OBJECTIVES: Malaria accounts for high maternal and infant morbidity and mortality among pregnant women in Kenya. The country adopted World Health Organization’s recommendation of using insecticide treated nets (ITNs) and intermittent prevention treatment in pregnancy (IPTp) using sulfadoxine-pyrimethamine (SP) to prevent malaria in pregnancy (MiP). These interventions are provided free of charge in public health facilities yet their uptake remains sub-optimal. The objective of this study is to estimate the trend of coverage and inequality of opportunity (IOp) in the prevention of malaria among pregnant women in the Lake Victoria and Coastal Malaria stable areas in Kenya and establish the determinants of these inequalities.

METHODS:The study uses pooled cross-sectional Kenya Demographic and Health Survey (KDHS) data for 2003, 2008/09 and 2014 and Human Opportunity Index (HOI) to examine the IOp in using ITN and IPTp-SP to prevent malaria in pregnancy. Shapley decomposition is used to capture the percentage contribution of each circumstance to IOp.

RESULTS:There is increase in percentage use of ITNs and IPTp – SP from 11.8% in 2003 to 83.3% in 2014. The opportunities for access to ITNs and IPTp-SP also increased from 8.4% and 81.2% between 2003 and 2014, as captured by HOI, while inequality of opportunity (Dissimarity index) significantly reduced from 28.7% to 2.4%. Shapley decomposition shows the top five circumstances contributing to IOp for ITNs and IPTp – SP use are: women’s level of education (16.8%), spouse occupation (13.5%), spouse education level (10.6%) place or residence (10.9%) and cluster average age at first birth (8.6%).

CONCLUSIONS:The average coverage of the intervention increased to 83.3% and HOI to 81.2.% in 2014, implying low inequality, however to achieve health universal coverage in prevention of MiP, the government needs to expand coverage and ensure that no expectant mother is left unprotected against malaria. This will reduce materna mortality.