Coverage and Determinants of Malaria Preventive Measures During Pregnancy in Urban Gabon: A Cross-Sectional Study of IPTp-SP Uptake and ITN Use in Owendo

Background Malaria in pregnancy remains a major public health challenge in sub-Saharan Africa. This study assessed the coverage and determinants of intermittent preventive treatment with sulfadoxine–pyrimethamine (IPTp-SP) and the use of insecticide-treated nets (ITNs) among postpartum women in a large urban maternity facility in Owendo, Gabon. Methods A cross-sectional study was conducted among postpartum women attending a public tertiary hospital in Gabon. Data were collected through structured interviews and clinical records. The main outcomes were receipt of at least three doses of IPTp-SP and consistent ITN use during pregnancy. Multivariable logistic regression was performed to identify factors associated with IPTp-SP uptake and ITN use. Results Among 302 participants, 77.1% received at least three doses of IPTp-SP, whereas ITN ownership was 40.6%, and only 28.1% achieved full preventive coverage (defined as ≥ 3 IPTp-SP doses and regular ITN use). Overall, 34.8% had 8 antenatal care (ANC) visits. IPTp-SP uptake was strongly associated with ANC attendance: women with more at least four visits were 22 times more likely to complete the recommended regimen (22.13[7.27-108-96]; p < 0.001 ). Employment status and gravidity also influenced adherence. ITN use was significantly associated with secondary (aOR: 15.91[1.30-47.57]; p = 0.049 ) or higher education (aOR: 27.26[2.14–82.30]; p = 0.021 ) and single (OR: 4.05[1.50-11.76]; p = 0.007 ) marital status. None of the IPTp-SP doses were administered under direct observation. Conclusions While IPTp-SP coverage was promising and approaching target levels, gaps remain in the delivery of comprehensive malaria prevention. Strengthening ITN distribution, ensuring supervised IPTp-SP administration, and addressing educational and behavioural barriers are essential to improving maternal protection against malaria in Gabon