Background: Malaria in pregnancy remains a serious public health concern in sub-Saharan Africa. The household head as a primary decision-maker plays a major role in women's utilization of maternal health services. This study aimed to examine the trends, and the association between the sex of household head and the uptake of intermittent preventive treatment of malaria in pregnancy using sulfadoxine-pyrimethamine (IPTp-SP) in six sub-Saharan African countries. The findings provide insight into the progress, status and gender-specific barriers to IPTp-SP uptake.

Methods: Secondary data from the most recent Malaria Indicator Surveys for the six countries were analysed. A total of 15,452 (weighted) women aged 15-49 years from the six countries were included in this study. Both descriptive and inferential statistics were computed, including a chi-square test and binary logistic regression.

Results: The pooled data showed that 77% of the participants took at least one dose of IPTp-SP and 37% took ≥ 3 doses. The trend analysis showed that the uptake of IPTp-SP has increased over time. Women with a female household head (AOR = 1.21, 95% CI 1.08-1.38) had higher odds of taking ≥ 3 doses of IPTp-SP compared to those with a male household head.

Conclusion: The findings suggest that promoting women's participation in decision-making and leadership at the household level may help increase the uptake of IPTp-SP in sub-Saharan Africa.

Keywords: Intermittent preventive treatment; Malaria in pregnancy; Sex of household head; Sub-Saharan Africa; Sulfadoxine-pyrimethamine.

© The Author(s) 2025.