Prevalence and Risk Factors for Plasmodium Falciparum Malaria among Pregnant Women Attending the Antenatal Clinic at Bor State Hospital, South Sudan

Abstract Malaria in pregnancy is still a major public health problem in sub-Saharan Africa with little locally generated evidence from South Sudan. The purpose of this study was to determine the prevalence of Plasmodium falciparum malaria and associated factors among pregnant women attending antenatal care at Bor State Hospital, South Sudan. An analytical cross-sectional study was conducted on 249 pregnant women in a hospital. Data were collected by using a standardized questionnaire, laboratory diagnosis form, and clinical record sheet presented by an interviewer. Malaria infection was identified utilizing a histidine-rich protein-2 quick diagnostic test and microscopy of Giemsa-stained thick and thin films, with microscopy as the reference diagnostic method. Data were analyzed using SPSS version 26. Bivariate analyses were done to identify variables for multivariable binary logistic regression, and adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were given. Statistical significance was set at p < 0.05. Of the 249 women, 107 were positive for malaria, giving a prevalence rate of 42.9% (95% CI 37.0-49.2%). The highest prevalence was observed among women less than 20 years old (66.7%), women with little formal education (54.3%), farmers (58.1%), women who lived in rural regions (48.9%), primigravidae (55.8%), and those who attended ANC just one to three times (52.9%). Multivariable analysis showed that no formal education (AOR 6.85, 95% CI 1.47–31.91), primary education (AOR 6.12, 95% CI 1.33–28.15), rural residence (AOR 2.29, 95% CI 1.13–4.64), primigravidity (AOR 5.65, 95% CI 2.37–13.47) and one to three ANC visits (AOR 7.00, 95% CI 1.88–26.01) were associated with increased odds of malaria. However, use of long-lasting insecticidal nets (LLINs) (AOR 0.41, 95% CI 0.19–0.89) and uptake of intermittent preventive treatment in pregnancy (IPTp) (AOR 0.38, 95% CI 0.19–0.76) were linked with decreased odds of infection. Malaria prevalence among pregnant women attending Bor State Hospital was very high. It is important to improve ANC attendance, access and usage of LLINs, delivery of IPTp, and targeted health education for women with inadequate educational backgrounds and those who reside in remote areas to help minimize malaria infection during pregnancy.