Prevalence and factors associated with malaria status among pregnant women attending Luwero regional referral hospital in central Uganda: a facility-based mixed-methods cross-sectional study

In the humid landscapes of sub-Saharan Africa, malaria remains a relentless force, a mosquito-borne illness that strikes hardest at the most vulnerable. For pregnant women, the stakes are uniquely high; the infection does not just threaten the mother's health but can silently harm the developing baby, leading to low birth weight or premature delivery. To protect against this, health systems rely on a two-pronged approach: preventing mosquitoes from breeding in stagnant water near homes, and ensuring pregnant women receive specific doses of preventive medicine during their regular check-ups. Yet, despite these known strategies, the disease continues to surge in many regions, leaving health officials with a difficult question: why are these protections failing for so many women, and what specific factors are driving the infection in their communities?

To find answers, researchers traveled to Luwero District in central Uganda, a region with a mix of urban and rural life where malaria transmission is steady year-round. They focused their attention on the antenatal care clinic at the regional referral hospital, a place where pregnant women gather for routine check-ups. Over the course of a few months, the team invited 300 pregnant women to participate in a study that combined hard numbers with personal stories. They did not just ask the women about their health; they tested them for malaria on the spot using a rapid diagnostic test, a simple finger-prick method that reveals the presence of the parasite. Simultaneously, the researchers interviewed ten healthcare workers, including nurses and clinic managers, to understand the challenges these women face from the perspective of those who treat them. The goal was to weave together the clinical facts with the lived reality of the patients to see what truly drives the infection in this specific setting.

The results painted a stark picture. More than one-third of the women tested positive for malaria during their visit, a prevalence rate that sits at the upper end of what is seen in similar facilities across the country. When the researchers looked closely at the data, two factors stood out as powerful, independent drivers of the disease. The first was the environment surrounding the home. Women who reported having stagnant water near their houses were significantly more likely to be infected than those who did not. This finding held true regardless of other variables, suggesting that standing water acts as a primary breeding ground for the mosquitoes carrying the disease in this area. The second major factor was the consistency of medical care. Women who had received fewer doses of the preventive medicine, known as intermittent preventive treatment, were far more likely to have malaria than those who had completed the full recommended course of four or more doses. The risk increased sharply as the number of missed doses went up, highlighting a clear gap between the availability of medicine and its actual completion by patients.

The study also uncovered a surprising and somewhat counterintuitive detail regarding housing. Contrary to the expectation that sturdier, permanent homes would offer better protection, the data showed that women living in permanent structures had higher odds of infection than those in temporary or semi-permanent housing. The researchers noted that this finding was specific to their statistical model and did not hold up in every variation of their analysis, so they treated it as a provisional observation rather than a final rule. They suggested that permanent housing in this specific area might cluster in neighborhoods with poorer drainage or different settlement patterns that inadvertently create more breeding sites, or that residents of these homes might feel less need to use protective nets. However, the most consistent story came from the interviews with healthcare workers, who confirmed that environmental factors like poor drainage and the rainy season were indeed major contributors, and that while the preventive medicine works well, getting women to take every single dose on time remains a persistent hurdle.

When the researchers compared the numbers with the stories from the clinic staff, the picture became even clearer. The quantitative data confirmed that stagnant water and incomplete medication courses were the strongest predictors of infection. The qualitative interviews added depth, revealing that even when women owned mosquito nets, they did not always use them consistently, and that logistical barriers often delayed their access to the full course of preventive treatment. The healthcare workers spoke of the challenges of reaching facilities, the impact of poverty on housing conditions, and the difficulty of ensuring every woman completes her treatment schedule. While the study could not prove that the distance to the hospital or the availability of drugs at the clinic were the direct causes of infection in the same way stagnant water was, the workers' accounts of transport difficulties and supply issues provided a crucial context for why the numbers looked the way they did.

Ultimately, this investigation points to a clear path forward for reducing malaria in this region. The evidence suggests that simply handing out medicine or nets is not enough; the solution requires a deeper engagement with the environment and the patient journey. Tackling the stagnant water near homes appears to be the most robust step, alongside a renewed effort to ensure that every pregnant woman receives and completes her full course of preventive treatment. The study does not claim to have solved the problem, but it has identified the specific levers that need to be pulled. By focusing on environmental management and the consistent delivery of care, health programs can move closer to the goal of protecting mothers and their unborn children from a disease that remains a significant burden in central Uganda.