Malaria prevalence and associated factors among pregnant women in Arua City, Northwestern Uganda

Abstract

Introduction: Malaria during pregnancy remains an important public health challenge in sub-Saharan Africa, including Uganda. In the West Nile sub-region, particularly Arua City, evidence on the prevalence of malaria and associated factors among pregnant women remains limited despite ongoing malaria-control interventions. We determined the prevalence of malaria and identified factors associated with malaria infection among pregnant women in Ayivu Division, Arua City, Northwestern Uganda. Methods: A cross-sectional study was conducted among 208 pregnant women recruited from Oluko Solidale HC III, Pajulu HC III, and Aroi HC III. Data were collected using questionnaires and health-facility records, while malaria infection was determined using rapid diagnostic tests (RDTs). Descriptive statistics, chi-square tests, bivariate logistic regression, and multivariable logistic regression were performed in R. Associations were reported as crude and adjusted odds ratios with 95% confidence intervals, with statistical significance set at p < 0.05. Results: Among the 208 pregnant women enrolled, 51.0% were rural residents, 52.9% were formally married, and 37.0% were primigravidae. Overall malaria prevalence by rapid diagnostic test was 37.5% (78/208). In multivariable logistic regression, women who reported checking their ITNs for holes had higher odds of malaria (aOR = 5.43, 95% CI: 2.19–13.48, p < 0.001), while uncertainty about ITN condition was also associated with increased odds (aOR = 3.38, 95% CI: 1.28–8.90, p = 0.014). Conversely, sleeping under an ITN was associated with substantially lower odds of malaria (aOR = 0.25, 95% CI: 0.11–0.60, p = 0.002). Some family-income categories also showed protective associations, although these findings should be interpreted cautiously because of possible sparse data and residual confounding. Conclusions: Malaria prevalence among pregnant women in Arua City remained high despite existing control interventions. The findings emphasise the importance of consistent ITN use, maintaining nets in good condition, and timely replacement of damaged nets. Strengthening community awareness and integrated vector-management approaches may further reduce malaria exposure. However, associations involving net-checking behaviour and household income should be interpreted cautiously because the cross-sectional design does not establish causality and residual confounding may remain.