A multilevel modeling of factors on Sulfadoine-Pyrimethanie uptake in Cameroon: Evidence from national cross-sectional survey

Introduction Pregnant women worldwide face significant risks from malaria, which can adversely affect both mother and baby. To combat malaria in Cameroon, the WHO, in 2004, recommended a strategy including intermittent preventive treatment during pregnancy (IPTp) using sulfadoxine-pyrimethamine (SP), insecticide-treated nets (ITNs), and proper management for clinical malaria and anaemia. This study explores the prevalence and predictors of IPTp-SP uptake across individual, community, and regional levels in Cameroon. Material and Method We utilized data from the 2018 Cameroon Demographic and Health Survey (CDHS) to analyze IPTp-SP uptake employing three-level multi-level models to capture individual, community, and regional influences. Responses from 4,823 women were analyzed, with results presented in 95% credible intervals. Results Women aged 35-39 were more likely to receive at least 3 doses of IPTp-SP during their last pregnancies compared to those aged 45-49 (aOR=1.92, 95% Crl=1.08-3.41). Women without formal education were less likely to have optimal IPTp-SP uptake (aOR=0.81, 95% Crl=0.70-0.92) compared to those with higher education. The wealthiest women and those attending at least eight ANC visits had higher odds of optimal IPTp-SP uptake (aOR=1.47, 95% Crl=1.20-2.09 and aOR=1.97, 95% Crl=1.25-3.12, respectively). Additionally, those with health insurance, urban residents, and moderately disadvantaged communities showed increased uptake (aOR=1.70, 95% Crl=1.46-1.94, aOR=2.15, 95% Crl=1.89-3.08, and aOR=1.84, 95% Crl=1.63-2.13, respectively). Conclusions Community-level factors such as urban residence, female-headed households, and residence in the least disadvantaged communities were also linked to higher IPTp-SP uptake. Optimal uptake of IPTp-SP was more evident in the least disadvantaged regions. The findings of this study should guide the Cameroonian Ministry of Health and other stakeholders in developing targeted interventions to enhance the uptake of IPTp-SP in Cameroon.