Maternal and household risk factors for malaria in pregnancy and low birthweight: a prospective cohort study from Uganda

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Nankabirwa, and 17 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7514414/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 30 Dec, 2025 Read the published version in Malaria Journal → Version 1 posted 7 You are reading this latest preprint version Abstract Background Malaria is a leading cause of illness and death in pregnant women and newborns. In 2023, an estimated 12.4 million pregnant women were infected with malaria parasites, resulting in 351,000 low birth weight deliveries. Maternal and household factors associated with malaria in pregnancy and low birth weight were investigated in a high-transmission area of Uganda. Methods. Data come from a randomized controlled trial of intermittent preventive treatment in pregnancy (IPTp) conducted from December 2020 to July 2024 in Busia District. Maternal and household data were collected using structured questionnaires. Women were followed through delivery including monthly assessment of microscopic parasitemia, assessment of placental malaria by histopathology, and birth weight. Associations between maternal and household factors were assessed: 1) parasitaemia at enrolment, 2) parasitaemia during pregnancy after starting IPTp, 3) high-grade placental malaria, and 4) low birth weight (< 2500gm). Results. Of 2,757 women enrolled, 2,728 (98.9%) had a household survey completed and were included in study. Overall, 38.1% had parasitemia at enrolment, 6.5% had parasitemia following initiation of IPTp, 6.4% had high-grade placental malaria, and 6.8% of live births had low birth weight. Parasitemia at enrolment was more common in those 16–21 years of age (RR = 1.62, 95% CI 1.31–1.99 p < 0.001), primigravida (RR = 1.86, 95% CI 1.57–2.21, p < 0.001)), and living in traditional houses (RR-1.17 95% CI 1.06–1.30, p = 0.002). These associations persisted after IPTp initiation: younger age (RR = 1.72, 95% CI 1.22–2.43, p < 0.002), primigravida (RR = 2.40, 95% CI 1.81–3.20, p < 0.001), and traditional housing (RR = 1.30 95% CI 1.01–1.60, p = 0.02). Maternal level of education was not associated with malaria parasitaemia both at enrollment and after initiation of IPTp. Primigravida was strongly associated with high-grade placental malaria (RR = 4.20, 95% CI 2.33–7.59, p < 0.001)) and low birth weight (RR = 2.14, 95% CI 1.18–3.89, p = 0.01). However, there were no significant associations between maternal age, level of education, household wealth, and household construction with high-grade placental malaria or low birthweight. Conclusions. In an area of high malaria transmission, young primigravida women and those living in traditionally constructed houses had the greatest risk of malaria parasitemia during pregnancy. Primigravida women also had higher risks of low birth weight and high grade placental malaria. Malaria in pregnancy risk factors malaria parasitaemia high grade placental malaria low birth weight Figures Figure 1 BACKGROUND Malaria remains a leading cause of morbidity and mortality among pregnant women and their newborns in sub-Saharan Africa. Malaria in pregnancy is associated with maternal anemia and adverse birth outcomes including fetal loss, preterm delivery, low birth weight and neonatal death [ 1 ]. In 2023, an estimated 12.4 million pregnant women in sub-Saharan Africa were infected with malaria parasites, resulting in 351,000 newborns with low birth weight [ 2 ]. Low birth weight is associated with neonatal and early childhood mortality [ 3 , 4 ]. To reduce the risk of malaria in pregnancy, the World Health Organization recommends the use of long-lasting insecticidal bed nets (LLINs) and intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) starting in the second trimester and given at every antenatal visit at least a month apart. However, the effectiveness of IPTp-SP is threatened by wide-spread antifolate resistance in East and Southern Africa [ 5 ]. Trials evaluating alternative IPTp regimens have shown dihydroartemisinin-piperaquine (DP) to be a promising alternative [ 6 , 7 ]. In a recent trial of 2,757 pregnant women in Uganda, monthly IPTp with DP was associated with a 94% reduction in clinical malaria and a 97% reduction in the risk microscopic parasitemia during pregnancy compared to IPTp with SP, but IPTp with DP was not associated with reduced risk of adverse birth outcomes, including low birth weight [ 7 ]. These findings highlight the need for additional interventions for the prevention of malaria in pregnancy. To help design new interventions for the prevention of malaria in pregnancy beyond IPTp-SP, it is important to assess risk factors for malaria in pregnancy and low birth weight. These risk factors are multifaceted and often intertwined with household dynamics and maternal health [ 8 ]. Studies have shown a range of socio-economic, environmental, and behavioral determinants that influence malaria exposure and its health impacts [ 8 , 9 ]. Few studies have been conducted to identify risk factors of malaria in pregnancy and low birth weight in Uganda. A study conducted in Eastern Uganda exploring household and maternal risk factors of microscopic and sub-microscopic parasitemia during pregnancy and placental malaria at delivery found that lower gravidity, IPTp with SP compared to DP, poverty, and poor house construction were associated with an increased risk of malaria in pregnancy [ 8 ]. However, this prior study did not examine risk factors for low birth weight. In the current study, household and maternal risk factors for measures of malaria in pregnancy and low birth weight were assessed in the same area of Eastern Uganda where the prior study was conducted and malaria is highly endemic. Data for the current study come from 2,757 pregnant women enrolled in a randomized controlled trial of IPTp with monthly SP versus DP versus monthly DP + SP followed through delivery [ 7 ]and includes a household survey conducted shortly after enrollment. METHODS Study setting and participants This study utilized data from a randomized controlled trial of monthly IPTp with SP vs. DP vs. DP+SP (ClinicalTrials.gov number: NCT04336189) [7]. The trial was conducted between December 2020 and July 2024 in Busia District, south-eastern Uganda. Busia is a high malaria endemic district with perennial transmission that is marked by two annual peaks following the rainy seasons. Prior to 2013, vector control in Busia was limited to targeted distribution of LLINs through antenatal care services. Universal distribution campaigns of free LLINs were conducted in Busia District in May 2013, May 2017, December 2020, and October 2023. The first two campaigns utilized standard pyrethroid LLINs and the last two LLINs containing deltamethrin plus piperonyl butoxide (PermaNet 3.0). Indoor residual spraying has never been implemented in Busia District. Participants were eligible for enrolment in the parent study if they were HIV-uninfected, at least 16 years of age with a viable singleton pregnancy between 12 and 20 weeks of gestation, resided in Busia district, agreed to come for all their medical care at a dedicated study clinic, and provided written informed consent. Study procedures At enrolment, women underwent a standardized medical history/physical examination and had a blood smear done for detection of malaria parasites by microscopy. Women were randomized to one of the IPTp arms and study drugs were given every 4 weeks starting at 16 or 20 weeks gestational age through delivery or 40 weeks gestational age. Following enrolment, women were visited at home where a household survey was conducted to collect detailed information about the participant’s household using a structured questionnaire. Women received all their medical care at a dedicated study clinic open every day. Women were provided with an LLIN following the household survey. Routine assessments were conducted every 4 weeks at the study clinic which included a standardized medical history, physical exam, administration of study drugs, and blood collection for detection of malaria parasites by microscopy. Women were encouraged to deliver at Masafu General Hospital adjacent to the study clinic. Women who delivered at home were visited and encouraged to come to the study clinic shortly after delivery. At delivery, a standardized assessment was made including measuring birth weight and collection of placental tissue for the detection of placental malaria by histopathology. Laboratory procedures: Blood samples for thick blood smears were collected at enrolment and at each routine visit until delivery. Blood smears were stained with 2% Giemsa and read by trained microscopists. A blood smear was considered negative if no asexual parasites were detected after examining 100 high power fields. For quality control, all slides were read by a second microscopist and a third reviewer settled any discrepant readings. Placental tissue collected at delivery was assessed for histological evidence of placental malaria including detection of parasites (active infection) and the proportion of high powered fields with malaria pigment detected (past infection) as previously described [7]. Data management and analysis Data were collected at the study clinic and at delivery using standardized case record forms entered into Microsoft Access. Household survey data was collected using handheld computers and customized software designed and programmed to include consistency and range checks. Data were analyzed using Stata version 18.0 (StataCorp, College Station, Tx, USA). The following characteristics were examined as risk factors of malaria in pregnancy and LBW: maternal age, gravidity, bednet ownership at enrolment, maternal education, household wealth, house construction, year of observation, and assigned IPTp regimen. Principal component analysis was used to generate a wealth index based on ownership of common household items which was categorized into tertiles. Houses were categorized based on construction materials as modern (having plaster or cement walls, metal or wooden roofs, and/or closed eaves) or traditional (mud and wattle walls, dirt floors, and/or open eaves). Outcomes of interest included: presence of asexual parasites detected by microscopy at enrolment and during monthly visits after initiation of study drugs; high-grade placental malaria defined as the detection of parasites or malaria pigment in > 30% of high powered fields (HPF) by histopathology which has been associated with adverse birth outcomes [10]; and low birth weight (birth weight <2500g) among live births. Associations between risk factors and dichotomous outcomes were made using bivariate and multivariate log-binomial regression models to obtain risk ratios (RRs). Associations between exposure variables of interest and dichotomous outcomes with repeated measures (microscopic parasitemia following initiation of study drugs) were performed using generalized estimating equations with a log-binomial model and robust standard errors. In all analyses, a p-value <0.05 was considered statistically significant. Ethical approval This study was approved by the Makerere University School of Biomedical Sciences Research Ethics Committee (SBS 714), the Uganda National Council for Science and Technology (HS 2746), the Uganda National Drug Authority (CTC 0135/2020), and the University of California, San Francisco Human Research Protection Program (19-29105). RESULTS Characteristics of participants and their households. Enrolment of participants occurred from December 28, 2020 through December 18, 2023. Among 2757 pregnant women enrolled in the parent clinical trial, 2728 (98.9%) had a household survey completed; 25 refused the household survey and 4 were withdrawn before the household survey could be completed (Figure 1). Of the 2728 participants who had a household survey completed, the median age was 23 years (range 16-44), 51.8% were multigravida, 53.9% reported owning a bed net at the time of enrolment, 68.9% had only primary school or no formal education, and 67.0% lived in a house with traditional construction (Table 1). There were no significant differences in characteristics of study participants across the IPTp arms (Table 1). Of the 2728 participants who had household survey completed, 2647 (97.0%) had at least one blood smear after initiation of study drugs, 2524 (92.5%) were followed up to delivery, and 2313 (85.1%) had a live birth with assessment for placental malaria by histopathology (Figure 1). Factors associated with microscopic parasitemia at enrolment. At enrolment, 38.1% of participants had malaria parasites detected by microscopy. Risk factors for parasitemia at enrolment are presented in Table 2. In multivariate analysis, younger age was associated with an increased risk of parasitemia, with women 16-21 years of age having a 62% greater risk of parasitemia compared to women 28-44 years of age (RR= 1.62, 95% CI 1.31-1.99, p<0.001). Similarly, lower gravidity was associated with a higher risk of parasitemia, with primigravida women having an 86% greater risk of parasitemia compared to multigravida women (RR=1.86, 95% CI 1.57-2.21, p<0.001). There were no significant associations between household wealth, bednet ownership at enrolment, and level of education with parasitemia in multivariate analysis. Women who lived in traditional houses had a 17% greater risk of parasitemia compared to those who lived in modern houses (RR=1.17, 95% CI 1.06-1.30, p=0.002). The risk of parasitemia at enrolment increased over the course of the study, with women enrolled in 2023 having a 29% greater risk of parasitemia compared to women enrolled in 2021 (RR=1.29, 95% CI 1.15-1.45, p<0.001). Factors associated with microscopic parasitemia following initiation of study drugs. Following initiation of study drugs, 6.5% of participants had malaria parasites detected by microscopy at the time of routine visits conducted every 4 weeks over the course of the study. Risk factors for parasitemia at the time of routine visits following the initiation of study drugs are presented in Table 3. Similar to parasitemia at enrolment, lower gravidity and younger age were independently associated with an increased risk of parasitemia after initiation of study drugs in multivariate analysis. Women 16-21 years of age had a 72% higher risk of parasitemia compared to women 28-44 years of age (RR=1.72, 95% CI 1.22-2.43, p=0.002). Primigravida women had more than twice the risk of microscopic parasitemia compared to multigravida women (RR=2.40, 95% CI 1.81-3.20, p<0.001). Women living in the poorest households had a 30% higher risk of parasitemia compared to women living in the least poor households (RR=1.30, 95% CI 1.05-1.60, p=0.02). Women who lived in traditional houses had a 28% greater risk of parasitemia compared to those who lived in modern houses (RR=1.28, 95% CI 1.05-1.55, p=0.01). Level of education was not significantly associated with the risk of parasitemia after the initiation of study drugs. The risk of parasitemia during routine assessments increased from 2021 to 2023, then decreased in 2024 after enrolment had been completed. As previously described, women randomized to IPTp regimens containing DP had a much lower risk of parasitemia following the initiation of study drugs, with the DP arm associated with a 97% reduction (RR=0.03, 95% CI 0.02-0.05, p<0.001) and the DP+SP arm associated with a 93% reduction (RR=0.07, 95% CI 0.05-0.10, p<0.001) compared to the SP arm[7]. Factors associated with high grade placental malaria There were 2313 women who were assessed for placental malaria by histopathology, of which 1147 (49.6%) had no evidence of placental malaria (no parasites or malaria pigment detected), 1019 (46.6%) had evidence of mild-moderate placental malaria (malaria pigment detected in 30% of HPF). Risk factors for high-grade placental malaria are presented in Table 4. In multivariate analysis, lower gravidity was associated with an increased risk of high-grade placental malaria, with primigravida women having over 4 times greater risk of compared to multigravida women (RR=4.20, 95% CI 2.33-7.59, p<0.001). There were no significant associations between age, household wealth, level of education, or house construction with high-grade placental malaria in multivariate analysis. The risk of high-grade placental malaria increased over the course of the study with women delivering in 2024 having over 4 times the risk of high-grade placental malaria compared to women who delivered in 2021 (RR=4.62, 95% CI 2.22-9.65, p<0.001). As previously described, women randomized to IPTp regimens containing DP had a much lower risk of high-grade placental malaria, with the DP arm associated with an 88% reduction (RR=0.12, 95% CI 0.07-0.20, p<0.001) and the DP+SP arm associated with an 86% reduction (RR=0.14, 95% CI 0.09-0.23, p<0.001) compared to the SP arm[7]. Factors are associated with low birth weight Among 2313 live births with placental histopathology assessed, 157 (6.8%) had low birth weight (< 2500 grams). Risk factors for low birth weight are presented in Table 5. In a multivariate analysis, lower gravidity was associated with a higher risk of low birth weight, with primigravida women having over twice the risk of low birth weight compared to multigravida women (RR= 2.14, 95% CI 1.18-3.89, p=0.01). The risk of low birth weight decreased in each subsequent year during the first 3 years of the study (but not the last year), with women who delivered in 2023 having 41% lower risk compared to women who delivered in 2021 (RR=0.59, 95% CI 0.37-0.95, p=0.03). Women with high-grade placental malaria had over 3 times the risk of delivering a low birth weight infant compared to women with no evidence of placental malaria (RR=3.02, 95% CI 1.77-5.16, p<0.001). Interestingly, as previously described, women randomized to IPTp regimens containing DP had a higher risk of delivering a low birth weight infant, with the DP arm associated with a 64% increase (RR=1.64, 95% CI 1 .08-2.50, p=0.01) and the DP+SP arm associated with an 85% increase (RR=1.85, 95% CI 1.24-2.77, p=0.003) compared to the SP arm [7]. Maternal age, household wealth, level of education, or house construction were not significantly associated low birth weight risk in multivariate analysis. DISCUSSION This study utilized data from a large randomized controlled trial of IPTp conducted in a rural, high transmission setting in Uganda to evaluate the risk factors of parasitemia, high-grade placental malaria, and low birth weight. Gravidity was the strongest and most consistent risk factor for malaria and LBW: primigravida women had approximately a two-fold higher risk of parasitemia before and after IPTp initiation, over 4 times the risk of placental malaria, and more than twice the risk of delivering a low-birth-weight infant compared to multigravida women. Independent of gravidity, younger maternal age was associated with a higher risk of parasitemia before and after initiation of IPTp, but not a significant increase in the risk of placental malaria or low birth weight. Living in a traditional house compared to a modern house was associated with a higher risk of parasitemia before and after initiation of IPTp but not placental malaria or low birth weight. Living in the poorest houses was only significantly associated with parasitemia following initiation of IPTp. Gravidity was the strongest risk factor for malaria and low birth weight, with primigravida women at a significantly higher risk than multigravidas, while younger age and living in a traditionally constructed house were also associated with increased risk of parasitemia. In high transmission settings, lower gravidity has consistently been identified as a key risk factor for malaria in pregnancy [11-13]. This study reaffirmed the phenomenon of “gravidity dependent immunity”, with primigravida women at highest risk of infection with malaria parasites both before and after receiving IPTp [14]. Although maternal age and gravidity are highly correlated, younger age has also been associated with an increased risk of infection with malaria parasites independent of gravidity [15], as observed in this study. Indeed, in this study the risk of parasitemia at enrollment was 65.1% among primigravida women 21 years or younger compared to 20.5% among multigravida women 28 years or older. These findings highlight the importance of targeting young, primigravida women for malaria prevention measures at the time of their first antenatal visit. Lower gravidity was also a strong risk factor for high-grade placental malaria, with primigravid women having a four-fold increased risk compared to multigravida women. Although in bivariate analyses, younger women had a 5-fold higher risk of high-grade placental malaria, this association was attenuated and not statistically significant in multivariable analyses, suggesting that much of this effect was potentially mediated by other risk factors. Notably, the presence of high-grade placental malaria was strongly associated with low birth weight, consistent with previous findings [14, 16]. A distinctive aspect of this study was the assessment of risk factors associated with delivering low birth weight infants; primigravidae had over twice the risk of low birth weight compared to multigravidae, consistent with previous studies [17-20]. In contrast, maternal age was not significantly associated with low birth weight independent of gravidity. Prior studies have reported mixed findings, with some studies reporting maternal age under 25 years [17-20] and over 35 years [21] associated with an increased risk of low birth weight, while others found no significant association between maternal age and low birth weight [21]. Considering household and other maternal demographic factors, living in a house constructed of traditional materials versus a modern house was associated with an increased risk of malaria parasitemia. Indeed, poor quality housing is a well-documented risk factor for infection with malaria parasites and has become a target for new malaria control interventions aimed at improving housing quality [22]. In contrast, house construction was not independently associated with high-grade placental malaria or low birth weight. With the exception of women from the poorest households being associated with an increased risk of parasitemia following initiation of study drugs, household wealth and maternal education were not significant, independent risk factors for any of the outcomes in this study. In contrast, evidence from previous studies has shown associations between improved socio-economic status and higher levels of education with better implementation of appropriate malaria control interventions and a lower burden of malaria in non-pregnant populations [23, 24]. Strengths of this study include a large sample size nested within a randomized controlled trial conducted over several years. However, this study also had several limitations. Firstly, given the observational nature of the risk factor analysis, estimated associations may have been biased due to unmeasured confounders. Secondly, our study was conducted in an area of high malaria transmission intensity and widespread SP resistance; findings may not be generalizable to regions where SP resistance is not widespread or where malaria transmission is low to moderate. Third, as this was a secondary analysis of data from a randomized controlled trial, it was not possible to evaluate the full spectrum of risk factors for malaria in pregnancy, high grade placental malaria, and low birth weight. Finally, with the exception of IPTp regimens (which were randomly assigned), associations between risk factors and outcomes are not evidence of causality. For example, malaria may contribute to poverty, limit educational attainment, and influence the choice of housing materials through its direct and indirect socioeconomic impacts. CONCLUSION In this study from a high transmission area of Uganda, primigravida women were at highest risk of measures of malaria in pregnancy and the delivery of low birth weight infants. Younger maternal age, poor house construction, and lower socioeconomic status were also associated with an increased risk of parasitemia during pregnancy. The risks of malaria in pregnancy and low birth weight varied from year to year, following different patterns, suggesting the presence of temporally varying unmeasured risk factors. Therefore, we suggest that interventions which target young and primigravida mothers and involve improvement of housing types should be introduced in order to reduce the burden on malaria in pregnancy. Abbreviations Abbreviations DP Dihydroartemisinin-piperaquine SP Sulfadoxine–pyrimethamine IPTp Intermittent preventive treatment for malaria during pregnancy LLIN Long Lasting Insecticidal Net MOH Ministry of Health qPCR Quantitative polymerase chain reaction HPF High Powered Fields UCSF University of California San Francisco WHO World Health Organization IDRC Infectious Diseases Research Collaboration Declarations Ethics approval and consent to participate: The study was approved by the Makerere University School of Biomedical Sciences Research Ethics Committee (SBS 714), the Uganda National Council for Science and Technology (HS 2746), the Uganda National Drug Authority (CTC 0135/2020), and the University of California San Francisco Human Research Protection Program (19-29105). Written informed consent was obtained from all participating households before participating in the study. Consent for publication: Not applicable. Availability of data and materials The datasets reported herein will be made available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding National Institute of Allergy and Infectious Diseases, National Institutes of Health (U01AI141308). Authors' contributions Conceptualization: AM, AK, GD; Funding acquisition: MRK, GD; Methodology: AK, JN, MRK, GD; Investigation: AM, JK, PO, AK, JO, HO, BO, AJ, MRK, GD; Data curation: GD; Data analysis: GD; Writing the first draft: AM, AK, GD; Writing – review & editing final manuscript: AM, JK, PO, AK, JN, MR,PR,NO,MN,JO, HO, BO, AJ, MRK, GD. Acknowledgements We would like to thank study participants for willingly accepting to give their consent and to participate in the study, study team at Masafu Hospital and Tororo Hospital and the administration of the Infectious Diseases Research Collaboration, UCSF for all their contributions. 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Characteristics of study participants at enrollment stratified by IPTp am Variable Categories IPTp am All (n=2728) SP (n=908) DP (n=909 DP+SP (n=911) Age in years 28-44 846 (31.0%) 288 (31.7%) 286 (31.5%) 272 (29.9%) 22-27 838 (30.7%) 279 (30.7%) 287 (31.6%) 272 (29.9%) 16-21 1044 (38.3%) 341 (37.6%) 336 (37.0%) 367 (40.3%) Gravidity Multigravida 1414 (51.8%) 480 (52.9%) 477 (52.5%) 457 (50.2%) Secundigravida 598 (21.9%) 201 (22.1%) 202 (22.2%) 195 (21.4%) Primigravida 716 (26.3%) 227 (25.0%) 230 (25.3%) 259 (28.4%) Wealth index Least poor 906 (33.2%) 290 (31.9%) 301 (33.1%) 315 (34.6%) Middle 912 (33.4%) 307 (33.8%) 305 (33.6%) 300 (32.9%) Poorest 910 (33.4%) 311 (34.3%) 303 (33.3%) 296 (32.5%) Bednet ownership Yes 1470 (53.9%) 491 (54.1%) 480 (52.8%) 499 (54.8%) No 1258 (46.1%) 417 (45.9%) 429 (47.2%) 412 (45.2%) Highest level of education Secondary or higher 848 (31.1%) 279 (30.7%) 290 (31.9%) 279 (30.6%) Primary or none 1880 (68.9%) 629 (69.3%) 619 (68.1%) 632 (69.4%) Type of house construction Modern 901 (33.0%) 309 (34.0%) 286 (31.5%) 306 (33.6%) Traditional 1827 (67.0%) 599 (66.0%) 623 (68.5%) 605 (66.4%) Year of enrollment 2021* 731 (26.8%) 243 (26.8%) 244 (26.8%) 244 (26.8%) 2022 984 (36.1%) 328 (36.1%) 326 (35.9%) 330 (36.2%) 2023 1013 (37.1%) 337 (37.1%) 339 (37.3%) 337 (37.0%) * includes 19 participants enrolled December 28-31, 2020 Table 2. Factors associated with microscopic parasitemia at enrollment Variable Categories Parasitemia, n/N (%) Univariate analysis Multivariate analysis RR (95% CI) p-value RR (95% CI) p-value Age in years 28-44 176/846 (20.8%) Reference Reference 22-27 275/838 (32.8%) 1.58 (1.34-1.86) <0.001 1.36 (1.14-1.62) 0.001 16-21 588/1044 (56.3%) 2.71 (2.35-3.12) <0.001 1.62 (1.31-1.99) <0.001 Gravidity Multigravida 346/1414 (24.5%) Reference Reference Secundigravida 239/598 (40.0%) 1.63 (1.43-1.87) <0.001 1.26 (1.07-1.49) 0.006 Primigravida 454/716 (63.4%) 2.59 (2.33-2.88) <0.001 1.86 (1.57-2.21) <0.001 Wealth index Least poor 302/906 (33.3%) Reference Reference Middle 339/912 (37.2%) 1.12 (0.98-1.26) 0.09 1.06 (0.95-1.19) 0.29 Poorest 398/910 (43.7%) 1.31 (1.17-1.48) <0.001 1.08 (0.96-1.20) 0.19 Bednet ownership Yes 486/1470 (33.1%) Reference Reference No 553/1258 (44.0%) 1.33 (1.21-1.46) <0.001 1.07 (0.98-1.17) 0.13 Highest level of education Secondary or higher 303/848 (35.7%) Reference Reference Primary or none 736/1880 (39.2%) 1.10 (0.99-1.22) 0.09 1.10 (1.00-1.21) 0.06 Type of house construction Modern 283/901 (31.4%) Reference Reference Traditional 756/1827 (41.4%) 1.32 (1.18-1.47) <0.001 1.17 (1.06-1.30) 0.002 Year of enrollment 2021* 228/731 (31.2%) Reference Reference 2022 374/984 (38.0%) 1.22 (1.07-1.39) 0.004 1.23 (1.09-1.38) 0.001 2023 437/1013 (43.1%) 1.38 (1.22-1.57) <0.001 1.29 (1.15-1.45) <0.001 * includes 19 participants enrolled December 28-31, 2020 Table 3. Factors associated with microscopic parasitemia following initiation of study drugs Variable Categories Parasitemia, n/N (%) Univariate analysis Multivariate analysis RR (95% CI) p-value RR (95% CI) p-value Age in years 28-44 133/4230 (3.1%) Reference Reference 22-27 209/4006 (5.2%) 1.66 (1.24-2.29) 0.001 1.38 (1.04-1.83) 0.03 16-21 504/4753 (10.6%) 3.45 (2.66-4.48) <0.001 1.72 (1.22-2.43) 0.002 Gravidity Multigravida 260/6984 (3.7%) Reference Reference Secundigravida 201/2798 (7.2%) 1.89 (1.47-2.44) <0.001 1.44 (1.08-1.91) 0.01 Primigravida 385/3207 (12.0%) 3.29 (2.64-4.10) <0.001 2.40 (1.81-3.20) <0.001 Wealth index Least poor 203/4328 (4.7%) Reference Reference Middle 276/4422 (6.2%) 1.32 (1.01-1.72) 0.04 1.14 (0.91-1.43) 0.24 Poorest 367/4239 (8.7%) 1.84 (1.44-2.36) <0.001 1.30 (1.05-1.60) 0.02 Highest level of education Secondary or higher 213/4022 (5.3%) Reference Reference Primary or none 633/8967 (7.1%) 1.34 (1.07-1.67) 0.01 1.16 (0.96-1.40) 0.14 Type of house construction Modern 214/4275 (5.0%) Reference Reference Traditional 632/8714 (7.3%) 1.45 (1.15-1.83) 0.002 1.28 (1.05-1.55) 0.01 Year of assessment 2021 101/2258 (4.5%) Reference Reference 2022 326/4807 (6.8%) 1.35 (1.01-1.82) 0.05 1.47 (1.13-1.92) 0.004 2023 355/4671 (7.6%) 1.44 (1.07-1.94) 0.02 1.64 (1.26-2.13) <0.001 2024 64/1253 (5.1%) 1.00 (0.66-1.50) 0.99 1.17 (0.80-1.70) 0.42 IPTp arm SP 764/4324 (17.7%) Reference Reference DP 23/4326 (0.5%) 0.03 (0.02-0.05) <0.001 0.03 (0.02-0.05) <0.001 DP+SP 59/4339 (1.4%) 0.08 (0.06-0.10) <0.001 0.07 (0.05-0.10) <0.001 Table 4. Factors associated with high-grade placental malaria Variable Categories Placental malaria, n/N (%) Univariate analysis Multivariate analysis RR (95% CI) p-value RR (95% CI) p-value Age in years 28-44 17/751 (2.3%) Reference Reference 22-27 28/710 (3.9%) 1.74 (0.96-3.15) 0.07 1.23 (0.65-2.34) 0.53 16-21 102/852 (12.0%) 5.29 (3.20-8.75) <0.001 1.83 (0.89-3.75) 0.10 Gravidity Multigravida 31/1238 (2.5%) Reference Reference Secundigravida 29/498 (5.8%) 2.33 (1.42-3.82) 0.001 1.73 (0.95-3.15) 0.08 Primigravida 87/577 (15.1%) 6.02 (4.04-8.96) <0.001 4.20 (2.33-7.59) <0.001 Wealth index Least poor 40/770 (5.2%) Reference Reference Middle 47/790 (6.0%) 1.15 (0.76-1.73) 0.52 0.86 (0.60-1.22) 0.40 Poorest 60/753 (8.0%) 1.53 (1.04-2.26) 0.03 0.97 (0.69-1.36) 0.86 Highest level of education Secondary or higher 33/711 (4.6%) Reference Reference Primary or none 114/1602 (7.1%) 1.53 (1.05-2.24) 0.03 1.36 (0.97-1.91) 0.08 Type of house construction Modern 39/757 (5.2%) Reference Reference Traditional 108/1556 (6.9%) 1.35 (0.94-1.92) 0.10 1.13 (0.83-1.53) 0.43 Year of delivery 2021 7/309 (2.3%) Reference Reference 2022 35/748 (4.7%) 2.07 (0.93-4.60) 0.08 2.00 (0.93-4.29) 0.08 2023 63/841 (7.5%) 3.31 (1.53-7.14) 0.002 3.34 (1.61-6.94) 0.001 2024 42/415 (10.1%) 4.47 (2.03-9.81) <0.001 4.62 (2.22-9.65) <0.001 IPTp arm SP 116/762 (15.2%) Reference Reference DP 14/776 (1.8%) 0.12 (0.07-0.20) <0.001 0.12 (0.07-0.20) <0.001 DP+SP 17/775 (2.2%) 0.14 (0.09-0.24) <0.001 0.14 (0.09-0.23) <0.001 Table 5. Factors associated with low birth weight Variable Categories Low birth weight n/N (%) Univariate analysis Multivariate analysis RR (95% CI) p-value RR (95% CI) p-value Age in years 28-44 41/751 (5.5%) Reference Reference 22-27 38/710 (5.4%) 0.98 (0.64-1.51) 0.93 0.81 (0.50-1.31) 0.39 16-21 78/852 (9.2%) 1.68 (1.16-2.42) 0.006 0.77 (0.41-1.44) 0.42 Gravidity Multigravida 62/1238 (5.0%) Reference Reference Secundigravida 32/498 (6.4%) 1.28 (0.85-1.94) 0.24 1.45 (0.84-2.49) 0.18 Primigravida 63/577 (10.9%) 2.18 (1.56-3.05) <0.001 2.14 (1.18-3.89) 0.01 Wealth index Least poor 53/770 (6.9%) Reference Reference Middle 49/790 (6.2%) 0.90 (0.62-1.31) 0.59 0.88 (0.60-1.28) 0.50 Poorest 55/753 (7.3%) 1.06 (0.74-1.53) 0.75 0.93 (0.64-1.37) 0.73 Highest level of education Secondary or higher 39/711 (5.5%) Reference Reference Primary or none 118/1602 (7.4%) 1.34 (0.95-1.91) 0.10 1.41 (0.98-2.02) 0.06 Type of house construction Modern 50/757 (6.6%) Reference Reference Traditional 107/1556 (6.9%) 1.04 (0.75-1.44) 0.81 1.00 (0.71-1.41) 0.99 Year of delivery 2021 26/309 (8.4%) Reference Reference 2022 56/748 (7.5%) 0.89 (0.57-1.39) 0.61 0.83 (0.53-1.29) 0.41 2023 47/841 (5.6%) 0.66 (0.42-1.05) 0.08 0.59 (0.37-0.95) 0.03 2024 28/415 (6.8%) 0.80 (0.48-1.34) 0.40 0.68 (0.40-1.14) 0.14 Placental malaria categories No parasites or pigment 66/1147 (5.8%) Reference Reference No parasites, pigment 30% HPF 24/147 (16.3%) 2.84 (1.84-4.38) <0.001 3.02 (1.77-5.16) <0.001 IPTp arm SP 41/762 (5.4%) Reference Reference DP 53/776 (6.8%) 1.27 (0.85-1.88) 0.24 1.64 (1.08-2.50) 0.02 DP+SP 63/775 (8.1%) 1.51 (1.03-2.21) 0.03 1.85 (1.24-2.77) 0.003 Additional Declarations No competing interests reported. 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Kamya","email":"","orcid":"","institution":"Infectious Diseases Research Collaboration","correspondingAuthor":false,"prefix":"","firstName":"Moses","middleName":"R.","lastName":"Kamya","suffix":""},{"id":514115317,"identity":"7480128e-df30-4d91-97a5-ebb44acc5716","order_by":21,"name":"Grant Dorsey","email":"","orcid":"","institution":"University of California","correspondingAuthor":false,"prefix":"","firstName":"Grant","middleName":"","lastName":"Dorsey","suffix":""}],"badges":[],"createdAt":"2025-09-02 07:08:43","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7514414/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7514414/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12936-025-05746-3","type":"published","date":"2025-12-30T15:57:55+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":91565893,"identity":"a8d622fb-f86e-4be2-8a49-840d41541ced","added_by":"auto","created_at":"2025-09-17 19:31:04","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":357981,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version.\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7514414/v1/2ea8cfe08962eae6ef676931.jpg"},{"id":99545290,"identity":"f7260b5b-beff-4588-ae3f-d3048918af20","added_by":"auto","created_at":"2026-01-05 16:05:29","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1863175,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7514414/v1/b6d48c9c-e68e-4f55-9a48-bffd6d9ce86f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Maternal and household risk factors for malaria in pregnancy and low birthweight: a prospective cohort study from Uganda","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eMalaria remains a leading cause of morbidity and mortality among pregnant women and their newborns in sub-Saharan Africa. Malaria in pregnancy is associated with maternal anemia and adverse birth outcomes including fetal loss, preterm delivery, low birth weight and neonatal death [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In 2023, an estimated 12.4\u0026nbsp;million pregnant women in sub-Saharan Africa were infected with malaria parasites, resulting in 351,000 newborns with low birth weight [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Low birth weight is associated with neonatal and early childhood mortality [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. To reduce the risk of malaria in pregnancy, the World Health Organization recommends the use of long-lasting insecticidal bed nets (LLINs) and intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) starting in the second trimester and given at every antenatal visit at least a month apart. However, the effectiveness of IPTp-SP is threatened by wide-spread antifolate resistance in East and Southern Africa [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Trials evaluating alternative IPTp regimens have shown dihydroartemisinin-piperaquine (DP) to be a promising alternative [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. In a recent trial of 2,757 pregnant women in Uganda, monthly IPTp with DP was associated with a 94% reduction in clinical malaria and a 97% reduction in the risk microscopic parasitemia during pregnancy compared to IPTp with SP, but IPTp with DP was not associated with reduced risk of adverse birth outcomes, including low birth weight [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. These findings highlight the need for additional interventions for the prevention of malaria in pregnancy.\u003c/p\u003e\u003cp\u003eTo help design new interventions for the prevention of malaria in pregnancy beyond IPTp-SP, it is important to assess risk factors for malaria in pregnancy and low birth weight. These risk factors are multifaceted and often intertwined with household dynamics and maternal health [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Studies have shown a range of socio-economic, environmental, and behavioral determinants that influence malaria exposure and its health impacts [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Few studies have been conducted to identify risk factors of malaria in pregnancy and low birth weight in Uganda. A study conducted in Eastern Uganda exploring household and maternal risk factors of microscopic and sub-microscopic parasitemia during pregnancy and placental malaria at delivery found that lower gravidity, IPTp with SP compared to DP, poverty, and poor house construction were associated with an increased risk of malaria in pregnancy [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. However, this prior study did not examine risk factors for low birth weight. In the current study, household and maternal risk factors for measures of malaria in pregnancy and low birth weight were assessed in the same area of Eastern Uganda where the prior study was conducted and malaria is highly endemic. Data for the current study come from 2,757 pregnant women enrolled in a randomized controlled trial of IPTp with monthly SP versus DP versus monthly DP\u0026thinsp;+\u0026thinsp;SP followed through delivery [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]and includes a household survey conducted shortly after enrollment.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003e\u003cstrong\u003eStudy setting and participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study utilized data from a randomized controlled trial of monthly IPTp with SP vs. DP vs. DP+SP (ClinicalTrials.gov number: NCT04336189) [7]. The trial was conducted between December 2020 and July 2024 in Busia District, south-eastern Uganda. Busia is a high malaria endemic district with perennial transmission that is marked by two annual peaks following the rainy seasons. Prior to 2013, vector control in Busia was limited to targeted distribution of LLINs through antenatal care services. Universal distribution campaigns of free LLINs were conducted in Busia District in May 2013, May 2017, December 2020, and October 2023. The first two campaigns utilized standard pyrethroid LLINs and the last two LLINs containing deltamethrin plus piperonyl butoxide (PermaNet 3.0). Indoor residual spraying has never been implemented in Busia District. Participants were eligible for enrolment in the parent study if they were HIV-uninfected, at least 16 years of age with a viable singleton pregnancy between 12 and 20 weeks of gestation, resided in Busia district, agreed to come for all their medical care at a dedicated study clinic, and provided written informed consent.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy procedures\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAt enrolment, women underwent a standardized medical history/physical examination and had a blood smear done for detection of malaria parasites by microscopy. Women were randomized to one of the IPTp arms and study drugs were given every 4 weeks starting at 16 or 20 weeks gestational age through delivery or 40 weeks gestational age. Following enrolment, women were visited at home where a household survey was conducted to collect detailed information about the participant’s household using a structured questionnaire. Women received all their medical care at a dedicated study clinic open every day. Women were provided with an LLIN following the household survey. Routine assessments were conducted every 4 weeks at the study clinic which included a standardized medical history, physical exam, administration of study drugs, and blood collection for detection of malaria parasites by microscopy. Women were encouraged to deliver at Masafu General Hospital adjacent to the study clinic. Women who delivered at home were visited and encouraged to come to the study clinic shortly after delivery. At delivery, a standardized assessment was made including measuring birth weight and collection of placental tissue for the detection of placental malaria by histopathology.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLaboratory procedures:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBlood samples for thick blood smears were collected at enrolment and at each routine visit until delivery. Blood smears were stained with 2% Giemsa and read by trained microscopists. A blood smear was considered negative if no asexual parasites were detected after examining 100 high power fields. For quality control, all slides were read by a second microscopist and a third reviewer settled any discrepant readings. Placental tissue collected at delivery was assessed for histological evidence of placental malaria including detection of parasites (active infection) and the proportion of high powered fields with malaria pigment detected (past infection) as previously described [7].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData management and analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were collected at the study clinic and at delivery using standardized case record forms entered into Microsoft Access. Household survey data was collected using handheld computers and customized software designed and programmed to include consistency and range checks. \u0026nbsp; Data were analyzed using Stata version 18.0 (StataCorp, College Station, Tx, USA). \u0026nbsp;The following characteristics were examined as risk factors of malaria in pregnancy and LBW: maternal age, gravidity, bednet ownership at enrolment, maternal education, household wealth, house construction, year of observation, and assigned IPTp regimen. \u0026nbsp;Principal component analysis was used to generate a wealth index based on ownership of common household items which was categorized into tertiles. Houses were categorized based on construction materials as modern (having plaster or cement walls, metal or wooden roofs, and/or closed eaves) or traditional (mud and wattle walls, dirt floors, and/or open eaves). Outcomes of interest included: presence of asexual parasites detected by microscopy at enrolment and during monthly visits after initiation of study drugs; high-grade placental malaria defined as the detection of parasites or malaria pigment in \u003cu\u003e\u0026gt;\u003c/u\u003e 30% of high powered fields (HPF) by histopathology which has been associated with adverse birth outcomes [10]; and low birth weight (birth weight \u0026lt;2500g) among live births. Associations between risk factors and dichotomous outcomes were made using bivariate and multivariate log-binomial regression models to obtain risk ratios (RRs). Associations between exposure variables of interest and dichotomous outcomes with repeated measures (microscopic parasitemia following initiation of study drugs) were performed using generalized estimating equations with a log-binomial model and robust standard errors. In all analyses, a p-value \u0026lt;0.05 was considered statistically significant.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Makerere University School of Biomedical Sciences Research Ethics Committee (SBS 714), the Uganda National Council for Science and Technology (HS 2746), the Uganda National Drug Authority (CTC 0135/2020), and the University of California, San Francisco Human Research Protection Program (19-29105).\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003e\u003cstrong\u003eCharacteristics of participants and their households.\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEnrolment of participants occurred from December 28, 2020 through December 18, 2023. Among 2757 pregnant women enrolled in the parent clinical trial, 2728 (98.9%) had a household survey completed; 25 refused the household survey and 4 were withdrawn before the household survey could be completed (Figure 1). Of the 2728 participants who had a household survey completed, the median age was 23 years (range 16-44), 51.8% were multigravida, 53.9% reported owning a bed net at the time of enrolment, 68.9% had only primary school or no formal education, and 67.0% lived in a house with traditional construction (Table 1). There were no significant differences in characteristics of study participants across the IPTp arms (Table 1). Of the 2728 participants who had household survey completed, 2647 (97.0%) had at least one blood smear after initiation of study drugs, 2524 (92.5%) were followed up to delivery, and 2313 (85.1%) had a live birth with assessment for placental malaria by histopathology (Figure 1).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFactors associated with microscopic parasitemia at enrolment.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAt enrolment, 38.1% of participants had malaria parasites detected by microscopy. Risk factors for parasitemia at enrolment are presented in Table 2. In multivariate analysis, younger age was associated with an increased risk of parasitemia, with women 16-21 years of age having a 62% greater risk of parasitemia compared to women 28-44 years of age (RR= 1.62, 95% CI 1.31-1.99, p\u0026lt;0.001). Similarly, lower gravidity was associated with a higher risk of parasitemia, with primigravida women having an 86% greater risk of parasitemia compared to multigravida women (RR=1.86, 95% CI 1.57-2.21, p\u0026lt;0.001). \u0026nbsp;There were no significant associations between household wealth, bednet ownership at enrolment, and level of education with parasitemia in multivariate analysis. Women who lived in traditional houses had a 17% greater risk of parasitemia compared to those who lived in modern houses (RR=1.17, 95% CI 1.06-1.30, p=0.002). The risk of parasitemia at enrolment increased over the course of the study, with women enrolled in 2023 having a 29% greater risk of parasitemia compared to women enrolled in 2021 (RR=1.29, 95% CI 1.15-1.45, p\u0026lt;0.001).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFactors associated with microscopic parasitemia following initiation of study drugs.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFollowing initiation of study drugs, 6.5% of participants had malaria parasites detected by microscopy at the time of routine visits conducted every 4 weeks over the course of the study. Risk factors for parasitemia at the time of routine visits following the initiation of study drugs are presented in Table 3. Similar to parasitemia at enrolment, lower gravidity and younger age were independently associated with an increased risk of parasitemia after initiation of study drugs in multivariate analysis. Women 16-21 years of age had a 72% higher risk of parasitemia compared to women 28-44 years of age (RR=1.72, 95% CI 1.22-2.43, p=0.002). Primigravida women had more than twice the risk of microscopic parasitemia compared to multigravida women (RR=2.40, 95% CI 1.81-3.20, p\u0026lt;0.001). Women living in the poorest households had a 30% higher risk of parasitemia compared to women living in the least poor households (RR=1.30, 95% CI 1.05-1.60, p=0.02). Women who lived in traditional houses had a 28% greater risk of parasitemia compared to those who lived in modern houses (RR=1.28, 95% CI 1.05-1.55, p=0.01). Level of education was not significantly associated with the risk of parasitemia after the initiation of study drugs. The risk of parasitemia during routine assessments increased from 2021 to 2023, then decreased in 2024 after enrolment had been completed. As previously described, women randomized to IPTp regimens containing DP had a much lower risk of parasitemia following the initiation of study drugs, with the DP arm associated with a 97% reduction (RR=0.03, 95% CI 0.02-0.05, p\u0026lt;0.001) and the DP+SP arm associated with a 93% reduction (RR=0.07, 95% CI 0.05-0.10, p\u0026lt;0.001) compared to the SP arm[7].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFactors associated with high grade placental malaria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere were 2313 women who were assessed for placental malaria by histopathology, of which 1147 (49.6%) had no evidence of placental malaria (no parasites or malaria pigment detected), 1019 (46.6%) had evidence of mild-moderate placental malaria (malaria pigment detected in \u0026lt; 30% of HPF), and 147 (6.4%) had evidence of high-grade placental malaria (detection of parasites or malaria pigment detected in \u003cu\u003e\u0026gt;\u003c/u\u003e 30% of HPF). Risk factors for high-grade placental malaria are presented in Table 4. In multivariate analysis, lower gravidity was associated with an increased risk of high-grade placental malaria, with primigravida women having over 4 times greater risk of compared to multigravida women (RR=4.20, 95% CI 2.33-7.59, p\u0026lt;0.001). There were no significant associations between age, household wealth, level of education, or house construction with high-grade placental malaria in multivariate analysis. The risk of high-grade placental malaria increased over the course of the study with women delivering in 2024 having over 4 times the risk of high-grade placental malaria compared to women who delivered in 2021 (RR=4.62, 95% CI 2.22-9.65, p\u0026lt;0.001). As previously described, women randomized to IPTp regimens containing DP had a much lower risk of high-grade placental malaria, with the DP arm associated with an 88% reduction (RR=0.12, 95% CI 0.07-0.20, p\u0026lt;0.001) and the DP+SP arm associated with an 86% reduction (RR=0.14, 95% CI 0.09-0.23, p\u0026lt;0.001) compared to the SP arm[7]. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFactors are associated with low birth weight\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong 2313 live births with placental histopathology assessed, 157 (6.8%) had low birth weight (\u0026lt; 2500 grams). Risk factors for low birth weight are presented in Table 5. In a multivariate analysis, lower gravidity was associated with a higher risk of low birth weight, with primigravida women having over twice the risk of low birth weight compared to multigravida women (RR= 2.14, 95% CI 1.18-3.89, p=0.01). The risk of low birth weight decreased in each subsequent year during the first 3 years of the study (but not the last year), with women who delivered in 2023 having 41% lower risk compared to women who delivered in 2021 (RR=0.59, 95% CI 0.37-0.95, p=0.03). Women with high-grade placental malaria had over 3 times the risk of delivering a low birth weight infant compared to women with no evidence of placental malaria (RR=3.02, 95% CI 1.77-5.16, p\u0026lt;0.001). Interestingly, as previously described, women randomized to IPTp regimens containing DP had a higher risk of delivering a low birth weight infant, with the DP arm associated with a 64% increase (RR=1.64, 95% CI 1 .08-2.50, p=0.01) and the DP+SP arm associated with an 85% increase (RR=1.85, 95% CI 1.24-2.77, p=0.003) compared to the SP arm [7]. Maternal age, household wealth, level of education, or house construction were not significantly associated low birth weight risk in multivariate analysis.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study utilized data from a large randomized controlled trial of IPTp conducted in a rural, high transmission setting in Uganda to evaluate the risk factors of parasitemia, high-grade placental malaria, and low birth weight. Gravidity was the strongest and most consistent risk factor for malaria and LBW: primigravida women had approximately a two-fold higher risk of parasitemia before and after IPTp initiation, over 4 times the risk of placental malaria, and more than twice the risk of delivering a low-birth-weight infant compared to multigravida women. Independent of gravidity, younger maternal age was associated with a higher risk of parasitemia before and after initiation of IPTp, but not a significant increase in the risk of placental malaria or low birth weight. Living in a traditional house compared to a modern house was associated with a higher risk of parasitemia before and after initiation of IPTp but not placental malaria or low birth weight. Living in the poorest houses was only significantly associated with parasitemia following initiation of IPTp.\u0026nbsp;\u0026nbsp;Gravidity was the strongest risk factor for malaria and low birth weight, with primigravida women at a significantly higher risk than multigravidas, while younger age and living in a traditionally constructed house were also associated with increased risk of parasitemia.\u003c/p\u003e\n\u003cp\u003eIn high transmission settings, lower gravidity has consistently been identified as a key risk factor for malaria in pregnancy [11-13]. This study reaffirmed the phenomenon of “gravidity dependent immunity”, with primigravida women at highest risk of infection with malaria parasites both before and after receiving IPTp [14]. Although maternal age and gravidity are highly correlated, younger age has also been associated with an increased risk of infection with malaria parasites independent of gravidity [15], as observed in this study. Indeed, in this study the risk of parasitemia at enrollment was 65.1% among primigravida women 21 years or younger compared to 20.5% among multigravida women 28 years or older. These findings highlight the importance of targeting young, primigravida women for malaria prevention measures at the time of their first antenatal visit. Lower gravidity was also a strong risk factor for high-grade placental malaria, with primigravid women having a four-fold increased risk compared to multigravida women. Although in bivariate analyses, younger women had a 5-fold higher risk of high-grade placental malaria, this association was attenuated and not statistically significant in multivariable analyses, suggesting that much of this effect was potentially mediated by other risk factors. Notably, the presence of high-grade placental malaria was strongly associated with low birth weight, consistent with previous findings [14, 16]. A distinctive aspect of this study was the assessment of risk factors associated with delivering low birth weight infants; primigravidae had over twice the risk of low birth weight compared to multigravidae, consistent with previous studies [17-20]. In contrast, maternal age was not significantly associated with low birth weight independent of gravidity. Prior studies have reported mixed findings, with some studies reporting \u0026nbsp;maternal age under 25 years [17-20] and over 35 years [21] associated with an increased risk of low birth weight, while others found no significant association between maternal age and low birth weight [21].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConsidering household and other maternal demographic factors, living in a house constructed of traditional materials versus a modern house was associated with an increased risk of malaria parasitemia. Indeed, poor quality housing is a well-documented risk factor for infection with malaria parasites and has become a target for new malaria control interventions aimed at improving housing quality [22]. In contrast, house construction was not independently associated with high-grade placental malaria or low birth weight. With the exception of women from the poorest households being associated with an increased risk of parasitemia following initiation of study drugs, household wealth and maternal education were not significant, independent risk factors for any of the outcomes in this study. In contrast, evidence from previous studies has shown associations between improved socio-economic status and higher levels of education with better implementation of appropriate malaria control interventions and a lower burden of malaria in non-pregnant populations [23, 24].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eStrengths of this study include a large sample size nested within a randomized controlled trial conducted over several years. However, this study also had several limitations. Firstly, given the observational nature of the risk factor analysis, estimated associations may have been biased due to unmeasured confounders. Secondly, our study was conducted in an area of high malaria transmission intensity and widespread SP resistance; findings may not be generalizable to regions where SP resistance is not widespread or where malaria transmission is low to moderate. Third, as this was a secondary analysis of data from a randomized controlled trial, it was not possible to evaluate the full spectrum of risk factors for malaria in pregnancy, high grade placental malaria, and low birth weight. Finally, with the exception of IPTp regimens (which were randomly assigned), associations between risk factors and outcomes are not evidence of causality. For example, malaria may contribute to poverty, limit educational attainment, and influence the choice of housing materials through its direct and indirect socioeconomic impacts.\u0026nbsp;\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eIn this study from a high transmission area of Uganda, primigravida women were at highest risk of measures of malaria in pregnancy and the delivery of low birth weight infants. Younger maternal age, poor house construction, and lower socioeconomic status were also associated with an increased risk of parasitemia during pregnancy. The risks of malaria in pregnancy and low birth weight varied from year to year, following different patterns, suggesting the presence of temporally varying unmeasured risk factors. \u0026nbsp;Therefore, we suggest that interventions which target young and primigravida mothers and involve improvement of housing types should be introduced in order to reduce the burden on malaria in pregnancy.\u0026nbsp;\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003eAbbreviations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDP\u0026nbsp;\u003c/strong\u003eDihydroartemisinin-piperaquine\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSP\u003c/strong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Sulfadoxine–pyrimethamine\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIPTp\u003c/strong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Intermittent preventive treatment for malaria during pregnancy\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLLIN \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/strong\u003eLong Lasting Insecticidal Net\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMOH\u003c/strong\u003e Ministry of Health\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eqPCR\u003c/strong\u003e \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Quantitative polymerase chain reaction\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHPF\u0026nbsp;\u003c/strong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;High Powered Fields\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eUCSF \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003eUniversity of California San Francisco\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWHO\u003c/strong\u003e World Health Organization\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIDRC \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003eInfectious Diseases Research Collaboration\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Makerere University School of Biomedical Sciences Research Ethics Committee (SBS 714), the Uganda National Council for Science and Technology (HS 2746), the Uganda National Drug Authority (CTC 0135/2020), and the University of California San Francisco Human Research Protection Program (19-29105). Written informed consent was obtained from all participating households before participating in the study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets reported herein will be made available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNational Institute of Allergy and Infectious Diseases, National Institutes of Health (U01AI141308).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization: AM, AK, GD; Funding acquisition: MRK, GD; Methodology: AK, JN, MRK, GD; Investigation: AM, JK, PO, AK, JO, HO, BO, AJ, MRK, GD; Data curation: GD; Data analysis: GD; Writing the first draft: AM, AK, GD; Writing – review \u0026amp; editing final manuscript: AM, JK, PO, AK, JN, MR,PR,NO,MN,JO, HO, BO, AJ, MRK, GD.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank study participants for willingly accepting to give their consent and to participate in the study, study team at Masafu Hospital and Tororo Hospital and the administration of the Infectious Diseases Research Collaboration, UCSF for all their contributions.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSatapathy P, Khatib MN, Gaidhane S, Zahiruddin QS, Sharma RK, Rustagi S, Al-Jishi JM, Albayat H, Al Fares MA, Garout M, et al. Adverse pregnancy outcomes in maternal malarial infection: A systematic review and meta-analysis. New Microbes New Infect. 2024;62:101474.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVenkatesan P. WHO world malaria report 2024. Lancet Microbe 2025:101073.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChang YS, Liang FW, Lin YJ, Lu TH, Lin CH. Neonatal and infant mortality of very-low-birth-weight infants in Taiwan: Does the level of delivery hospital matter? Pediatr Neonatol. 2021;62:419\u0026ndash;27.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMcCormick MC. The contribution of low birth weight to infant mortality and childhood morbidity. N Engl J Med. 1985;312:82\u0026ndash;90.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSundararaman SA, Odom John AR. Prevention of malaria in pregnancy: The threat of sulfadoxine-pyrimethamine resistance. Front Pediatr. 2022;10:966402.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKakuru A, Jagannathan P, Muhindo MK, Natureeba P, Awori P, Nakalembe M, Opira B, Olwoch P, Ategeka J, Nayebare P, et al. Dihydroartemisinin-Piperaquine for the Prevention of Malaria in Pregnancy. N Engl J Med. 2016;374:928\u0026ndash;39.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKakuru A, Kizza J, Aguti M, Adrama H, Ategeka J, Olwoch P, Nakalembe M, Nankabirwa JI, Opira B, Ozarslan N et al. [Preprint] Dihydroartemisinin\u0026ndash;piperaquine plus sulfadoxine-pyrimethamine versus either drug alone for intermittent preventive treatment of malaria in pregnancy: a double-blind, randomized, controlled trial. \u003cem\u003emedRxiv\u003c/em\u003e 2025:2025.2003.2024.25324508..\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOkiring J, Olwoch P, Kakuru A, Okou J, Ochokoru H, Ochieng TA, Kajubi R, Kamya MR, Dorsey G, Tusting LS. Household and maternal risk factors for malaria in pregnancy in a highly endemic area of Uganda: a prospective cohort study. Malar J. 2019;18:144.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTapias-Rivera J, Guti\u0026eacute;rrez JD. Environmental and socio-economic determinants of the occurrence of malaria clusters in Colombia. Acta Trop. 2023;241:106892.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAtegeka J, Kakuru A, Kajubi R, Wasswa R, Ochokoru H, Arinaitwe E, Yeka A, Jagannathan P, Kamya MR, Muehlenbachs A, et al. Relationships Between Measures of Malaria at Delivery and Adverse Birth Outcomes in a High-Transmission Area of Uganda. J Infect Dis. 2020;222:863\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAlruwaili M, Uwimana A, Sethi R, Murindahabi M, Piercefield E, Umulisa N, Abram A, Eckert E, Munguti K, Mbituyumuremyi A, et al. Peripheral and Placental Prevalence of Sulfadoxine-Pyrimethamine Resistance Markers in Plasmodium falciparum among Pregnant Women in Southern Province, Rwanda. Am J Trop Med Hyg. 2023;109:1057\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNnaji GA, Okafor CI, Ikechebelu JI. An evaluation of the effect of parity and age on malaria parasitaemia in pregnancy. J Obstet Gynaecol. 2006;26:755\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNosten F, ter Kuile F, Maelankirri L, Decludt B, White NJ. Malaria during pregnancy in an area of unstable endemicity. Trans R Soc Trop Med Hyg. 1991;85:424\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBihoun B, Zango SH, Traor\u0026eacute;-Coulibaly M, Valea I, Ravinetto R, Van Geertruyden JP, D'Alessandro U, Tinto H, Robert A. Age-modified factors associated with placental malaria in rural Burkina Faso. BMC Pregnancy Childbirth. 2022;22:248.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDesai M, ter Kuile FO, Nosten F, McGready R, Asamoa K, Brabin B, Newman RD. Epidemiology and burden of malaria in pregnancy. Lancet Infect Dis. 2007;7:93\u0026ndash;104.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTran EE, Cheeks ML, Kakuru A, Muhindo MK, Natureeba P, Nakalembe M, Ategeka J, Nayebare P, Kamya M, Havlir D, et al. The impact of gravidity, symptomatology and timing of infection on placental malaria. Malar J. 2020;19:227.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDemelash H, Motbainor A, Nigatu D, Gashaw K, Melese A. Risk factors for low birth weight in Bale zone hospitals, South-East Ethiopia: a case-control study. BMC Pregnancy Childbirth. 2015;15:264.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMomeni M, Danaei M, Kermani AJ, Bakhshandeh M, Foroodnia S, Mahmoudabadi Z, Amirzadeh R, Safizadeh H. Prevalence and Risk Factors of Low Birth Weight in the Southeast of Iran. Int J Prev Med. 2017;8:12.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRaman TR, Devgan A, Sood SL, Gupta A, Ravichander B. LOW BIRTH WEIGHT BABIES: INCIDENCE AND RISK FACTORS. Med J Armed Forces India. 1998;54:191\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShah PS. Parity and low birth weight and preterm birth: a systematic review and meta-analyses. Acta Obstet Gynecol Scand. 2010;89:862\u0026ndash;75.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAwoleke JO. Maternal risk factors for low birth weight babies in Lagos, Nigeria. Arch Gynecol Obstet. 2012;285:1\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNankabirwa JI, Gonahasa S, Katureebe A, Mutungi P, Nassali M, Kamya MR, Westercamp N. The Uganda housing modification study - association between housing characteristics and malaria burden in a moderate to high transmission setting in Uganda. Malar J. 2024;23:223.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDike N, Onwujekwe O, Ojukwu J, Ikeme A, Uzochukwu B, Shu E. Influence of education and knowledge on perceptions and practices to control malaria in Southeast Nigeria. Soc Sci Med. 2006;63:103\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKouam\u0026eacute; RMA, Guglielmo F, Abo K, Ouattara AF, Chabi J, Sedda L, Donnelly MJ, Edi C. Education and Socio-economic status are key factors influencing use of insecticides and malaria knowledge in rural farmers in Southern C\u0026ocirc;te d'Ivoire. BMC Public Health. 2022;22:2443.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1. Characteristics of study participants at enrollment stratified by IPTp am\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategories\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 576px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIPTp am\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAll (n=2728)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSP (n=908)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDP (n=909\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDP+SP (n=911)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 132px;\"\u003e\n \u003cp\u003eAge in years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003e28-44\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e846 (31.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e288 (31.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e286 (31.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e272 (29.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003e22-27\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e838 (30.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e279 (30.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e287 (31.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e272 (29.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003e16-21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1044 (38.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e341 (37.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e336 (37.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e367 (40.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 132px;\"\u003e\n \u003cp\u003eGravidity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eMultigravida\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1414 (51.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e480 (52.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e477 (52.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e457 (50.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eSecundigravida\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e598 (21.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e201 (22.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e202 (22.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e195 (21.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003ePrimigravida\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e716 (26.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e227 (25.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e230 (25.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e259 (28.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 132px;\"\u003e\n \u003cp\u003eWealth index\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eLeast poor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e906 (33.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e290 (31.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e301 (33.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e315 (34.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eMiddle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e912 (33.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e307 (33.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e305 (33.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e300 (32.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003ePoorest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e910 (33.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e311 (34.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e303 (33.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e296 (32.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 132px;\"\u003e\n \u003cp\u003eBednet ownership\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1470 (53.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e491 (54.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e480 (52.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e499 (54.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1258 (46.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e417 (45.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e429 (47.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e412 (45.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 132px;\"\u003e\n \u003cp\u003eHighest level of education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eSecondary or higher\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e848 (31.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e279 (30.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e290 (31.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e279 (30.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003ePrimary or none\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1880 (68.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e629 (69.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e619 (68.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e632 (69.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 132px;\"\u003e\n \u003cp\u003eType of house construction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eModern\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e901 (33.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e309 (34.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e286 (31.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e306 (33.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eTraditional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1827 (67.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e599 (66.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e623 (68.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e605 (66.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 132px;\"\u003e\n \u003cp\u003eYear of enrollment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003e2021*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e731 (26.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e243 (26.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e244 (26.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e244 (26.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003e2022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e984 (36.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e328 (36.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e326 (35.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e330 (36.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003e2023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1013 (37.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e337 (37.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e339 (37.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e337 (37.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e* includes 19 participants enrolled December 28-31, 2020\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. Factors associated with microscopic parasitemia at enrollment\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategories\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParasitemia, \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;n/N (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 216px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUnivariate analysis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 216px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMultivariate analysis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRR (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRR (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 132px;\"\u003e\n \u003cp\u003eAge in years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003e28-44\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e176/846 (20.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003e22-27\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e275/838 (32.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1.58 (1.34-1.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1.36 (1.14-1.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003e16-21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e588/1044 (56.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e2.71 (2.35-3.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1.62 (1.31-1.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 132px;\"\u003e\n \u003cp\u003eGravidity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eMultigravida\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e346/1414 (24.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eSecundigravida\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e239/598 (40.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1.63 (1.43-1.87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1.26 (1.07-1.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003ePrimigravida\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e454/716 (63.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e2.59 (2.33-2.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1.86 (1.57-2.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 132px;\"\u003e\n \u003cp\u003eWealth index\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eLeast poor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e302/906 (33.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eMiddle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e339/912 (37.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1.12 (0.98-1.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1.06 (0.95-1.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.29\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003ePoorest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e398/910 (43.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1.31 (1.17-1.48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1.08 (0.96-1.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 132px;\"\u003e\n \u003cp\u003eBednet ownership\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e486/1470 (33.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e553/1258 (44.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1.33 (1.21-1.46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1.07 (0.98-1.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 132px;\"\u003e\n \u003cp\u003eHighest level of education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eSecondary or higher\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e303/848 (35.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003ePrimary or none\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e736/1880 (39.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1.10 (0.99-1.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1.10 (1.00-1.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 132px;\"\u003e\n \u003cp\u003eType of house construction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eModern\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e283/901 (31.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eTraditional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e756/1827 (41.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1.32 (1.18-1.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1.17 (1.06-1.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 132px;\"\u003e\n \u003cp\u003eYear of enrollment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003e2021*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e228/731 (31.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003e2022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e374/984 (38.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1.22 (1.07-1.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1.23 (1.09-1.38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003e2023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e437/1013 (43.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1.38 (1.22-1.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1.29 (1.15-1.45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e* includes 19 participants enrolled December 28-31, 2020\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3. Factors associated with microscopic parasitemia following initiation of study drugs\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategories\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParasitemia, \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;n/N (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 216px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUnivariate analysis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 216px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMultivariate analysis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRR (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRR (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 132px;\"\u003e\n \u003cp\u003eAge in years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003e28-44\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e133/4230 (3.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003e22-27\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e209/4006 (5.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1.66 (1.24-2.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1.38 (1.04-1.83)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003e16-21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e504/4753 (10.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e3.45 (2.66-4.48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1.72 (1.22-2.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 132px;\"\u003e\n \u003cp\u003eGravidity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eMultigravida\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e260/6984 (3.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eSecundigravida\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e201/2798 (7.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1.89 (1.47-2.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1.44 (1.08-1.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003ePrimigravida\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e385/3207 (12.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e3.29 (2.64-4.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e2.40 (1.81-3.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 132px;\"\u003e\n \u003cp\u003eWealth index\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eLeast poor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e203/4328 (4.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eMiddle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e276/4422 (6.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1.32 (1.01-1.72)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1.14 (0.91-1.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.24\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003ePoorest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e367/4239 (8.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1.84 (1.44-2.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1.30 (1.05-1.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 132px;\"\u003e\n \u003cp\u003eHighest level of education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eSecondary or higher\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e213/4022 (5.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003ePrimary or none\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e633/8967 (7.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1.34 (1.07-1.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1.16 (0.96-1.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 132px;\"\u003e\n \u003cp\u003eType of house construction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eModern\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e214/4275 (5.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eTraditional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e632/8714 (7.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1.45 (1.15-1.83)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1.28 (1.05-1.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" style=\"width: 132px;\"\u003e\n \u003cp\u003eYear of assessment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003e2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e101/2258 (4.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003e2022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e326/4807 (6.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1.35 (1.01-1.82)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1.47 (1.13-1.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003e2023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e355/4671 (7.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1.44 (1.07-1.94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1.64 (1.26-2.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003e2024\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e64/1253 (5.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1.00 (0.66-1.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1.17 (0.80-1.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.42\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 132px;\"\u003e\n \u003cp\u003eIPTp arm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eSP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e764/4324 (17.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eDP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e23/4326 (0.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e0.03 (0.02-0.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e0.03 (0.02-0.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eDP+SP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e59/4339 (1.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e0.08 (0.06-0.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e0.07 (0.05-0.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4. Factors associated with high-grade placental malaria\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategories\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePlacental malaria, \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;n/N (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 216px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUnivariate analysis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 216px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMultivariate analysis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRR (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRR (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 132px;\"\u003e\n \u003cp\u003eAge in years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003e28-44\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e17/751 (2.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003e22-27\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e28/710 (3.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1.74 (0.96-3.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1.23 (0.65-2.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.53\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003e16-21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e102/852 (12.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e5.29 (3.20-8.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1.83 (0.89-3.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 132px;\"\u003e\n \u003cp\u003eGravidity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eMultigravida\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e31/1238 (2.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eSecundigravida\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e29/498 (5.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e2.33 (1.42-3.82)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1.73 (0.95-3.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003ePrimigravida\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e87/577 (15.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e6.02 (4.04-8.96)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e4.20 (2.33-7.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 132px;\"\u003e\n \u003cp\u003eWealth index\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eLeast poor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e40/770 (5.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eMiddle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e47/790 (6.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1.15 (0.76-1.73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e0.86 (0.60-1.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.40\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003ePoorest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e60/753 (8.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1.53 (1.04-2.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e0.97 (0.69-1.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.86\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 132px;\"\u003e\n \u003cp\u003eHighest level of education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eSecondary or higher\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e33/711 (4.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003ePrimary or none\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e114/1602 (7.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1.53 (1.05-2.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1.36 (0.97-1.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 132px;\"\u003e\n \u003cp\u003eType of house construction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eModern\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e39/757 (5.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eTraditional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e108/1556 (6.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1.35 (0.94-1.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1.13 (0.83-1.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.43\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" style=\"width: 132px;\"\u003e\n \u003cp\u003eYear of delivery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003e2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e7/309 (2.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003e2022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e35/748 (4.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e2.07 (0.93-4.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e2.00 (0.93-4.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003e2023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e63/841 (7.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e3.31 (1.53-7.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e3.34 (1.61-6.94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003e2024\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e42/415 (10.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e4.47 (2.03-9.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e4.62 (2.22-9.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 132px;\"\u003e\n \u003cp\u003eIPTp arm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eSP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e116/762 (15.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eDP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e14/776 (1.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e0.12 (0.07-0.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e0.12 (0.07-0.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eDP+SP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e17/775 (2.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e0.14 (0.09-0.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e0.14 (0.09-0.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5. Factors associated with low birth weight\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 216px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategories\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLow birth weight \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;n/N (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 216px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUnivariate analysis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 216px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMultivariate analysis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRR (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRR (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 102px;\"\u003e\n \u003cp\u003eAge in years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 216px;\"\u003e\n \u003cp\u003e28-44\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e41/751 (5.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 216px;\"\u003e\n \u003cp\u003e22-27\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e38/710 (5.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e0.98 (0.64-1.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e0.81 (0.50-1.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.39\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 216px;\"\u003e\n \u003cp\u003e16-21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e78/852 (9.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1.68 (1.16-2.42)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e0.77 (0.41-1.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.42\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 102px;\"\u003e\n \u003cp\u003eGravidity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 216px;\"\u003e\n \u003cp\u003eMultigravida\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e62/1238 (5.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 216px;\"\u003e\n \u003cp\u003eSecundigravida\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e32/498 (6.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1.28 (0.85-1.94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1.45 (0.84-2.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 216px;\"\u003e\n \u003cp\u003ePrimigravida\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e63/577 (10.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e2.18 (1.56-3.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e2.14 (1.18-3.89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 102px;\"\u003e\n \u003cp\u003eWealth index\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 216px;\"\u003e\n \u003cp\u003eLeast poor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e53/770 (6.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 216px;\"\u003e\n \u003cp\u003eMiddle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e49/790 (6.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e0.90 (0.62-1.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e0.88 (0.60-1.28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 216px;\"\u003e\n \u003cp\u003ePoorest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e55/753 (7.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1.06 (0.74-1.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e0.93 (0.64-1.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.73\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 102px;\"\u003e\n \u003cp\u003eHighest level of education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 216px;\"\u003e\n \u003cp\u003eSecondary or higher\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e39/711 (5.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 216px;\"\u003e\n \u003cp\u003ePrimary or none\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e118/1602 (7.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1.34 (0.95-1.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1.41 (0.98-2.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 102px;\"\u003e\n \u003cp\u003eType of house construction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 216px;\"\u003e\n \u003cp\u003eModern\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e50/757 (6.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 216px;\"\u003e\n \u003cp\u003eTraditional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e107/1556 (6.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1.04 (0.75-1.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1.00 (0.71-1.41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" style=\"width: 102px;\"\u003e\n \u003cp\u003eYear of delivery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 216px;\"\u003e\n \u003cp\u003e2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e26/309 (8.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 216px;\"\u003e\n \u003cp\u003e2022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e56/748 (7.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e0.89 (0.57-1.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e0.83 (0.53-1.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.41\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 216px;\"\u003e\n \u003cp\u003e2023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e47/841 (5.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e0.66 (0.42-1.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e0.59 (0.37-0.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 216px;\"\u003e\n \u003cp\u003e2024\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e28/415 (6.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e0.80 (0.48-1.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e0.68 (0.40-1.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 102px;\"\u003e\n \u003cp\u003ePlacental malaria categories\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 216px;\"\u003e\n \u003cp\u003eNo parasites or pigment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e66/1147 (5.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 216px;\"\u003e\n \u003cp\u003eNo parasites, pigment \u0026lt; 30% HPF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e67/1019 (6.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1.14 (0.82-1.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1.03 (0.72-1.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.84\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 216px;\"\u003e\n \u003cp\u003eParasites or pigment \u003cu\u003e\u0026gt;\u003c/u\u003e 30% HPF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e24/147 (16.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e2.84 (1.84-4.38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e3.02 (1.77-5.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 102px;\"\u003e\n \u003cp\u003eIPTp arm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 216px;\"\u003e\n \u003cp\u003eSP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e41/762 (5.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 216px;\"\u003e\n \u003cp\u003eDP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e53/776 (6.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1.27 (0.85-1.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1.64 (1.08-2.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 216px;\"\u003e\n \u003cp\u003eDP+SP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e63/775 (8.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1.51 (1.03-2.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1.85 (1.24-2.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"malaria-journal","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"malj","sideBox":"Learn more about [Malaria Journal](http://malariajournal.biomedcentral.com/)","snPcode":"12936","submissionUrl":"https://submission.nature.com/new-submission/12936/3","title":"Malaria Journal","twitterHandle":"@malariajournal","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Malaria in pregnancy, risk factors, malaria parasitaemia, high grade placental malaria, low birth weight","lastPublishedDoi":"10.21203/rs.3.rs-7514414/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7514414/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eMalaria is a leading cause of illness and death in pregnant women and newborns. In 2023, an estimated 12.4\u0026nbsp;million pregnant women were infected with malaria parasites, resulting in 351,000 low birth weight deliveries. Maternal and household factors associated with malaria in pregnancy and low birth weight were investigated in a high-transmission area of Uganda.\u003c/p\u003e\u003ch2\u003eMethods.\u003c/h2\u003e\u003cp\u003eData come from a randomized controlled trial of intermittent preventive treatment in pregnancy (IPTp) conducted from December 2020 to July 2024 in Busia District. Maternal and household data were collected using structured questionnaires. Women were followed through delivery including monthly assessment of microscopic parasitemia, assessment of placental malaria by histopathology, and birth weight. Associations between maternal and household factors were assessed: 1) parasitaemia at enrolment, 2) parasitaemia during pregnancy after starting IPTp, 3) high-grade placental malaria, and 4) low birth weight (\u0026lt;\u0026thinsp;2500gm).\u003c/p\u003e\u003ch2\u003eResults.\u003c/h2\u003e\u003cp\u003eOf 2,757 women enrolled, 2,728 (98.9%) had a household survey completed and were included in study. Overall, 38.1% had parasitemia at enrolment, 6.5% had parasitemia following initiation of IPTp, 6.4% had high-grade placental malaria, and 6.8% of live births had low birth weight. Parasitemia at enrolment was more common in those 16\u0026ndash;21 years of age (RR\u0026thinsp;=\u0026thinsp;1.62, 95% CI 1.31\u0026ndash;1.99 p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), primigravida (RR\u0026thinsp;=\u0026thinsp;1.86, 95% CI 1.57\u0026ndash;2.21, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001)), and living in traditional houses (RR-1.17 95% CI 1.06\u0026ndash;1.30, p\u0026thinsp;=\u0026thinsp;0.002). These associations persisted after IPTp initiation: younger age (RR\u0026thinsp;=\u0026thinsp;1.72, 95% CI 1.22\u0026ndash;2.43, p\u0026thinsp;\u0026lt;\u0026thinsp;0.002), primigravida (RR\u0026thinsp;=\u0026thinsp;2.40, 95% CI 1.81\u0026ndash;3.20, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and traditional housing (RR\u0026thinsp;=\u0026thinsp;1.30 95% CI 1.01\u0026ndash;1.60, p\u0026thinsp;=\u0026thinsp;0.02). Maternal level of education was not associated with malaria parasitaemia both at enrollment and after initiation of IPTp. Primigravida was strongly associated with high-grade placental malaria (RR\u0026thinsp;=\u0026thinsp;4.20, 95% CI 2.33\u0026ndash;7.59, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001)) and low birth weight (RR\u0026thinsp;=\u0026thinsp;2.14, 95% CI 1.18\u0026ndash;3.89, p\u0026thinsp;=\u0026thinsp;0.01). However, there were no significant associations between maternal age, level of education, household wealth, and household construction with high-grade placental malaria or low birthweight.\u003c/p\u003e\u003ch2\u003eConclusions.\u003c/h2\u003e\u003cp\u003eIn an area of high malaria transmission, young primigravida women and those living in traditionally constructed houses had the greatest risk of malaria parasitemia during pregnancy. Primigravida women also had higher risks of low birth weight and high grade placental malaria.\u003c/p\u003e","manuscriptTitle":"Maternal and household risk factors for malaria in pregnancy and low birthweight: a prospective cohort study from Uganda","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-17 19:30:59","doi":"10.21203/rs.3.rs-7514414/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2025-11-25T18:42:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"172758324860740181006383539271510108816","date":"2025-10-21T06:20:44+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"28588263316604729684289531280154770557","date":"2025-10-03T17:05:47+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-09T20:30:34+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-02T18:01:47+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-02T18:01:30+00:00","index":"","fulltext":""},{"type":"submitted","content":"Malaria Journal","date":"2025-09-02T06:56:40+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"malaria-journal","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"malj","sideBox":"Learn more about [Malaria Journal](http://malariajournal.biomedcentral.com/)","snPcode":"12936","submissionUrl":"https://submission.nature.com/new-submission/12936/3","title":"Malaria Journal","twitterHandle":"@malariajournal","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0af48c2b-c076-4f04-a500-b52ddb78025f","owner":[],"postedDate":"September 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-01-05T16:00:41+00:00","versionOfRecord":{"articleIdentity":"rs-7514414","link":"https://doi.org/10.1186/s12936-025-05746-3","journal":{"identity":"malaria-journal","isVorOnly":false,"title":"Malaria Journal"},"publishedOn":"2025-12-30 15:57:55","publishedOnDateReadable":"December 30th, 2025"},"versionCreatedAt":"2025-09-17 19:30:59","video":"","vorDoi":"10.1186/s12936-025-05746-3","vorDoiUrl":"https://doi.org/10.1186/s12936-025-05746-3","workflowStages":[]},"version":"v1","identity":"rs-7514414","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7514414","identity":"rs-7514414","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}