Socioeconomic factors, perceptions, and healthcare utilization in malaria management among pregnant women in Plateau State, Nigeria

Malaria in pregnancy remains a public health concern in Nigeria.This study examined factors associated with the occurrence and frequency of malaria episodes among pregnant women attending primary healthcare facilities in Plateau State, Nigeria.A cross-sectional study was conducted among 608 pregnant women attending antenatal care in 14 primary healthcare facilities.Data were collected using structured interviewer-administered questionnaires.Generalized linear mixed models (GLMMs), with facility-level random intercepts, assessed predictors of at least one self-reported malaria episode using logistic regression and episode frequency using Poisson regression.Overall, 57.9% of participants reported at least one malaria episode during the current pregnancy (mean: 0.95 ± 1.06).In the logistic GLMM, lack of awareness of safe antimalarial drugs (AOR = 2.09; 95% CI: 1.20-3.65)and primigravidity (AOR = 2.13; 95% CI: 1.41-3.21)were associated with higher odds of experiencing an episode.Regular ITN use was also associated with higher odds (AOR = 1.90), although this counterintuitive association may reflect confounding rather than a true effect.In the Poisson GLMM, gravidity was associated with malaria episode frequency, with primigravidae having lower incidence (IRR = 0.61; 95% CI: 0.50-0.75),while non-use of ITNs (IRR = 1.51; 95% CI: 1.19-1.92)and low confidence in prevention adherence (IRR = 1.66; 95% CI: 1.04-2.64)were associated with higher frequency.Findings indicate associations between malaria burden, reproductive factors, knowledge, and preventive practices.Strengthening antenatal education and access to prevention services is warranted.Outcomes were self-reported and not parasitologically confirmed; findings do not establish causality.