Journal of AI and Integrative Medicine (JAIIM) Volume 1 | Issue 1 | May-July 2026 | Pages 09-15 DOI: https://doi.org/10.5281/zenodo.21739983 REVIEW ARTICLE OPEN ACCESS https://journals.novadexpub.com/index.php/jaiim/index Copyright © 2026 The Author(s). This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International (CC BY 4.0) License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, adaptation, and reproduction in any medium, provided the original author(s) and the source are properly credited. 1 Maternal Educational Attainment and Uptake of Intermittent Preventive Treatment with Sulfadoxine-Pyrimethamine among Pregnant Women in Orlu Zone, Imo State 1 Ogoke Ikechukwu V., 1 Uzoma Maria - Joanne's K., 1 Ejikunle Samson D.., 2 Onyemekara Darlington and 3 Ibe Joy Ada 1 Department of Obstetrics and Gynecology, Imo State University Teaching Hospital, Orlu. 2. Department of Medical laboratory Science, Imo State University Teaching Hospital, Orlu. 3 Department of Public health, Imo State Corresponding Author: * 1 Ogoke Ikechukwu V, (ogokevictorikechukwu865@gmail.com) Received: 15 June, 2026 | Revised: 01 August 2026 | Accepted: 8 August 2026 Abstract— Malaria in pregnancy continues to be a public health menace especially in malaria endemic countries like Nigeria. Intermittent preventive treatment of malaria with sulfadoxine-pyrimethamine (IPT-SP) is an effective strategy for the prevention of malaria and its adverse effects. Maternal educational status could influence health seeking behaviors including treatment seeking for malaria and the adoption of preventive measures such as IPT-SP. The study evaluated the association between maternal educational status and IPT-SP uptake among pregnant women attending antenatal care at primary health centers in Orlu Zone, Imo State, Nigeria. A cross-sectional survey was conducted among pregnant women attending ante-natal care at selected primary health centers in Orlu Zone, Imo State. A total of 280 pregnant women were recruited for the study. Data on the level of education and IPT-SP uptake were obtained using a pretested and validated questionnaire/questioner administered by interview. Analysis of the data was descriptive and explored the association between maternal educational status and IPT- SP uptake. Maternal educational status was categorized as no formal education, primary, junior secondary, senior secondary and tertiary education. The highest proportion of the pregnant women who received IPT-SP had senior secondary education (105/37.50%). This was followed by those with tertiary education (67/23.93%) and those that had junior secondary education (67/23.93%). Fewer women with primary education (36/12.86%) and those with no formal education (5/1.79%) received IPT-SP. It was further observed that IPT-SP uptake increased with increase in maternal educational level and peaked among women with senior secondary education. Maternal educational status was associated with increased odds of IPT-SP uptake among pregnant women in Orlu Zone, Imo State. Women with higher educational status were more likely to receive IPT-SP compared to those with less education. However, those with no formal education comprised the least proportion of those who received IPT-SP. There is a need for enhanced health education during antenatal care visits, targeting pregnant women with lower levels of education to increase their knowledge of IPT-SP and encourage uptake of this effective intervention for the prevention of malaria in pregnancy. Keywords: Maternal education; IPT-SP; sulfadoxine- pyrimethamine; malaria prevention; pregnancy; antenatal care; Orlu Zone; Nigeria INTRODUCTION Malaria remains a major public health problem in sub Saharan Africa where pregnant women are among the most vulnerable groups to malaria infection and its adverse effects[1]. Pregnancy causes immunological and physiological changes that increase susceptibility to malaria infection and worsen the condition[1]. Malaria in pregnancy is associated with maternal anaemia, placental malaria, miscarriage, preterm birth, intrauterine growth restriction, stillbirth and poor birth outcomes[2]. Malaria transmission is high in Nigeria compared to other countries and as a result, pregnant women

Johnkennedy Nnodim(2026) 2 and their foetuses are at high risk of developing severe forms of malaria and its adverse consequences[3]. Therefore, preventing malaria infection during pregnancy remains a priority in antenatal care. Intermittent preventive treatment of malaria in pregnancy with sulfadoxine-pyrimethamine (IPT-SP) is one of the key malaria prevention interventions used in pregnancy. IPT-SP is recommended in areas with moderate-to-high Plasmodium falciparum transmission and involves the administration of two or more doses of sulfadoxine-pyrimethamine at specified intervals to pregnant women regardless of their malaria status[4]. IPT-SP significantly reduces the risk of maternal malaria infection, placental parasitaemia, maternal anaemia, and adverse birth outcomes[5]. However, for IPT-SP to be effective, pregnant women must have access to antenatal care services and adhere to IPT-SP regimen[6]. Maternal educational status can influence healthcare seeking behaviours[7], decision making regarding antenatal care[8] including IPT-SP uptake, and knowledge of malaria prevention during pregnancy. Women with higher level of education are more likely to know about and utilise malaria prevention measures such as IPT-SP. Those with little or no education may lack the knowledge and understanding needed to take up IPT-SP or utilise other effective malaria prevention measures. Education could also indirectly influence IPT-SP uptake by determining a woman’s social status, autonomy, and access to antenatal care services including IPT-SP[9]. IPT-SP remains an effective malaria prevention intervention but its uptake is low among pregnant women in many malaria endemic communities[10]. The low uptake of IPT-SP could be due to individual factors such as age, parity, knowledge of IPT-SP, and beliefs about the intervention. Other factors include the distance to health facilities, the availability and affordability of drugs, the perceived quality of antenatal care services, the number of antenatal care visits, and the presence of negative perceptions and fears about IPT-SP such as beliefs about its harmful effects[11]. Maternal educational status determines individual beliefs about malaria and IPT- SP and could influence decision making around malaria prevention during pregnancy. Understanding how maternal education influences IPT-SP uptake will contribute to improved malaria prevention strategies in pregnancy. In Nigeria, malaria prevention during pregnancy is promoted as part of antenatal care. Pregnant women are encouraged to undertake intermittent preventive treatment with sulfadoxine- pyrimethamine as part of their antenatal care visits in accordance with the World Health Organization guidelines. The association between maternal educational status and IPT- SP uptake could vary in different communities based on several factors such as access to health services and information, socio-demographic characteristics, cultural beliefs and practices and the pattern of ante-natal care utilisation[12]. Orlu Zone in Imo state has many communities that are served by primary health centres that provide antenatal care and IPT- SP services to pregnant women. These women are important partners in malaria prevention and control but differences in their level of education could determine their knowledge of IPT-SP and utilisation of the intervention. Therefore, understanding the association between maternal educational status and IPT-SP uptake among pregnant women in Orlu zone will provide useful information on how to improve IPT- SP uptake and malaria prevention in pregnancy. The study focused on pregnant women attending ante-natal care at primary health centres in Orlu zone, Imo state. The study aimed to determine the association between maternal educational status and IPT-SP uptake. It also evaluated the pattern of IPT-SP use among pregnant women in the study area in relation to their level of education. Malaria in pregnancy continues to be a public health menace, especially in malaria endemic countries like Nigeria. Intermittent preventive treatment of malaria with sulfadoxine- pyrimethamine (IPT-SP) is an effective strategy for the prevention of malaria and its adverse effects. Maternal educational status could influence health seeking behaviours including treatment seeking for malaria and the adoption of preventive measures such as IPT-SP. This study aimed to assess the association between maternal educational status and IPT-SP uptake among pregnant women attending primary health centres in Orlu Zone, Imo State, Nigeria. In addition, it also evaluated the pattern of IPT-SP use in relation to maternal educational level among pregnant women in the study area. Findings from the study will provide insight into the influence of maternal educational status on IPT-SP uptake and help inform health education efforts targeting pregnant women. Materials and Methods Study Design This study employed a longitudinal study design to assess the uptake of intermittent preventive treatment with sulfadoxine- pyrimethamine (IPT-SP) among pregnant women attending antenatal care at selected primary health centres in Orlu Zone, Imo State, Nigeria. Participants were followed from recruitment during pregnancy through subsequent antenatal visits to document IPT-SP uptake, missed doses, and reasons for non-uptake where applicable. Study Area The study was conducted in Orlu Zone of Imo State, southeastern Nigeria. Orlu Zone is the largest of the three senatorial zones in Imo State and comprises 12 Local Government Areas (LGAs): Orlu, Orsu, Isu, Njaba, Nwangele, Nkwerre, Oru East, Oru West, Ideato South, Ideato North, Oguta, and Ohaji/Egbema. The zone has approximately 72 primary health centres distributed across the various communities. Thirty-three (33) primary health centres were selected as study sites. The population of Orlu Zone is estimated at approximately 3 million people. The primary health centres provide essential maternal and child health services, including antenatal care, health education, malaria prevention, and administration of IPT-SP to eligible pregnant women. The distribution of antenatal services across the selected primary health centres provided an appropriate setting for assessing maternal characteristics and uptake of IPT-SP during pregnancy. Study Population The study population consisted of approximately 3,500 pregnant women who attended antenatal clinics at the 33 designated primary health centres during the study period. The

Johnkennedy Nnodim(2026) 3 participants represented pregnant women receiving routine antenatal services within the study area. Sample Size Determination The sample size was determined using the finite population correction formula: The calculated minimum sample size was approximately 258 participants. To improve the adequacy of the study sample and account for possible incomplete responses or loss to follow-up, the sample size was increased to 280 pregnant women, representing approximately 11.4% of the estimated study population. Sampling Technique A purposive (judgmental) sampling technique was used to select eligible participants for the study. This non-probability sampling approach enabled the researchers to recruit pregnant women who met the predetermined eligibility criteria and attended antenatal clinics at the designated primary health centres during the study period. Instrument for Data Collection Data were collected using a structured, semi-structured questionnaire developed in accordance with the objectives of the study. The questionnaire consisted of sections addressing maternal demographic characteristics, relevant spousal characteristics, antenatal care information, and IPT-SP uptake. At the first antenatal visit, information obtained included the participant's initials, age, occupation, marital status, parity, level of education, husband's age, husband's educational attainment, and indicators of household wealth. Information concerning booking date and gestational age at booking was also documented. During subsequent antenatal visits, information was recorded on the date and number of antenatal visits, IPT-SP administration or uptake, and reasons for refusal or non- uptake where applicable. At approximately the 38th week of gestation, the total number of IPT-SP doses taken during the index pregnancy, the number of doses missed, and reasons for non-uptake were documented. The maternal educational attainment variable was categorized as no formal education, completed primary education, completed junior secondary education, completed senior secondary education, and tertiary education. This categorization was used to assess the relationship between maternal educational attainment and IPT-SP uptake. Validity of the Instrument The questionnaire was assessed for face and content validity. The items were developed to reflect the objectives and variables of the study. The instrument was reviewed by the research supervisors and revised based on their recommendations to ensure that the questions were clear, relevant, appropriate, and adequately covered the domains under investigation. A pilot study was also conducted before the main data collection to identify ambiguous or poorly structured items and facilitate further refinement of the questionnaire. Reliability of the Instrument The reliability of the data collection instrument was assessed through pre-testing and post-testing procedures. The questionnaire was organized into sections corresponding to the major variables of the study to ensure consistency in data collection. The instrument was administered during the pilot phase and reviewed for consistency and clarity before commencement of the main study. Ethical Considerations Participation in the study was voluntary. Eligible participants were adequately informed about the purpose and procedures of the study before recruitment, and informed consent was obtained from each participant. Participants were informed that they could decline participation or withdraw from the study without affecting the antenatal care they received. Confidentiality of participants' information was maintained throughout data collection, analysis, and reporting, and questionnaires were handled securely and used solely for the purposes of the study. Data Collection Procedure Research assistants comprising doctors, nurses, midwives, community health workers, and students were recruited and trained before commencement of data collection. The training focused on the objectives of the study, eligibility criteria, administration of the questionnaire, procedures for obtaining informed consent, documentation of IPT-SP uptake, and ethical considerations. Permission to conduct the study was obtained from the staff in charge of the selected primary health centres. Staff nurses and other willing healthcare personnel at the participating centres were also recruited and oriented on the study procedures. Eligible participants were approached during antenatal clinic visits and were adequately informed about the purpose, procedures, potential benefits, and voluntary nature of participation before enrolment. two hundred and eighty consenting pregnant women who fulfilled the eligibility criteria were recruited. The questionnaire was administered at the initial antenatal visit, and relevant information was subsequently updated during follow-up antenatal visits. IPT-SP uptake was documented during subsequent visits, including the number of doses received and any missed doses. Where a participant did not take the recommended medication, the reason for non-uptake was documented. At the end of the pregnancy, completed questionnaires were retrieved from the research assistants, checked for completeness, and prepared for data analysis. Inclusion Criteria Participants were included if they: 1. were pregnant women attending antenatal care at any of the designated primary health centres; 2. consented voluntarily to participate in the study; 3. were in the early second or third trimester of pregnancy at recruitment; and 4. had no known contraindication or hypersensitivity to sulfadoxine-pyrimethamine or its constituent sulfonamide/pyrimethamine components. Exclusion Criteria

Johnkennedy Nnodim(2026) 4 Women were excluded if they: 1. did not provide informed consent to participate; 2. attended antenatal care at health facilities outside the designated study centres; 3. had a known hypersensitivity to sulfonamides or pyrimethamine; or 4. were in the first trimester of pregnancy at the time of recruitment. Measurement of IPT-SP Uptake IPT-SP uptake was assessed by documenting the number of doses received by each participant during the index pregnancy. Information obtained during successive antenatal visits was used to determine whether the participant received the recommended IPT-SP doses, missed any scheduled doses, or declined treatment. Reasons for missed or refused doses were also documented. For the analysis of maternal educational attainment, participants were grouped according to their highest level of education attained: no formal education, primary education, junior secondary education, senior secondary education, and tertiary education. The distribution of IPT-SP uptake across these educational categories was subsequently examined. Statistical Analysis Completed questionnaires were checked for completeness, coded, and entered into a statistical database for analysis. Results were presented using frequencies, percentages, tables, and bar charts The association between maternal educational attainment and IPT-SP uptake was assessed using the chi-square ((\chi^2)) test of association.. Statistical significance was set at a 5% significance level (p < 0.05). Results Level of educat ion Did not go to sch ool Compl eted primar y school Compl eted only junior WAEC Compl eted senior WAEC Has tertiar y educat ion No of wome n 5 36 67 105 67 % 1.79 12.86 23.93 37.50 23.93 Table 1: Maternal Level of Education and Uptake No formal educaon Primary educaon Junior WAEC Senior WAEC Terary Educaon 0 50 100 150 5 36 67 105 67 Maternal Level of Education and Up- take Figure-1 From table 1 , on the effect of maternal level of education and the uptake of intermittent preventive treatment among the participants, it can be seen that the highest number of women that took the drug was 105 (37.50%), and these were women that have completed secondary education, the second highest number of women that took the IPT-SP was 67 (23.93%), and these women had tertiary education, and coincidentally was the same number as those that completed only junior secondary education. The lowest number was 5 (1.79%), and were those that did not complete primary education Discussion A study of the association between maternal educational attainment and intermittent preventive treatment with sulfadoxine-pyrimethamine uptake among pregnant women attending ante-natal care at selected primary health centres in Orlu Zone, Imo State The present study assessed the association between maternal educational attainment and intermittent preventive treatment (IPT) uptake with sulfadoxine-pyrimethamine (SP) among pregnant women attending ante-natal care (ANC) at selected Primary Health Centres (PHCs) in Orlu Zone, Imo State. The study revealed a differential pattern of IPT with SP uptake among pregnant women according to their educational attainment. The highest proportion of pregnant women who received IPT with SP had senior secondary education (105, 37.50%). This was followed by those who had tertiary education and junior secondary education each comprising 67 (23.93%). Those with primary education comprised 36 (12.86%) and the least educated women with no formal education were 5 (1.79%). Consequently, the odds of IPT use among pregnant women were strongly associated with their educational attainment . A significantly higher proportion of women with secondary and tertiary education received IPT with SP suggesting that maternal education might be a significant social determinant of IPT with SP uptake . The high IPT with SP uptake (105, 37.5%) among women with senior secondary education could be attributable to the positive impact of education on health literacy [13]. Education empowers individuals to seek, understand, and act upon health information. Women with secondary and tertiary education are more likely to comprehend health information received during ANC visits regarding the benefits of IPT with SP and the possible adverse consequences of refusing it [14]. They are also likely to have good health-seeking behaviour and engage in effective communication to obtain health care information from their providers [15]. The high IPT with SP uptake among women with tertiary education (67, 23.93%) indicates that education might contribute to women’s good health-seeking conduct [16]. Women with tertiary education are likely to be well-informed about health issues affecting them due to their access to health information through electronic and digital media [13]. They are also more likely to take action in response to health information received [17]. Consequently, women with tertiary education may be aware of the need for IPT with SP during ANC visits and the risks of malaria infection to themselves and their unborn children.

Johnkennedy Nnodim(2026) 5 The high IPT with SP uptake among women who had senior secondary education (105, 37.5%) suggests that education could determine health care utilisation in pregnancy. The high IPT with SP uptake among women with junior secondary education (67, 23.93%) implies that a moderate level of education could be sufficient for effective health information dissemination and health promotion among pregnant women. Women with junior secondary education might have acquired adequate health literacy to enable them make informed decisions about their health [18]. Effective ANC education, therefore, plays a crucial role in IPT with SP uptake. During ANC visits, healthcare providers should present health information in simple language so that pregnant women can understand the importance of IPT with SP and the adverse consequences of refusing it [19]. The low IPT with SP uptake among women who had completed primary education (36, 12.86%) could be due to their low health literacy level and inadequate comprehension of the benefits of IPT with SP [20]. Although education is a critical determinant of health literacy, health information access and utilisation would depend on individual health literacy levels [21]. Women with primary education might have limited skills to access and utilise health information appropriately during ANC visits [20]. The very low IPT with SP uptake (5, 1.79%) among women with no formal education suggests that health education efforts targeting pregnant women with minimal or no formal education require special attention [22]. Women with no formal education often have inadequate health literacy to comprehend health information given during ANC visits [23]. Written health information might also be inappropriate for such women [24]. Caregivers should, therefore, use verbal health education and other relevant materials to reinforce health information during ANC visits for women with minimal or no formal education. The observed association between maternal educational attainment and IPT with SP uptake is consistent with the general understanding of education as a social determinant of health [25]. Education influences health in various ways. It enhances an individual’s health literacy, increases awareness of available health services, improves socioeconomic status, and facilitates effective interpersonal relationships with caregivers [26]. Consequently, mothers with secondary and tertiary education are more likely to utilise preventive maternal health services such as IPT with SP [27]. However, the study’s descriptive nature raises some questions about the strength of the association found between maternal educational attainment and IPT with SP uptake in the study area. The percentages of women with various levels of education who received IPT with SP do not seem to indicate a linear relationship between educational attainment and IPT with SP uptake [28]. For instance, the table below shows that while the percentage of women with junior secondary education who received IPT with SP was 23.93%, a higher percentage of women with senior secondary (37.5%) and tertiary education (23.93%) received IPT with SP Accordingly, although a higher percentage of women with senior secondary education received IPT with SP compared to those with tertiary education, the difference in IPT with SP uptake between them might not be statistically significant. The statement that “education was a strong predictor of IPT with SP uptake among pregnant women” should, therefore, be supported by the appropriate inferential statistics [29]. More specifically, the percentages of pregnant women who received and refused IPT with SP should have been presented for each educational group to justify the statement [30]. Conclusion The study established an association between maternal educational attainment and IPT with SP uptake in pregnancy. The highest proportion of pregnant women who had received IPT with SP had senior secondary education followed by those with tertiary and junior education. The least educated women who received IPT with SP had no formal education. These results suggest that maternal education could significantly predict IPT with SP utilisation among pregnant women in Orlu Zone, Imo State. Enhancing health education during ante-natal care visits and targeting pregnant women with limited formal education could improve IPT with SP uptake among pregnant women in Orlu Zone, Imo State. Funding: This research received no external funding. Institutional Review Board Statement: Not applicable. 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