Factors Influencing the Prevention of Malaria in Pregnancy in Zambia; a Case of Shiwang'andu District.

Abstract Background:Malaria remains endemic in Zambia, carrying about 2% of the global malaria burden (MIS, 2019). Malaria is preventable, treated and can be eliminated. Zambia launched a National Malaria Elimination Strategic Plan 2017-2021, with the aim of eliminating malaria completely. However, a lot of factors have influenced this strategy, and this study wishes to explore such factors in Shiwang’andu district of Muchinga province. Therefore, the aim of this study was to determine the effectiveness of the measures put in place to prevent malaria in pregnancy in Shiwang'andu District. Methodology: a cross-sectional study was done using convergent mixed method at 5 randomly selected health facilities in Shiwang’andu district. 323 pregnant women were selected using systematic random sampling together with 10 health workers selected from the health facilities. Quantitative data was collected from the pregnant women using a pre-designed self-administered questionnaire and a semi structured interview guide during focused group discussions. Qualitative data was collected from healthcare workers using semi structured interview guide during in-depth interview. Quantitative data collected was entered and analyzed using STATA whereas qualitative data was analyzed using thematic code analysis. Results: There were fluctuations in the prevalence trends of malaria in pregnancy from 2017-2024 in Shiwang’andu district with the highest being 14% in 2017 and 2020 and the lowest being 9% in 2022. However, the results show an upward trend in the last 3 years from 9% in 2022 to 14% in 2024. The pregnant women had high knowledge about malaria in pregnancy (61.3%). However, gaps in knowledge still exist on the complications and the misconceptions on the cause. Qualitative data showed that health care workers demonstrated a solid understanding of malaria in pregnancy and recognized serious complications. Most facilities reported having preventive strategies in place, including the administration of Fansidar (IPTp), distribution of insecticide-treated nets (ITNs), and periodic indoor residual spraying (IRS) when supported by the district. Challenges included lack of clean drinking water or cups, stock-outs of Fansidar, ITNs were not always available, IRS was irregular. Quantitative data further showed that majority (55.7%) of the respondents received more than 3 doses of Fansidar. Majority (57.3%) of the women agreed that the Fansidar was given under observation (DOT). Only a few (31.6%) received insecticide treated mosquito nets despite majority (58.8%) of the respondents sleeping under a mosquito net. Further, few houses (28.9%) had been sprayed. There was a relationship between receiving more than 3 doses of IPTp and knowledge, and between IPTp and not having malaria. Conclusion: Pregnant women and healthcare workers demonstrated good knowledge about malaria despite having gaps in knowledge and some misconceptions. Systematic challenges hindered the effective implementation of the preventive measures. There is need for strengthened health system support, improved community education, and consistent implementation of malaria prevention strategies in pregnancy.