Compliance with intermittent preventive malaria treatment in pregnancy at a tertiary hospital in Sierra Leone

OBJECTIVES To describe receipt of intermittent preventive treatment for malaria in pregnancy (IPTp) doses, assess compliance with the recommended minimum of three IPTp doses, and identify factors associated with non-compliance among antenatal care attendees. This was a non-concurrent cohort study using routinely collected hospital data in 2024 at the Princess Christian Maternity Hospital, a university-affiliated tertiary teaching hospital in Freetown, Sierra Leone. RESULTS Among the 733 pregnant antenatal care attendees, 682 (93%) registered after the first trimester, and only 30 (4%) had ≥4 antenatal contacts. Of the 733, 406 (55%) received first dose and only 62 (8%) received three doses. The maximum number of doses received was six by a single woman. In adjusted analysis, women with less than four antenatal contacts had three times higher risk of non-compliance (adjusted relative risk: 2.7, 95% confidence interval: 1.6–4.5) compared with those with ≥4 contacts. Receipt of IPTp doses and compliance with the recommended minimum of three doses were low and were associated with fewer antenatal care contacts. CONCLUSION Our findings underscore the need to understand the reasons for the gaps in treatment and to address them systematically. Strategies to increase the number of antenatal care contacts may improve compliance with the recommended minimum three doses.