Overall, the findings of this study showed that family size, the number of ANC visits, and the first ANC initiation time affect the likelihood of pregnant women receiving the optimal SP. These results are consistent with existing evidence, especially from LMICs. The findings revealed that women with four or more ANC contacts during their pregnancy had higher odds of receiving optimal SP than women who attended fewer than four ANC visits. This positive correlation between ANC numbers and optimal SP uptake aligns with the literature emphasizing the importance of ANC services in promoting SP use. For instance, pregnant women who attended four or more ANC visits had a high likelihood of receiving the optimal SP in studies conducted in Uganda (29) and Kenya (30). Additionally, a study conducted in Nigeria showed that women who attended more ANC contacts had high odds of receiving optimal SP (31). Similar findings have been reported in previous studies, which revealed that more ANC visits increase the odds of SP uptake (19, 32). Pregnant women who attend ANC contacts have ample opportunities to interact with healthcare providers, which increases the likelihood that they may receive SP as a component of ANC services. There is evidence to support the premise that more ANC attendance is associated with high uptake of SP (26).
Furthermore, the first ANC initiation time was an important predictor of optimal SP uptake. The number of ANC visits is also related to the early initiation (within the first trimester) of ANC. Since the main channel used to deliver SP, it is important to promote the early initiation of ANC during pregnancy. A study carried out in Kenya showed that women who initiated their first ANC after 16 weeks of gestation had a lower likelihood of receiving optimal SP than women who initiated their first ANC before 16 weeks of pregnancy (30). Comparable results were also found in Tanzania (33). However, these findings are not consistent with those of a study conducted among 4,772 Nigerian women of reproductive age, in which those who started their first ANC during the second trimester had greater odds of receiving optimal SP than did those who started their first ANC during the first trimester (34). These findings should be understood in light of the fact that ANC services are an important platform for delivering SP, and early ANC initiation allows health professionals to early promote and provide information about pregnancy including IPTp-SP.
The findings also showed that women from a family with more than six members were more likely to receive optimal SP. Similarly, a study in Guinea established that women from a family of 2 to 5 members were more likely to complete the optimal SP (35). The difference in family size in terms of optimal SP uptake could be attributed to pregnancy experience among women with high parity and a high number of children.
The findings of the present study demonstrated that optimal SP uptake varies by region, with the highest uptake occurring in the northern part of Ghana. According to these findings, women from the Upper West and Upper Esat had high optimal SP uptake, with more than 70% receiving the optimal SP. These regional disparities are consistent with findings from a previous study by (19), which showed that community-based education and maternal interventions improved the utilization of maternal healthcare services, including IPTp, in northern Ghana. These regional disparities are also consistent with the results reported in two recent studies in Nigeria (31) and Guinea (35). For the study in Nigeria, the highest optimal SP uptake was observed in the South‒East and South‒South regions, while the lowest was observed in the North‒East and North‒West regions. These regional disparities can be attributed to differences in the programs and activities used to reduce the prevalence of malaria in the northern part of Ghana.
The lowest prevalence observed in the Eastern region, with less than 50% of the optimal SP uptake, is a concerning finding. Additionally, Volta, an Eastern bordering region, has a lower prevalence of optimal SP uptake (approximately 55%), which is slightly lower than the national prevalence. These findings are consistent with the findings of a study exploring regional variations in optimal SP uptake in Zambia, which revealed a lower prevalence of SP uptake in the western and southern provinces (36). Spatial autocorrelation analysis revealed a significant correlation between spatial factors and optimal SP uptake across different regions. In addition to spatial factors, the lower optimal SP uptake in the Volta and Eastern regions could be explained by disparities in maternal healthcare service accessibility and utilization, including IPTp.
Briefly, these findings did not challenge the existing evidence on the determinants of receiving SP during pregnancy. However, this study did not find an association between SP uptake and several factors, such as residence area, sex of household, household wealth index, possession of ITNs, use of ITNs, health insurance coverage, and exposure to malaria messages. Some of these factors, even if they were not significant in this study, have been cited by many authors (34, 35, 37, 38). For instance, contrary to the findings of Figueroa-Romero et al. (2022); Gutman et al. (2021); Okedo-Alex et al. (2020); Okeke Kalu et al. (2022), the source of SP did not predict the uptake of SP. Nevertheless, there is not enough evidence to support the effect of the source of SP since most women in this study received SP from ANC services.
Strengths and limitations
This study’s strength is that it used a nationally representative sample obtained using multistage sampling procedures. Therefore, the findings can be applied to the entire population of Ghana. Additionally, the DHS dataset used was based on a standardized questionnaire, and only data from the most recent pregnancy within two years were included, which could minimize recall bias. As limitations, the analysis was restricted to the variables available in the GMIS-2019 questionnaire, which did not include other factors, such as health system factors, that can influence IPTp-SP. Additionally, the survey was self-reported, and women’s responses might not accurately reflect the issues as they are.