Knowledge, attitudes, and behavioural intentions toward IPTp-SP use among pregnant women in rural Nigeria: A theory of reasoned action approach

Abstract

Background. Globally, malaria cases increased from 228 million in 2018 to 282 million in 2024, with the African region accounting for 95% of the cases. Nigeria bears the highest malaria burden in the world, and pregnant women carry a significant number of the cases. Malaria in pregnancy (MiP) may have negative implications for maternal and neonatal health. The WHO-recommended intermittent preventive treatment using sulphadoxine-pyrimethamine (IPTp-SP) helps to prevent MiP, but its uptake is low in Nigeria. Using the theory of reasoned action (TRA), this study investigated the attitudes and intentions of pregnant women in Bayelsa State towards the use of IPTp-SP. Methods. The study adopted qualitative methods, including focus group discussions with pregnant women and key informant interviews with relevant community stakeholders. Six focus group discussions and seventeen key informant interviews were conducted with pregnant women and stakeholders, respectively. Data were managed using NVivo (version 12) and analysed thematically and deductively in line with the TRA. Results. Pregnant women had limited knowledge of preventing MiP and specifically IPTp-SP use. This resulted in a negative attitude towards the preventive technique. Interestingly, while the role of significant others, such as traditional birth attendants (TBAs), husbands and mothers-in-law, was acknowledged, many pregnant women did not succumb to the social pressure to use IPTp-SP when they did not think it was best for them. Many women intended to use IPTp-SP but had not done so at the time of the study due to structural barriers, poor access to facilities, and the unavailability of IPTp-SP. Conclusions. The use of IPTp-SP is poor among pregnant women in the sample. These women have their own will and are not necessarily pressured by social norms. Intentions may not translate to actual practice or use if structural barriers are not eliminated.