Barriers to the Uptake of Intermittent Preventive Treatment in Pregnancy with Sulfadoxine-pyrimethamine among Pregnant Women in Northern Ghana: A Qualitative Study

Abstract

Introduction: Malaria in pregnancy remains a major public health concern in sub-Saharan Africa, contributing to maternal morbidity, anaemia, and adverse birth outcomes. The World Health Organization (WHO) recommends intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) to reduce these risks. However, despite its proven efficacy, many pregnant women in Ghana, particularly in Sagnarigu Municipality, are reluctant to use IPTp-SP. Understanding the reasons behind this reluctance is crucial for improving uptake and maternal health outcomes. Aim: This study aimed to explore the factors influencing pregnant women’s reluctance to use IPTp-SP in Sagnarigu Municipality from their perspectives. Methods: A qualitative study was conducted using a content analysis approach. Sixteen pregnant women were purposively selected and interviewed using a semi-structured interview guide. Data were analyzed thematically, ensuring rigour through bracketing, member checking, peer debriefing, and maintaining an audit trail. Results: The findings revealed multiple barriers to IPTp-SP uptake. These included limited knowledge about the benefits of the drug, fears of side effects, mistrust in the healthcare system, cultural and religious beliefs, and the influence of family members and traditional healers. Healthcare system challenges, such as drug stockouts and poor communication from providers, further discouraged utilization. Despite these barriers, some women expressed willingness to take IPTp-SP if reassured by healthcare workers and community influencers. Conclusion: Addressing IPTp-SP barriers requires targeted health education, stronger community engagement, and improved healthcare provider communication. Ensuring a reliable supply of SP and enhancing antenatal counselling could significantly increase uptake. These findings provide critical insights for policymakers and healthcare providers seeking to improve malaria prevention strategies among pregnant women in Ghana.