Bill Brieger and Bright Orji conducted an examination of national surveys and program reviews to document achievement of antenatal care and IPTp targets in Nigerian preparation for a poster presentation at the 2023 American Society of Tropical Medicine and Hygiene annual meeting in Chicago.

In 2012, the World Health Organization updated the Intermittent Preventive Treatment of malaria during pregnancy (IPTp) coverage indicator to a minimum of three doses. In 2014, Nigeria set the national target of 100% of women attending ANC to receive IPTp.

This study reviewed national survey data for antenatal care (ANC) attendance and IPTp provision from the 2013 and 2018 Demographic Health Surveys (DHS) and the 2015 and 2021 Malaria Indicator Surveys (MIS). Extracted from the national malaria program reviews (MPR) of the National Malaria Strategic Plans (NMSP) of 2014 and 2019 were explanations of program implementation issues. ANC4 attendance and IPTp uptake (1st and 3rd doses) were compared using descriptive statistics.

The 2015 MIS did not document ANC 4th visit, so attendance in the remaining surveys was 51%, 57%, and 52% (X2=160.0, df2, p <0.0001). The slow increase of ANC attendance and drop in 2021 meant that opportunity to acquire three IPTp doses was not possible for most women. Over the four surveys, IPT1 increased from 23% to 47% to 64%, then dropped to 58%. IPTp3 rose from 6% to 19% then dropped to 16.6% before increasing to 31% (X2= 1755, df3, p<0.0001).

The MPR reports identified four factors inhibiting achievement of the ANC and IPTp targets including insecurity (terrorism, civil unrest), poor integration of malaria in pregnancy into reproductive and maternal health programs, inadequate procurement and stock-outs of SP, and logistical hurdles (lack of vehicles and fuel). By not meeting ANC4 and IPTp1 targets, limits were set for IPTp3 uptake.

As other researchers have suggested, NMSPs embody global targets and may not reflect local realities. Local governments, who deliver the bulk of ANC and IPTp services, must be part of the process of setting and planning how to achieve targets.