Antenatal care attendance, intermittent preventive treatment in pregnancy and knowledge on malaria: A cross sectional study in a government and a private district Hospitals

Ghana has made significant strides in maternal healthcare under the National Health Insurance Scheme, but more effort is required to achieve the Sustainable Development Goal 3.1 target of <70 deaths/100,000 live births from the current 308 deaths/100,000. This study sought to investigate knowledge about ANC, ANC attendance, knowledge about malaria and IPTp among pregnant women, visiting a government Hospital in Mafi-Adidome (a rural community) and a private Hospital in Battor-Dugame (a rural-urban community) in the Volta region (a high malaria endemic area in Ghana). A total of 1295 consenting pregnant women participated in the study. Information on sociodemographic characteristics, knowledge about ANC, IPTp and knowledge about malaria were collected by questionnaire. Chi-square tests were used to compare proportions of variables across the two study sites. Higher proportion (70.8%) of participants accessing Battor Catholic Hospital showed adequate knowledge about ANC than 38.1% in Adidome Government Hospital (X2(7) =105.11; p<0.001). Also, higher numbers (46.6%) in Battor Catholic Hospital showed adequate knowledge on the timing for IPTp administration than 21.1% in Adidome Government Hospital (X2(2) =83.37; p<0.001). Although knowledge about malaria was generally low (0–33.3%) at both health centres, high proportions of participants (>80%) possess and use mosquito bed nets for malaria prevention. A lower proportion (46.6%) of participants in Battor Catholic Hospital made the WHO recommended 4-7 visits compared to 50.2% participants in Adidome Government Hospital. Age, marital status, employment and education influenced utilization of antenatal and delivery services. More sensitization on the importance of ANC and hospital delivery is needed in the study areas. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The field work was supported by IRD (Institute of Research and Development) as part of a large study titled 'Malaria-helminth coinfection in Southern Ghana: issue and challenge in vaccine development against placental malaria'. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ghana Health Service Ethical review Noguchi Memorial Institute for Medical Research IRB I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data will be made available on request