisse D, Diallo A, et al. Variations in the use of malaria preventive measures among pregnant women in Guinea: a secondary analysis of the 2012 and 2018 demographic and health surveys. Malar J. 2022;21(1):309. 10.1186/s12936-022-04322-3 . PMID: 36316702; PMCID: PMC9623996. Ahorlu CS, Adongo P, Koenker H, Zigirumugabe S, Sika-Bright S, Koka E, et al. Understanding the gap between access and use: a qualitative study on barriers and facilitators to insecticide-treated net use in Ghana. Malar J. 2019;18(1):417. 10.1186/s12936-019-3051-0 . PMID: 31831004; PMCID: PMC6909499. Cheng B, Htoo SN, Mhote NPP, Davison CM. A systematic review of factors influencing participation in two types of malaria prevention intervention in Southeast Asia. Malar J. 2021;20:195. https://doi.org/10.1186/s12936-021-03733-y . Taremwa IM, Ashaba S, Adrama HO, Ayebazibwe C, Omoding D, Kemeza I, et al. Knowledge, attitude and behaviour towards the use of insecticide treated mosquito nets among pregnant women and children in rural Southwestern Uganda. BMC Public Health. 2017;17:794. https://doi.org/10.1186/s12889-017-4824-4 . Additional Declarations No competing interests reported. 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Ditombi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6ElEQVRIiWNgGAWjYBACAwbGBgkom40hoQJIMTM3EKeFB6zlDEgLIyEtDAwILYxtICYBLebShxtv8+bYJO5n70578HBebTR/O1DLj4ptOLVY9iU2W/NuS0vs4Tm73SBx2/HcGYcZGxh7ztzG7bAzjG3SvNsOJ/ZI5G6TSNx2LLcBqIWZsY1oLXOO5c4nUUtDTe4GQlosexibLeduSzPuOQP0S8KxA7kbgVoO4vOLOQ/7wxtvt9nItrf3bnv4o6Yud975wwcf/KjArQUEmHgQ7MNg8gBe9UDA+APBriOkeBSMglEwCkYgAADbcF6IZYEsRgAAAABJRU5ErkJggg==","orcid":"","institution":"Department of Parasitology-Mycology and Tropical Medicine, Université des Sciences de la Santé, BP: 4009","correspondingAuthor":true,"prefix":"","firstName":"Bridy","middleName":"Chesly Moutombi","lastName":"Ditombi","suffix":""},{"id":470053071,"identity":"a022a214-0e42-4233-8ddc-18d1c52de92f","order_by":1,"name":"Sidi Gerard Mba Edou","email":"","orcid":"","institution":"Obstetrics and Gynecology Ward, Centre Hospitalier Universitaire 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4009","correspondingAuthor":false,"prefix":"","firstName":"Charleine","middleName":"Manomba","lastName":"Boulingui","suffix":""},{"id":470053077,"identity":"45d84986-12b3-4ab2-b0b2-447c7b7c1537","order_by":7,"name":"Bedrich Pongui Ngondza","email":"","orcid":"","institution":"Department of Parasitology-Mycology and Tropical Medicine, Université des Sciences de la Santé, BP: 4009","correspondingAuthor":false,"prefix":"","firstName":"Bedrich","middleName":"Pongui","lastName":"Ngondza","suffix":""},{"id":470053078,"identity":"ae70aa5b-526d-4cd4-a6e9-501add69ced1","order_by":8,"name":"Luccheri Ndong Akomezoghe","email":"","orcid":"","institution":"Department of Parasitology-Mycology and Tropical Medicine, Université des Sciences de la Santé, BP: 4009","correspondingAuthor":false,"prefix":"","firstName":"Luccheri","middleName":"Ndong","lastName":"Akomezoghe","suffix":""},{"id":470053079,"identity":"f52e629d-87c8-4ebb-8ef8-124d881e17e3","order_by":9,"name":"Boniface Sima Ole","email":"","orcid":"","institution":"Obstetrics and Gynecology Ward, Centre Hospitalier Universitaire d'Owendo","correspondingAuthor":false,"prefix":"","firstName":"Boniface","middleName":"Sima","lastName":"Ole","suffix":""},{"id":470053080,"identity":"47b068f1-e908-4227-adee-4056e72cc8b6","order_by":10,"name":"Denise Patricia Mawili-Mboumba","email":"","orcid":"","institution":"Department of Parasitology-Mycology and Tropical Medicine, Université des Sciences de la Santé, BP: 4009","correspondingAuthor":false,"prefix":"","firstName":"Denise","middleName":"Patricia","lastName":"Mawili-Mboumba","suffix":""},{"id":470053081,"identity":"027aae94-95ae-4260-8b1a-52b8e6f3a60b","order_by":11,"name":"Marielle Karine Bouyou Akotet","email":"","orcid":"","institution":"Department of Parasitology-Mycology and Tropical Medicine, Université des Sciences de la Santé, BP: 4009","correspondingAuthor":false,"prefix":"","firstName":"Marielle","middleName":"Karine Bouyou","lastName":"Akotet","suffix":""}],"badges":[],"createdAt":"2025-05-12 19:53:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6649416/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6649416/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":84597815,"identity":"670c023e-d927-4fb8-ad59-7dbccb034c93","added_by":"auto","created_at":"2025-06-14 07:27:58","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1447333,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6649416/v1/43d2d67c-6df9-42f2-b89b-ccf8a90e830f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Coverage and Determinants of Malaria Preventive Measures During Pregnancy in Urban Gabon: A Cross-Sectional Study of IPTp-SP Uptake and ITN Use in Owendo","fulltext":[{"header":"Introduction","content":"\u003cp\u003eMalaria remains a significant public health challenge, particularly in sub-Saharan Africa (SSA), where it continues to be one of the leading causes of morbidity and mortality among pregnant women and young children. According to the World Health Organization (WHO), approximately 263\u0026nbsp;million cases of malaria and 597,000 malaria-related deaths were reported globally in 2023, with the majority of these cases occurring in the African region [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In 2022, an estimated 12.4\u0026nbsp;million pregnant women in Africa were affected by malaria, exposing both mothers and their unborn children to a range of adverse outcomes, including maternal anaemia, stillbirth, preterm birth, and low birth weight [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTo mitigate these risks, the WHO recommends a combination of preventive measures, including the use of long-lasting insecticidal nets (LLINs), prompt diagnosis and treatment, and intermittent preventive treatment during pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. IPTp-SP has proven particularly effective in reducing placental malaria, maternal anaemia, and poor neonatal outcomes when administered in three or more doses during antenatal care (ANC) visits [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. While WHO initially recommended two doses of IPTp-SP in 2004, this guideline was updated in 2012 to recommend at least three doses during pregnancy [7; 3]. These SP doses should be administered at least one month apart, starting at 13 weeks of gestation until the final ANC visit, under directly observed therapy [3;8]. The uptake of three or more doses of IPTp-SP is significantly associated with lower rates of pregnancy outcomes [6; 9,10]. Despite the adoption of these policy guidelines, coverage remains suboptimal in many malaria-endemic countries. Two meta-analyses have reported IPTp-SP coverage rates ranging from 5.3\u0026ndash;98.9%, with an average of 30.7% across sub-Saharan Africa, highlighting significant variation between countries [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eInsecticide-treated nets (ITNs) are another key preventive strategy recommended by the WHO, significantly reducing the burden of malaria. Although global and national funding for malaria control primarily focuses on the procurement of drugs and LLINs, numerous studies have pointed out the persistently low utilisation of ITNs among pregnant women and children under five in SSA [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. A recent survey in East Africa revealed that only 47.05% of pregnant women reported sleeping under an ITN, with coverage ranging from 6.08% in Zimbabwe to 64.13% in Uganda [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. In SSA, only about half of net owners sleep under an ITN [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe factors influencing IPTp-SP uptake and ITN adherence among pregnant women are multifactorial, involving a combination of sociodemographic factors, education, insufficient knowledge, cultural beliefs, healthcare service quality, ANC attendance, as well as concerns related to side effects of IPTp-SP [\u003cspan additionalcitationids=\"CR17 CR18 CR19\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn Gabon, a Central African country with perennial malaria transmission, data on the use of malaria prevention strategies during pregnancy are limited. A 2013 study in Libreville found that 57.4% of pregnant women received at least two doses of IPTp-SP, while only 49.5% had full preventive coverage [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. More recently, Bitheghe et \u003cem\u003eal\u003c/em\u003e. (2022) found that in southern Gabon, only 58.8% of women received three or more doses of IPTp-SP [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. These coverage rates remain below both the national and WHO targets of 80%. Information from Estuaire province, where nearly half of the country\u0026rsquo;s population resides, is outdated, despite improved access to maternal and child health services since the implementation of universal health coverage. Moreover, there has been limited research into the combined coverage of IPTp-SP and ITN use among pregnant women in Gabon, and factors influencing their uptake have not been fully explored. This gap hampers the ability of health authorities to assess the effectiveness of malaria control programmes and adjust strategies accordingly.\u003c/p\u003e \u003cp\u003eThe present study aims to address this gap by assessing the levels of IPTp-SP and ITN use, and identifying the associated determinants, among postpartum women in an urban maternity setting in Owendo located in the Estuaire province of Gabon. The findings of this study will contribute to the development of context-specific, evidence-based interventions to enhance malaria prevention during pregnancy.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design, setting, and population\u003c/h2\u003e \u003cp\u003eThis analytical cross-sectional study was conducted over a four-month period, from February to May 2024, in the maternity ward of the Owendo University Hospital Centre (CHUO). Owendo is an industrial district located in the Estuaire province approximately 20 kilometres south of Libreville, the capital city of Gabon. It hosts the country\u0026rsquo;s first and largest seaport. The CHUO maternity unit is the second most utilised maternity service in the country and the only public facility in the municipality offering comprehensive and free maternal healthcare services, including antenatal care (ANC) and delivery.\u003c/p\u003e \u003cp\u003eThe study population comprised volunteers women during their immediate postpartum seen when they were placed under observation in the maternity ward of the CHUO, who provided verbal informed consent. Exclusion criteria included: women receiving cotrimoxazole prophylaxis, those admitted for unrelated medical conditions, and those who declined to participate in the interview.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSample size calculation\u003c/h3\u003e\n\u003cp\u003eThe sample size was calculated based on a 15% estimated prevalence of three-dose IPTp-SP coverage, as reported by the Gabonese Malaria National Control Programme (MNCP) in 2020 (Data from the MNCP). The sample size was determined using the standard formula for prevalence studies:\u003c/p\u003e \u003cp\u003en=(Z\u003csup\u003e2\u003c/sup\u003ex P(1\u0026thinsp;\u0026minus;\u0026thinsp;P))/e\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eWhere:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;minimum required sample size\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cem\u003eZ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1.96 (standard normal deviate for 95% confidence level)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;estimated prevalence (0.15)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cem\u003ee\u003c/em\u003e\u0026thinsp;=\u0026thinsp;margin of error (0.05)\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eThe minimum calculated sample size was 196. To account for a potential 10% non-response rate, the final sample size was increased to 216 women.\u003c/p\u003e\n\u003ch3\u003eData collection procedure\u003c/h3\u003e\n\u003cp\u003e Participants were recruited using a convenience systematic approach. Prior to participation, women were informed of the study objectives, procedures, and their rights. Those who consented orally were enrolled.\u003c/p\u003e \u003cp\u003eData were collected via structured, face-to-face interviews complemented by a review of ANC booklets and the delivery registry. The questionnaire was developed based on existing scientific literature, pre-tested among ten postpartum women for clarity and completeness and adjusted accordingly. Data were entered directly into REDCap (Research Electronic Data Capture) using tablet-based forms.\u003c/p\u003e \u003cp\u003eCollected variables included: identification (anonymous ID, age); sociodemographic data (residence, marital status, education, employment status of the woman and her partner) ; obstetric history (gravidity, parity, number of ANC visits) ; malaria prevention measures: number of IPTp-SP doses received, ITN ownership and regular use, and reasons for lack of ITN use.\u003c/p\u003e \u003cp\u003eCorrect or full preventive coverage was defined as uptake of three or more doses of IPTp-SP combined with regular use of an IITN.\u003c/p\u003e\n\u003ch3\u003eData management and statistical analysis\u003c/h3\u003e\n\u003cp\u003e All data were reviewed weekly by the Parasitology Department\u0026rsquo;s data management team for completeness and consistency. The final database was cleaned and exported to Excel, then analysed using Statview version 5.0 and R software for advanced statistical modelling.\u003c/p\u003e \u003cp\u003eDescriptive statistics were used to summarise participant characteristics and estimate coverage rates. Categorical variables were compared using the Chi-square or Fisher\u0026rsquo;s exact test. Continuous variables were analysed using the non-parametric Mann\u0026ndash;Whitney U test or Kruskal\u0026ndash;Wallis test, as appropriate.\u003c/p\u003e \u003cp\u003eMultivariable analyses were performed using a two-level logistic regression model in R to identify individual- and context-level factors associated with IPTp-SP and ITN uptake. A p-value of \u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e\n\u003ch3\u003eEthical considerations\u003c/h3\u003e\n\u003cp\u003eThis study is part of the routine malaria surveillance activities conducted by the Department of Parasitology and Mycology, in collaboration with the National Malaria Control Programme. Ethical clearance was granted by the Ministry of Health. Administrative authorisation was obtained from the CHUO Medical Director and the Head of the Obstetrics and Gynaecology Department.\u003c/p\u003e \u003cp\u003eAll participants were informed of the study\u0026rsquo;s objectives, voluntary participation, and confidentiality assurances. Verbal informed consent was obtained before enrolment. Each participant was assigned a unique anonymous identifier, and all data were handled in compliance with the principles outlined in the Declaration of Helsinki.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eGeneral characteristics of study population\u003c/h2\u003e \u003cp\u003eA total of 302 postpartum women were enrolled. The majority (84.4% ; n\u0026thinsp;=\u0026thinsp;255/302) were under 35 years of age, with a median age of 28 [\u003cspan additionalcitationids=\"CR25 CR26 CR27 CR28 CR29 CR30 CR31 CR32\" citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e] years, and most were single. Educational attainment was relatively high, with 93.4% (n\u0026thinsp;=\u0026thinsp;382) of participants having completed at least secondary school and nearly one in four (24.2%) participants were unemployed. Regarding obstetric history, 60.9% were either primiparous or secondiparous, and 58.3% (n\u0026thinsp;=\u0026thinsp;176) were primigravidae or secundigravidae. The median number of ANC visits was 7[\u003cspan additionalcitationids=\"CR6 CR7\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], 47% of women attended between five (5) and seven (7) ANC visits and 34.8% had eight (8).\u003c/p\u003e \u003cp\u003e Among the 252 participants who reported on their partner\u0026rsquo;s occupation, 73.9% stated that their partner was engaged in an income-generating activity. Participants characteristics are summarised in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eGeneral characteristics of participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge group, years\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e24\u0026ndash;34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e186\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e61.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e153\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e129\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e42.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eParity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimiparous\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondiparous\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMultiparous\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e118\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e39.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGravidity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimigravidae\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecundigravidae\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMultigravida\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e126\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e41.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMatrimonial status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e259\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e86.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOccupation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWorker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e106\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e35.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMiddle management\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e105\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSenior executive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of ANC\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e281\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e93.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHusband\u0026rsquo;s sector activity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrivate sector\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePublic sector\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf-employed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eITN use\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e65.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSP doses received\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e233\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e77.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eMalaria prevention during pregnancy\u003c/h3\u003e\n\u003cp\u003eOwnership of ITNs was reported by 40.6% (n\u0026thinsp;=\u0026thinsp;130) of participants. Among these, 65.4% (n\u0026thinsp;=\u0026thinsp;85) declared regular use. Common reasons cited for not owning or using an ITN included discomfort due to heat (n\u0026thinsp;=\u0026thinsp;11), financial constraints (n\u0026thinsp;=\u0026thinsp;28), personal dislike of the net (n\u0026thinsp;=\u0026thinsp;120), and preference for alternative prevention methods (n\u0026thinsp;=\u0026thinsp;13).\u003c/p\u003e \u003cp\u003eThe mean number of sulfadoxine-pyrimethamine (SP) doses received during pregnancy was 3.0 (\u0026plusmn;\u0026thinsp;3.3). Among, the 233 women who had received at least three doses of IPTp-SP, 32.5% received three doses, 29.5% received four, 9.3% received five, and 5.6% received six doses. None of the reported SP doses had been administered under direct observation by healthcare personnel.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eCombined preventive coverage\u003c/h2\u003e \u003cp\u003eDespite the high level of IPTp-SP uptake, the proportion of women who achieved correct preventive coverage defined as receipt of at least three doses of IPTp-SP combined with regular ITN use was much lower. Only 85 (28.1%) women met this definition; 148 (49.0%) received at least three doses of IPTp-SP but did not regularly use an ITN. Additionally, 69 (22.8%) participants received fewer than three doses of IPTp-SP and did not regularly use an ITN whereas none of those who received fewer than three IPTp-SP doses regularly used an ITN.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eDeterminants of optimal IPTp-SP uptake (\u0026ge;\u0026thinsp;3 doses)\u003c/h2\u003e \u003cp\u003eOptimal uptake of IPTp-SP was observed in over three-quarters of participants (Table III). Bivariate analyses showed no significant association with age, level of school attended or marital status. However, a woman\u0026rsquo;s employment status was significantly associated with IPTp-SP adherence. Compared to unemployed women, those in the worker and middle-management categories were respectively 1.96 (p\u0026thinsp;=\u0026thinsp;0.049) and 2.52 (p\u0026thinsp;=\u0026thinsp;0.010) times more likely to receive at least three doses (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003ePartner\u0026rsquo;s employment status also influenced SP uptake. Women whose partners were employed in the public sector had a higher chance to complete the recommended regimen compared to those whose partners were unemployed (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn the multivariable logistic regression model, two factors remained significantly associated with optimal IPTp-SP uptake. Attending fewer than four ANC visits was strongly associated with inadequate SP coverage (\u003cem\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/em\u003e); primigravidae were significantly less likely to complete the regimen compared to secundigravidae (p\u0026thinsp;=\u0026thinsp;0.006). (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePredictive factors for optimal IPTp-SP use\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ecrude OR [95%]\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eadjusted OR [95%]\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;3 doses\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;3 doses\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge, years\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e76.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e23.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e24\u0026ndash;34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e145\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e78.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e21.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.09[0.55\u0026ndash;2.09]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e72.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e27.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.79[0.34\u0026ndash;1.87]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e50.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e84.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e15.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5.50[0.64\u0026ndash;60.76]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.55[0.031\u0026ndash;9.38]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.67\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e115\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e75.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e24.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.02[0.54\u0026ndash;16.90]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.74[0.060\u0026ndash;7.04]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e103\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e79.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e20.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.96[0.70-22.51]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.92[0.072-9.20]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.94\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGravidity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimigravidae\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e82.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e17.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecundigravidae\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e67.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e32.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.43[0.21\u0026ndash;0.87]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.019\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.30[0.13\u0026ndash;0.70]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e0.006\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMultigravida\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e79.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e20.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.81[0.40\u0026ndash;1.58]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.72[0.30\u0026ndash;1.69]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.45\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e82.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e17.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e197\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e76.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e23.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.65[0.26\u0026ndash;1.47]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOccupation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e66.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e33.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWorker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e77.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e22.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.96[1.01\u0026ndash;3.88]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.049\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.44[0.14\u0026ndash;10.16]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.73\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMiddle management\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e80.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e19.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.52[1.25\u0026ndash;5.14]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.010\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3.14[0.28\u0026ndash;24.41]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.29\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSenior executive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e85.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e14.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.82[0.58\u0026ndash;6.95]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.98[0.14-25.00]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.59\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of ANC\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e81.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e228\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e81.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e18.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e18.6[6.58\u0026ndash;66.8]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e22.13[7.27-108.96]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHusband\u0026rsquo;s sector activity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e61.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e39.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e68.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e32.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.36[0.84\u0026ndash;2.98]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.03[0.32\u0026ndash;3.46]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.95\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrivate sector\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e71.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e28.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.60[0.64\u0026ndash;4.07]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.74[0.089\u0026ndash;8.66]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.79\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePublic sector\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e80.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e19.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.70[1.15\u0026ndash;6.44]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.023\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.96[0.12\u0026ndash;11.31]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.97\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf-employed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e80.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e20.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.56[1.09\u0026ndash;6.12]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.032\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.85[0.26\u0026ndash;19.53]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.56\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eDeterminants of ITN use\u003c/h2\u003e \u003cp\u003eAmong women who owned an ITN, 65.4% reported regular use. Multivariate analysis identified educational level and marital status as predictors of ITN use (Table III). Women with secondary and university-level education were respectively 1.91 and 22.26 times more likely to use ITNs than those with only primary education (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Single women were more likely to report ITN use than married women (aOR\u0026thinsp;=\u0026thinsp;5.41 [1.53\u0026ndash;22.83]; p\u0026thinsp;=\u0026thinsp;0.012). (Table III). Other variables such as gravidity, parity, age group, number of ANC visits, and partner\u0026rsquo;s occupation showed no significant association with ITN use (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePredictive factors for optimal ITN Use\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eITN use\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ecrude OR [95%]\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" morerows=\"2\" nameend=\"c8\" namest=\"c7\" rowspan=\"3\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eadjusted OR [95%]\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge group, years\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e28.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e24\u0026ndash;34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e42.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e0.54[0.22\u0026ndash;1.25]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.58[0.20\u0026ndash;1.65]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.31\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e85.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e2.27[0.59\u0026ndash;11.22]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e5.66[1.01\u0026ndash;48.24]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.069\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e80.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e62.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e37.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e6.6[0.91\u0026ndash;13.21]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e15.91[1.30-47.57]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cb\u003e0.049\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e27.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e10.8[1.43\u0026ndash;22.14]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0.041\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e27.26[2.14\u0026ndash;82.30]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cb\u003e0.021\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003cp\u003e\u003cb\u003eGravidity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.99\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimigravidae\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecundigravidae\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e24.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMultigravida\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e42.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e0.42[0.15\u0026ndash;1.11]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.40[0.13\u0026ndash;1.17]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.097\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e62.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e37.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e0.43[0.17\u0026ndash;1.04]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.83[0.27\u0026ndash;2.53]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.75\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e63.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOccupation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e70.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e29.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e4.05[1.50-11.76]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0.007\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e5.41[1.53\u0026ndash;22.83]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cb\u003e0.012\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWorker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e29.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMiddle management\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e73.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e26.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e0.92[0.34\u0026ndash;2.49]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSenior management\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e62.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e37.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e0.76[0.53\u0026ndash;3.33]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of ANC\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e30.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHusband\u0026rsquo;s sector activity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e65.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e35.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e0.82[0.21\u0026ndash;2.70]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e28.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrivate sector\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e50.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e0.4[0.071\u0026ndash;7.01]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePublic sector\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e65.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e35.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e0.74[0.19\u0026ndash;2.79]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf-employed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e41.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e0.57[0.17\u0026ndash;1.79]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eNone of the studied variables were detected as factor significantly associated with the correct prevention.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study aimed to assess the coverage and determinants of malaria preventive measures, namely intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) and insecticide-treated net (ITN) use, among postpartum women in a large public maternity ward in Centre Hospitalier Universtaire d\u0026rsquo;Owendo, Gabon. While the uptake of IPTp-SP was relatively high, ITN ownership and usage were considerably lower, and only a small proportion of women received comprehensive malaria prevention during pregnancy.\u003c/p\u003e \u003cp\u003eThe proportion of women who received at least three doses of IPTp-SP (77.1%) exceeded the average reported in SSA (30.7%) the estimates of the last Demographic Health Survey (DHS) performed in 2019 (37.9%) and rate from southern Gabon in 2022 (58.8%) [11; 23; 22]. This variability may stem from differences in healthcare access, awareness, cultural beliefs, and provider practices [19; 24]. This encouraging figure likely reflects improvements in awareness in malaria prevention and ANC visit, as the vast majority of participants (93.0%) attended at least four visits. This reinforces the established role of ANC as a key platform for delivering IPTp-SP and disseminating preventive messages [5; 25]. This upward trend in our urban setting may be linked to improvement in ANC access, explained by the availability of free service at this facility under the universal health coverage program. Greater awareness could also be responsible, though ANC coverage likely remains heterogenous. In multivariable analysis, ANC attendance was a strong predictor of IPTp-SP adherence. Women who attended fewer than four ANC visits were significantly less likely to complete the recommended three-dose regimen, emphasising the importance of early and sustained engagement with maternal health services [\u003cspan additionalcitationids=\"CR27\" citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Though coverage likely remains heterogeneous across regions. Nevertheless, a notable gap remains in implementation quality, as none of the IPTp-SP doses were administered under direct observation, contrary to WHO recommendations, raising concerns about health staff adherence and drug efficacy [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eGravidity was also associated with SP uptake, with secundigravidae more likely to complete the regimen than primigravidae. This may reflect differences in health-seeking behaviour or prior experience with malaria prevention during earlier pregnancy. Socioeconomic factors also played a significant role. Women engaged in professional activity, and those whose partners were employed in the public sector or self-employed, were more likely to adhere to SP regimens. These findings support previous evidence that economic empowerment and household income positively influence maternal health outcomes [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eBy contrast, ITN ownership and use were low. While our findings are consistent with those from Ethiopia (47.1% and 39.9%) and Uganda (35%), they remain below the levels needed to ensure effective malaria prevention [15; 29]. In the most recent DHS 2019\u0026ndash;2021 in Gabon, the proportion of pregnant women owning an ITN was 14% with a usage rate of 62% [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. These figures are comparable those reported Mozambique (68.4%) and Ghana (61.0%) [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eBoth education level and marital status were significant predictors of net use. Women with secondary or higher education were more likely to use ITNs consistently, supporting the view that education attainment improves health literacy and fosters preventive behaviours [12; 32\u0026ndash;34]. Conversely, lower education levels have been associated with limited awareness of malaria risks and reduced engagement with ANC services. Interestingly, single women in our cohort used more often ITNs than their married counterparts, possibly reflecting greater autonomy or decision-making power in health-related decisions among unmarried women \u003cb\u003e[\u003c/b\u003e15; 35,36\u003cb\u003e]\u003c/b\u003e. This observation is confirmed in some settings; data from DHS of SSA countries showed that women in male-headed household were more likely to use ITN than those in female-headed households [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Participants cited several barriers to ITN use, including discomfort due to heat, personal aversion, financial constraints, and a preference for alternative prevention methods such as mosquito insecticide spray. These challenges are consistent with findings from other contexts and reflect both behavioural and structural barriers to ITN use [\u003cspan additionalcitationids=\"CR40\" citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCrucially, only 85 women representing, less than one-third of the study population, achieved full malaria preventive coverage, defined as receiving at least three doses of IPTp-SP combined with regular ITN use. Almost half of study participants received\u0026thinsp;\u0026ge;\u0026thinsp;3 IPTp-SP doses but did not use an ITN regularly, while 22.8% received neither adequate chemoprevention nor consistent vector protection. This highlights a significant implementation gap: despite effective ANC-based SP delivery, household-level preventive practices remain insufficient. Similar disparities have been documented in other malaria-endemic settings [20; 24].\u003c/p\u003e \u003cp\u003eDespite the strengths of the study, including a robust sample size and integration of clinical records with interviews, some limitations must be acknowledged. First, the cross-sectional design precludes causal inference. Second, self-reported ITN use, and SP uptake may be affected by recall and social desirability bias.\u003c/p\u003e \u003cp\u003eThe findings underscore the need to reinforce community-level malaria prevention, particularly through improved ITN distribution and promotion. While IPTp-SP coverage appears encouraging, ensuring supervised administration during ANC visits and tackling behavioural barriers to ITN use remain essential. Future studies should further explore qualitative determinants of ITN non-use and assess the effectiveness of free ITN distribution campaigns in other Gabonese settings.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study highlights both progress and persistent gaps in the implementation of malaria prevention strategies among pregnant women in urban Gabon. Although IPTp-SP coverage was relatively high, consistent with improvements in ANC utilisation, the lack of directly observed therapy and the low uptake of ITNs underscore significant shortcomings in achieving comprehensive protection. Socioeconomic status, education, and ANC attendance emerged as key determinants of preventive behaviour, while disparities in ITN use suggest a need for targeted behavioural and structural interventions.\u003c/p\u003e \u003cp\u003eTo close the prevention gap, policy efforts should prioritise supervised IPTp-SP delivery during ANC, strengthen ITN distribution and education campaigns, and tailor strategies to reach vulnerable subgroups, including primigravidae, low-income households, and less-educated women. Expanding community engagement and addressing contextual barriers to ITN use will be critical for enhancing malaria prevention during pregnancy and achieving national and regional targets in malaria control.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eIPTp-SP\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003e\u0026bull; Intermittent Preventive Treatment in Pregnancy with Sulfadoxine\u0026ndash;Pyrimethamine\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eITN\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003e\u0026bull; Insecticide-Treated Net\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eLLIN\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003e\u0026bull; Long-Lasting Insecticidal Net\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eANC\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003e\u0026bull; Antenatal Care\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eWHO\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003e\u0026bull; World Health Organization\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eSP\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003e\u0026bull; Sulfadoxine\u0026ndash;Pyrimethamine\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eCHUO\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003e\u0026bull; Centre Hospitalier Universitaire d\u0026rsquo;Owendo\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eSSA\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003e\u0026bull; Sub-saharan Africa\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eRedCap\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003e\u0026bull; Research Electronic Data Capture\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to express their gratitude to the healthcare staff of the maternity ward of the Centre Hospitalier Universitaire d’Owendo for their collaboration and support during data collection. We also thank all the women who participated in the study and shared their experiences. Special thanks go to the research team of Department of Parasitology-Mycology of Université des Sciences de la Santé.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBCMD and BAMK conceived and designed the study, interpreted the results and prepared the manuscript. SGME, DAMM, CM, CMB and BPN: performed the study methodology, interviewed and collected data, NPM and LNA: analysed data and interpreted results;BSO and DPMM: revised the manuscript; BAMK: correction of the final manuscript. All authors read and approved the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author upon reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflicts of interest related to this work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWorld Health Organization. World malaria report 2023. 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Malar J. 2021;20:195. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12936-021-03733-y\u003c/span\u003e\u003c/span\u003e.\u003c/li\u003e\n\u003cli\u003eTaremwa IM, Ashaba S, Adrama HO, Ayebazibwe C, Omoding D, Kemeza I, et al. Knowledge, attitude and behaviour towards the use of insecticide treated mosquito nets among pregnant women and children in rural Southwestern Uganda. BMC Public Health. 2017;17:794. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12889-017-4824-4\u003c/span\u003e\u003c/span\u003e.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Antenatal care, IPTp-SP, ITN, pregnancy, malaria","lastPublishedDoi":"10.21203/rs.3.rs-6649416/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6649416/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eMalaria in pregnancy remains a major public health challenge in sub-Saharan Africa. This study assessed the coverage and determinants of intermittent preventive treatment with sulfadoxine\u0026ndash;pyrimethamine (IPTp-SP) and the use of insecticide-treated nets (ITNs) among postpartum women in a large urban maternity facility in Owendo, Gabon.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA cross-sectional study was conducted among postpartum women attending a public tertiary hospital in Gabon. Data were collected through structured interviews and clinical records. The main outcomes were receipt of at least three doses of IPTp-SP and consistent ITN use during pregnancy. Multivariable logistic regression was performed to identify factors associated with IPTp-SP uptake and ITN use.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAmong 302 participants, 77.1% received at least three doses of IPTp-SP, whereas ITN ownership was 40.6%, and only 28.1% achieved full preventive coverage (defined as \u0026ge;\u0026thinsp;3 IPTp-SP doses and regular ITN use). Overall, 34.8% had 8 antenatal care (ANC) visits. IPTp-SP uptake was strongly associated with ANC attendance: women with more at least four visits were 22 times more likely to complete the recommended regimen (22.13[7.27-108-96]; \u003cem\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/em\u003e). Employment status and gravidity also influenced adherence. ITN use was significantly associated with secondary (aOR: 15.91[1.30-47.57]; \u003cem\u003ep\u0026thinsp;=\u0026thinsp;0.049\u003c/em\u003e) or higher education (aOR: 27.26[2.14\u0026ndash;82.30]; \u003cem\u003ep\u0026thinsp;=\u0026thinsp;0.021\u003c/em\u003e) and single (OR: 4.05[1.50-11.76]; \u003cem\u003ep\u0026thinsp;=\u0026thinsp;0.007\u003c/em\u003e) marital status. None of the IPTp-SP doses were administered under direct observation.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eWhile IPTp-SP coverage was promising and approaching target levels, gaps remain in the delivery of comprehensive malaria prevention. Strengthening ITN distribution, ensuring supervised IPTp-SP administration, and addressing educational and behavioural barriers are essential to improving maternal protection against malaria in Gabon\u003c/p\u003e","manuscriptTitle":"Coverage and Determinants of Malaria Preventive Measures During Pregnancy in Urban Gabon: A Cross-Sectional Study of IPTp-SP Uptake and ITN Use in Owendo","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-14 07:11:53","doi":"10.21203/rs.3.rs-6649416/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-09T15:54:34+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-02T08:50:39+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-25T13:17:26+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-20T14:12:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"148466459283432607937856912382228863066","date":"2025-06-19T23:05:35+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"38990354117012263458439113314013710312","date":"2025-06-18T08:44:33+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-17T22:16:04+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"187326726987725208155804130349720990943","date":"2025-06-12T00:32:05+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"143647906476894980193758028806237163329","date":"2025-06-11T18:07:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"272026113704224512525187621515607572404","date":"2025-06-11T07:05:59+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-06-11T05:30:51+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-05-16T08:11:11+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-05-13T06:58:34+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-05-13T06:52:59+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pregnancy and Childbirth","date":"2025-05-12T19:38:37+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"74598ef6-d239-4ce0-b480-dfde944106c5","owner":[],"postedDate":"June 14th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-05T20:53:12+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-14 07:11:53","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6649416","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6649416","identity":"rs-6649416","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}