Malarial infection during pregnancy increases the risks of severe sequelae for the pregnant woman and the risk of delivering a low birth weight baby. The present study showed that the IPTp with SP programme is helpful in reducing malaria-related maternal anaemia and P. falciparum parasitaemia in pregnant women as discussed by various studies and reports [1, 6, 9, 10, 15, 16]. Increased doses of SP were associated with increased Hb levels which do confirm the previous study done . Among the gravida in the pregnant women, Hb level did not show any significant association with use of SP and thus, nearly two third, 61% of them had normal Hb level (Hb ≥11.0 g/dl) with no recording of severe anaemia (Hb < 7 g/dl). This however, contradicts the previous study  significant association of Hb level with gravidity since not all the study participants did take SP. Thus, the use of SP in pregnancy improves Hb levels in them.
There was reduced parasitaemia 15% (47/306) in the pregnant women, which could be attributed to the increased doses of SP taken. The SP negatively correlated with parasitaemia but was not significant (r = -0.07, p ≥0.24). In the qualitative studies however, SP was commented on to protect against malaria-related anaemia in pregnancy; "It protects us from getting malaria and anaemia"; said one pregnant woman in the FGD "Yes, only if the pregnant women will follow the instructions and take it" commented a chief. Though parasitaemia was high among the multigravidae as compared to the secundigravidae and primigravidae, the primigravid women recorded higher parasite densities (≥5000 per μl of blood) as compared to secundigravid and multigravid pregnant women. This indicates the high susceptibility of the primigravid women to malaria and possible development of parasite resistance to the SP as reported in the previous study .
There were lots of chequered reactions on taking the doses of SP as commented by some of the pregnant women in the FGD: "When I took the first dose, I was bodily weak, nauseous and even vomited later on, but when I took the second dose nothing happened"; "I didn't vomit when I took the first dose but with the second dose and the third dose, I vomited".; "When I took the first dose, I felt weak and lost appetite". However, these adverse effects were not serious enough to pick up on SP in pregnancy and not significant with the number of doses of SP taken, hence, supports the mild effects of SP reported in other studies [1, 9, 10, 15, 17].
SP use as a preventive treatment drug for malaria in pregnancy was not well known among the people in the communities (particularly the chemical sellers) and, thus, they were less informed and educated about it "I have heard about that one and some of them even come here (the drug store) to buy it because when it was given to them in the hospital they realized it is good", "... we know it as Fansidar and in the hospital it's Malafan".
A comment from one chemical seller: "I heard that the pregnant women go to the hospital for some chloroquine tablets" indicates that most of the people are less knowledgeable about the use of SP in the IPTp and not following the instructions on administering the drug could lead to abuse by pregnant women and the subsequent resistance of the malaria parasite to it. However, majority of the respondents (especially the pregnant women) were aware of IPTp with SP and its benefits, including reduction of maternal morbidity and stillbirths, improved weights of babies "It protects the mother and the baby against malaria infection" said a pregnant woman in the FGD; "It makes both the mother and the baby to be healthy" said another pregnant woman in the FGD. They normally get educated on the IPTp during visits to antenatal clinics and at community durbars and electronic media including radio of which majority, 85% of the women owned.
In spite of the little or no formal education, low socioeconomic status and poor housing units of most (72%) of the pregnant women with over 60% being traders and farmers, the patronage of SP in IPTp was good and higher among multigravid women (58%) as compared to the secundigravid (24%) and primigravid women (18%). The low patronage by the primigravid women as found in the previous studies  is discouraging since they are the vulnerable group with high maternal morbidity and low birth weight deliveries [2, 13, 18, 19].
Helminthic infection, malnutrition and other disease conditions could contribute to anaemia in pregnancy  aside malaria, and these were not determined. For the purpose of this study, SP doses administered to the pregnant women were obtained from the ANC cards at the health facilities, and possible non-recording of doses might have led to an underestimation of doses received.
The acceptance/ownership of ITNs as a means of preventing mosquito bites was quite encouraging since over 50% of the pregnant women studied had ITNs although less than 50% admitted usage of the nets. However, the use of ITNs by the pregnant women in combination with the IPTp programme was not assessed since there were chequered responses to the use of the nets. However, these are not expected to significantly influence the observed findings.