Publication date: Jan 21, 2025

Background: Malaria in pregnancy contributes to high maternal mortality, warranting the adoption of intermittent preventive treatment (IPTp) of malaria in pregnancy in Sierra Leone in 2017. Since then, the uptake of IPTp has increased but it is unclear whether COVID-19 has any impact on these services. We aimed to assess the impact of COVID-19 on the uptake of IPTp among pregnant women in Sierra Leone at district, regional, and national levels. Methods: A retrospective cross-sectional study design was used to assess the monthly aggregated data from DHIS2 for all 5 regions of Sierra Leone. We describe the trends of IPTp1, IPTp2, and IPTp3+ uptake at national, regional, and district levels before, during and after COVID-19. Data was analyses using STATA. The median and interquartile range for each outcome in each period were calculated. Results: The median monthly uptake of total IPTp was the lowest before COVID (53,244) but increased during COVID-19 (55,257) and after COVID-19 (59,439). IPTp1 uptake was lowest during COVID-19 (20,338) but highest after COVID-19 (20,914). All three variables (IPTp1, IPTp2 and IPTp3) showed a clear decline in uptake in early 2020 and recovered within 3 months in a similar pattern of magnitude, except in Eastern Sierra Leone. Both IPTp2 and IPTp3 showed more pronounced increases in uptake after recovery than IPTp1 and they both experienced sustained increases in the post-COVID-19 period. Conclusion: The negative impact of the COVID-19 pandemic in reducing IPTp uptake was followed by rapid recovery, underscoring the resilience of the Sierra Leones health system in response to public health emergencies. However, the delay in recovery in the IPTp uptake in the Eastern Sierra Leone highlight the need for strong differentiated regional strategies in protecting essential health services during public health emergencies.

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