Inequality of Opportunity in Prevention of Malaria in Pregnancy in Kenya
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Date
2026
Authors
Elizabeth Owiti
Journal Title
Journal ISSN
Volume Title
Publisher
AERC
Abstract
Background: Kenya is classified as a malaria epidemic zone with more than
70% of the population at high risk of the disease, while the remaining are at
low risk. Pregnant women are more vulnerable to malaria infection, and
maternal and infant morbidity and mortality in Kenya are associated with
malaria in pregnancy. The government of Kenya promotes malaria prevention
in pregnancy using insecticide-treated nets (ITNs) and intermittent prevention
treatment in pregnancy (IPTp) using sulfadoxine-pyrimethamine (SP). The
objective of this study is to estimate the trend of coverage and inequality of
opportunity in the prevention of malaria in pregnancy in Kenya and establish
the determinants of these inequalities.
Methodology: We used the Human Opportunity Index (HOI) to examine the
equality of opportunity in joint use of two malaria prevention interventions:
insecticide-treated nets (ITNs) and intermittent preventive treatment in
pregnancy (IPTp) using sulfadoxine-pyrimethamine (SP) among pregnant
women in Kenya. The Shapley decomposition method is used to capture the
contribution of each circumstance to inequality of these opportunities, using
pooled KDHS data for 2003, 2008/09, 2014, and 2022.
Results: We find that between 2003 and 2022 the cummulative national
coverage, dissimilarity, and HOI of using ITNs and IPTp–SP were 45.4%, 3.8%
and 43.7%. The trend of coverage and HOI increased from 12.2% to 65.3% and
from 10.7% to 62.4% during the same period. While inequality decreased
from12.8% to 1.6% and then increased to 4.4% in 2022. The coverage implies
that malaria prevention services were not available for 34.7% of pregnant
women in by 2022. The HOI increased by 48.6% from 2003 to 2008/09, 0.7% of
the increase was due to change in the distribution of circumstances and 41.1%
increase was due to increase in overall coverage and 6.9% increase was due to
equalization effect. In the Lake Victoria region and the Coastal malaria stable
areas in Kenya, there was an increasing trend in of utilization of both ITNs and
IPTp–SP from 11.8% in 2003 to 83.3% in 2014, then a declined to 65.4% in 2022.
The HOI increased from 9.2% to 83.14%, then declined to 59.2%. The
dissimilsrity index declined from 22.3 % to 0.16% in 2014, then incresed to
9.5% in 2022. There was a significant decline in inequality of opportunity
between 2003 and 2014, but an increase there after. These increase could be
attributed to distruptiosn in access to health services during and after COVID 19 outbreak. Using Shapley decomposition, we find the top five circumstances
contributing to inequality of opportunity for ITNs and IPTp – SP utilization are:
women’s level of education, spouse occupation, average number of women
per cluster delivering in the health facilities, among others.
Conclusion: While the country made progress in increasing coverage, access
and reducing inequality in malaria prevenion among pregnant women
between 2003 and 2014, there were set backs post 2014 leaving over 34%
unprotected by 2022. The malaria endemic zone is the most affected. To
achieve univeral coverage, the government needs to intensify the efforts to
close the gap in coverage and access while eliminating dispatities especially in
high risk Lake Victoria region and the Coastal regions