Asymptomatic malaria in pregnancy and associated risk factors in Majang Zone, Gambella Region, Southwest Ethiopia: A hard-to-reach malaria hotspot

Abstract Background Asymptomatic malaria in pregnancy (AMiP) is a daunting public health problem with multifaceted adverse outcomes for mothers, fetuses, newborns and beyond. This study aimed to assess the prevalence and risk factors of AMiP in Majang Zone, Gambella Region, Southwest Ethiopia. Method A facility-based cross-sectional study was conducted among 425 pregnant women attending the ANC clinics of five health facilities in the Majang Zone from November 01, 2022, to February 28, 2023. Sociodemographic, obstetric, and antimalarial intervention data were collected using an interviewer-administered questionnaire. Capillary blood specimen was collected to diagnose malaria and anemia as well as determine blood group. Malaria was diagnosed by rapid diagnostic test (RDT), microscopy, and quantitative Polymerase Chain Reaction (qPCR). Statistical analyses were done by SPSS version 26.0 for Windows. The associations between dependent and independent variables were assessed by multivariable binary logistic regression considering P < 0.05 statistically significant. The magnitude of associations was quantified with the AOR along with the corresponding 95% CI. Results The prevalence of AMiP was 11.3%, 11.7%, and 15.3% by RDT, microscopy and qPCR, respectively. More than half of the infections were due to P. falciparum (55.4%). Moderate parasitemia accounted for half (50.8%) of the overall infection severity and a geometric mean asexual parasitemia was 2,683/µl. Approximately 32.3% of pregnant women with AMiP carried gametocytes with a geometric mean density of 1,213/µl. Not using ITN in the last week (AOR: 9.43 95% CI: 1.57, 56.62), having a history of malaria in the last year (AOR: 2.26 95% CI: 1.16, 4.42), lack of IRS spraying in the last year (AOR: 3.00 95% CI: 1.50, 6.00), and ANC contact less than two (AOR: 4.28 95% CI: 2.06, 8.87) were identified as risk factors associated with AMiP. Conclusion The prevalence of AMiP was high, and remained as an important public health problem in the study area. The identified risk factors should be considered to mitigate AMiP in the study area.