Abstract
Background: Worldwide, maternal morbidity from malaria during pregnancy is a major contributor to poor birth outcomes. Malaria remains a major public health concern in Kenya, with pregnant women and their unborn children being particularly vulnerable to the adverse effects of the disease. Despite efforts to control and eliminate malaria, its prevalence among pregnant women in Kenya remains high, contributing to adverse pregnancy outcomes such as maternal anaemia, low birth weight, premature delivery, and increased risk of infant mortality. According to the Kenya Malaria Indicator Survey (KMIS) conducted in 2022, the prevalence of malaria among pregnant women in Kenya was estimated to be around 27%. This has caused an alarming situation especially with Kenya aiming to achieve Sustainable Development Goal (SDG) three by 2030. Addressing the high prevalence of malaria among pregnant women in Kenya requires a multifaceted approach that involves improving access to effective malaria prevention and control measures, enhancing antenatal care services, and addressing the underlying socioeconomic determinants that increase vulnerability to the disease.
Aim: This study aimed to evaluate the prevalence and associated factors of malaria among pregnant women in Kenya.
Methods: A retrospective cross-sectional study was conducted, using secondary data across different regions of Kenya by Demographic and Health Survey (KDHS). The target population comprised all women who were currently pregnant between the ages of 15 and 45 years. The target sample was 333, with the confidence level of 95%, and 5% marginal error where elements that were sampled randomly using a stratified random sampling technique. Data was collected through structured interviews to gather sociodemographic information, obstetric history, and malaria prevention practices. Malaria prevalence was calculated as the proportion of pregnant women with confirmed malaria infection. Logistic regression analysis was performed to identify factors associated with malaria during pregnancy, including age, parity, education level, household wealth index, use of insecticide-treated bed nets, and uptake of intermittent preventive treatment. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs)
v
were calculated to quantify the strength of association between these factors and malaria prevalence. Data was prepared and analysed using IBM SPSS version 29.0. A p-value less than 0.05 was the level factor that was statistically significant. The expected outcome of the study was to show the link of the associated factors to malaria cases which will benefit in preventing the emergence of further cases and deaths that are related to malaria illness. The study was conducted with all ethical considerations being maintained throughout the study.
Results:
Among the 333 pregnant women enrolled in the study, the overall prevalence of malaria was found to be 17.4% (95% CI: 14.5%-23.4%). Variations were observed across different regions, with the highest prevalence of 22.5% reported in the Rift Valley area and the lowest of 1.5% in Nairobi. The bivariate statistics analysis revealed that residing in rural areas (COR = 1.24, 95% CI: 0.58-2.67) and having lowest form of education (COR = 5.50, 95% CI: 2.05-5.14.73) were significantly associated with increased odds of malaria during pregnancy. Furthermore, pregnant women who did not use insecticide-treated bed nets (ITNs) consistently (COR = 0.82, 95% CI: 0.23-2.87) and those who did not receive intermittent preventive treatment (IPTp) during their current pregnancy (COR = 1.65, 95% CI: 1.01-2.35) had substantially higher odds of malaria infection compared to their counterparts who practiced these preventive measures.
Conclusion: This study highlights the substantial burden of malaria among pregnant women in Kenya, with over one-fifth of the participants testing positive for the disease. The findings underscore the need for targeted interventions to address the significant regional disparities and the disproportionate impact on socioeconomically disadvantaged populations. Consistent use of preventive measures, including insecticide-treated bed nets and intermittent preventive treatment, emerged as crucial factors in reducing the risk of malaria during pregnancy. Efforts should be made to improve access to these interventions, particularly in rural and low-resource settings. Additionally, addressing the socioeconomic determinants of malaria, such as poverty, lack of education, and limited access to healthcare services, is crucial for comprehensively tackling this issue. Further research is warranted to explore contextspecific barriers and facilitators to the uptake of malaria prevention strategies among pregnant women in Kenya. Effective implementation
vi
of evidence-based interventions and policies can contribute to improved maternal and child health outcomes by reducing the substantial burden of malaria during pregnancy.
Keywords: Malaria, socio-demographic factors, pregnant women, antenatal care, malaria treatment, use of bed nets, Kenya.