Prevalence of Asymptomatic Malaria and Associated Factors among Pregnant Women in Mogadishu, Somalia: A Cross-Sectional Study

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Furthermore, these silent infections hinder malaria control efforts as asymptomatic individuals can unknowingly transmit Plasmodium within communities. This study aimed to assess the prevalence of asymptomatic malaria and its associated factors in pregnant women in Mogadishu, Somalia. Methods A cross-sectional investigation was conducted at Ayaan Hospital in Mogadishu, Somalia, involving 171 asymptomatic expectant mothers selected via random sampling between February and March 2025. The data collection methods included the use of questionnaires, rapid diagnostic tests (RDTs), and microscopic examinations of blood samples. The statistical analysis employed descriptive statistics, chi-square tests, and odds ratios, with statistical significance established at p < 0.05. Results Of the 171 asymptomatic pregnant women enrolled in the study, 5 (2.9%) had asymptomatic Plasmodium infections according to RDTs and microscopy, and all Plasmodium species identified were P. falciparum. Among the variables analysed, only residence in urban areas was significantly associated with a decreased risk of infection (OR, 0.124; 95% CI: 0.01–1.32; p = 0.042). Conclusions This study revealed a low occurrence of subclinical Plasmodium falciparum parasitemia in pregnant women. Among the numerous factors examined, only the participants' residential location was significantly associated with asymptomatic Plasmodium infection. This finding suggests that where pregnant women live may play a crucial role in their risk of carrying the malaria parasite without showing symptoms. Prevalence Asymptomatic Malaria Pregnant Women Somalia Background Malaria remains a critical health concern, predominantly impacting sub-Saharan Africa, which bears the brunt of morbidity and mortality. The illness is induced by five distinct Plasmodium species, which are transmitted primarily to humans via the bites of infected female Anopheles mosquitoes ( 1 ). The World Malaria Report 2023 presents a comprehensive overview of the global malaria situation in 2022. This reveals a concerning increase in prevalence, with 249 million cases recorded across 85 countries, marking a 5 million rise from the previous year. While there was a slight decrease in the mortality rate from 14.5 to 14.3 per 100,000 individuals, and a marginal reduction in total deaths from 610,000 to 608,000 individuals, these improvements were minimal. Africa bears the brunt of the disease burden, accounting for 93.6% (233,000) of global cases and 95.4% (580,000) of deaths ( 2 ). The complex interaction between spatial variations in malaria transmission, parasite diversity, and acquired immunity levels engenders a multifaceted public health conundrum regarding gestational malaria manifestations, warranting focused investigation ( 3 ). The term 'asymptomatic malaria' refers to the presence of Plasmodium parasites in the bloodstream without any noticeable clinical symptoms ( 4 ). In regions where malaria is endemic, asymptomatic Plasmodium infections are frequently observed among pregnant women. This phenomenon is attributed primarily to the sequestration of the pathogen in the placenta, which allows it to evade detection by the immune system. Inadequate access to healthcare, combined with a reluctance to seek treatment and the decreased effectiveness of standard diagnostic methods, this condition often remains untreated ( 5 ). Consequently, subclinical malarial infection in gravid women may lead to substantial risks to both maternal and fetal well-being. One prevalent complication is maternal anaemia, which arises from haemolysis caused by Plasmodium and results in a reduced oxygen supply to both the mother and the developing foetus ( 5 – 7 ). Additionally, fetal and neonatal outcomes are frequently adversely affected, with an increased probability of preterm birth, low birth weight, and infants being smaller than anticipated for their gestational age. These factors collectively contribute to elevated rates of neonatal morbidity and mortality. Furthermore, placental malaria can hinder the transport of nutrients and interfere with placental formation, which in turn can negatively impact fetal development ( 8 ). From a public health perspective, asymptomatically infected pregnant women serve as reservoirs for malaria transmission, thereby complicating efforts to control and eliminate the disease in endemic regions ( 7 , 9 ). Mitigating the detrimental impact of gestational malaria necessitates the integration of prophylactic measures into prenatal healthcare protocols within endemic regions, notably across sub-Saharan Africa ( 10 ). The World Health Organization (WHO) is currently endeavoring to augment the accessibility of intermittent preventive treatment with sulfadoxine‒pyrimethamine (IPT-SP) administration for expectant mothers in African regions with moderate to elevated malaria transmission rates. This initiative is being implemented through incorporation into existing prenatal healthcare services ( 11 ). However, efforts to eradicate malaria continue to face challenges in achieving the level of effectiveness anticipated by the WHO and key collaborators. National-level data on malaria incidence and associated risk factors are variable. Despite this, a significant knowledge gap exists regarding subclinical malarial infections in gravid females within community settings, especially in the region where this investigation was undertaken. Thus, this study aimed to elucidate the burden of asymptomatic malaria and its associated factors in pregnant women residing in Mogadishu, Somalia. Methodology Study Area and Period This study was conducted at Ayaan Hospital in Mogadishu, Somalia, between February and March 2025. Ayan Hospital is a private, multispecialty institution located in the Banaadir region of Mogadishu that serves a densely populated urban community with limited access to public healthcare services. The facility is composed of 120 beds and includes departments such as internal medicine, obstetrics and gynecology, surgery, and pediatrics. In addition, it provides specialized services, including dialysis and diagnostic imaging. The hospital predominantly caters to low- to middle-income patients, with a particular focus on women and children, addressing medical conditions, such as infections, chronic diseases, and trauma. Study Design and Population This hospital-based cross-sectional study included asymptomatic healthy pregnant women who exhibited no signs or symptoms of malaria within the preceding 48-hour period and provided informed consent. The exclusion criteria included recent antimalarial usage, psychiatric conditions, severe comorbidities, chronic therapy, and refusal to participate. Sample size determination and sampling technique The sample size for prevalence estimation was determined using a single-population proportion formula. The calculation incorporated the following parameters: a previously documented 12.7% prevalence of asymptomatic malaria in pregnant women in Burkina Faso ( 6 ), a 95% confidence interval and a 5% margin of error. This computation gave a requisite sample of 171 subjects. Participant selection employed a simple random sampling methodology. Sociodemographic, obstetric and other associated factor data collection A semi-structured interviewer-administered questionnaire was used to collect data on sociodemographic factors (age, residence, marital status, educational level, and occupational status), obstetric factors (gravidity, trimester, and previous history of Plasmodium infection within the previous year), behavioral factors (antenatal care visits, possession and use of insecticide-treated bed net (ITN), and indoor residual spray (IRS) usage), and environmental and clinic-related factors (living near stagnant water, household mosquito presence, intermittent preventive treatment availability and giving to pregnant women, and education about prevention methods for malaria). The interviews were conducted in the Somali language, and the responses of each participant were recorded using a questionnaire according to the instructions. To ensure the accuracy of data collection, the questionnaire was subjected to a preliminary test before the commencement of actual data gathering. Additionally, training was provided to personnel responsible for data and sample collection to ensure adherence to appropriate procedures. Blood specimen collection Following the interviews, approximately 2 ml of blood was drawn from the study participants via the peripheral vein into an ethylenediaminetetraacetic acid (EDTA) tube. The samples were then labelled, stored in cool boxes, and transported to the Microbiology Laboratory, Faculty of Medicine and Health Sciences, SIMAD University Mogadishu, Somalia, for diagnosis. Laboratory investigation To detect Plasmodium infections, both rapid diagnostic tests (RDTs) and microscopic examination of stained blood smears were used as diagnostic methods. Rapid Diagnostic Tests (RDTs) Parasite detection using Malaria Pf/Pv (anti-HRP-II/anti-LDH) Ag Combo RDTs (Hangzhou Yicare Biotech Co., Ltd, China) was conducted according to the manufacturer's guidelines. A micropipette was used to add ten microliters of blood to the sample well, and then three drops (80 µl) of buffer solution were added to the buffer well. After 10–15 minutes wait, the results were recorded according to the manufacturer's instructions ( 12 ). Malaria microscopy For each participant, two glass slides were used to prepare the thick (6 µL) and thin (2 µL) blood films. The thin film was fixed in absolute methanol for 10–15 seconds prior to staining both films with 10% Giemsa stain for 10 minutes. Subsequently, the films were examined at 1000X magnification using an Olympus CX23 light microscope (Olympus, Japan) by a trained medical laboratory technologist. The diagnostic protocol involved examining blood films to identify Plasmodium parasites, determine their species, and assess their developmental stage. The specimens were deemed uninfected if no parasites were observed across 200 high-power fields ( 13 ). Data analysis The data were gathered and analysed utilizing the Statistical Package for Social Sciences version 20. Data refinement and organization were conducted. Frequency analyses were employed to determine the prevalence of subclinical malaria in gravid females. Potential correlates were identified through odds ratio calculations, incorporating 95% confidence intervals, and chi-square analyses. Statistical significance was established at p < 0.05 for predictive variables. Results Sociodemographic and obstetric characteristics of pregnant women in Mogadishu, Somalia. In a survey of 171 pregnant women, nearly half (49.7%) were aged between 18 and 24 years, 39.2% were aged between 25 and 34 years, and 11.1% were older than 34 years. Most participants were married (90.6%) and predominantly resided in urban areas (96.5%). More than half (50.9%) had not received formal education, 18.1% had completed primary education, 25.1% had completed secondary education, and 5.8% had attained diploma-level education. The majority of the participants were unemployed (93%). Regarding obstetric characteristics, 46.2% were in the third trimester, 36.8% were in the second trimester, and 17.0% were in the first trimester. Most participants (74.9%) had experienced multiple pregnancies. Additionally, 63.2% of the women reported having malaria, indicating prior exposure to the disease (Table 1 ). Table 1 Sociodemographic and Obstetric Characteristics of Pregnant Women in Mogadishu, Somalia. Variables Frequency Percent (%) Age category 18–24 years 85 49.7 25–34 years 67 39.2 > 34 years 19 11.1 Marital status Married 155 90.6 Widowed/Divorced 16 9.4 Residence Urban 165 96.5 Rural 6 3.5 Education level No Formal Education 87 50.9 Primary 31 18.1 Secondary 43 25.1 College and above 10 5.8 Occupational Status Employed 12 7.0 Un -employed 169 93.0 Gestational age First trimester 29 17.0 Second trimester 63 36.8 Third trimester 79 46.2 Gravidity status One time 43 25.1 More than one time 128 74.9 Previous History of Malaria infection Yes 108 63.2 No 63 36.8 Behavioural characteristics related to malaria prevention and antenatal care services among pregnant women in Mogadishu, Somalia. A study of behavioral patterns indicated that 69.1% of pregnant women had never engaged in antenatal care (ANC), whereas only 4.1% had attended ANC more than four times. Insecticide-treated net (ITN) ownership was notably low, with only 16.4% of women reporting that they owned one, and a substantial majority (86.5%) mentioned that they never used an ITN during their pregnancy. Indoor residual spraying (IRS) was relatively well covered, with 72.4% of participants reporting their homes being sprayed. However, the adoption of intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP) was exceedingly rare: 96.5% had not received any dose, and only 0.6% had received the recommended two doses (Table 2 ). Table 2 Behavioural characteristics related to Malaria Prevention and Antenatal Care Services Among Pregnant Women in Mogadishu, Somalia. Variables Frequency Percent (%) ANC follow up Never 84 69.1 1–2 times 60 35.1 3 times 20 11.7 >4 7 4.1 Insecticide-treated bed net (ITN) ownership Yes 28 16.4 No 143 83.6 ITN utilization Never 148 86.5 1–2 9 5.3 3 times 7 4.1 > 4 times 7 4.1 Indoor residual spray (IRS) usage Yes 124 72.4 No 47 27.5 Sulfadoxine-pyrimethamine (IPT-SP) received dose in the clinic None 165 96.5 1 time 5 2.9 2 time 1 0.6 Environmental and clinical characteristics related to malaria prevention and antenatal care services among pregnant women in Mogadishu, Somalia. Among the 171 individuals surveyed, a significant majority (97.7%) did not have access to free IPTp-SP, with only 2.3% confirming the receipt of this intervention at no cost. A considerable proportion (76%) of the respondents reported the presence of mosquitoes in their environment, whereas 24% did not. Regarding malaria education, only 8.2% of the women had received any information, leaving 91.8% without such educational exposure. Additionally, only 14.6% of the participants indicated that IPTp-SP was available at their health facility during their visit, underscoring a potential deficiency in access to preventive care (Table 3 ). Table 3 Environmental and clinical characteristics related to Malaria Prevention and Antenatal Care Services Among Pregnant Women in Mogadishu, Somalia. Variables Frequency Percent (%) IPTPsp Free availability in the clinic Yes 4 2.3 No 167 97.2 Household mosquito presence Yes 130 76.0 No 41 24.0 Malaria Education in the clinic Yes 14 8.2 No 157 91.8 Prevalence of asymptomatic Plasmodium species infection among pregnant women in Mogadishu, Somalia This study revealed a 2.9% prevalence of asymptomatic Plasmodium species infection in pregnant women, with P.falciparum accounting for all cases. The remaining 97.1% of the participants tested negative. Factors associated with asymptomatic Plasmodium species infection among pregnant women in Mogadishu, Somalia This study assessed 171 pregnant women with asymptomatic Plasmodium infection, considering various sociodemographic, obstetric, and malaria prevention factors. Among these participants, only five (2.9%) were identified as asymptomatic carriers of the Plasmodium parasite without symptoms. Of all the variables analysed, district of residence demonstrated a statistically significant association with asymptomatic malaria status (p = 0.042). Pregnant women residing in urban areas were significantly less likely to have asymptomatic Plasmodium infections than those residing in rural areas were (OR = 0.124, 95% CI: 0.01–1.32), suggesting a potential protective effect of living in urban areas, possibly attributable to improved access to preventive interventions. No statistically significant associations were observed between asymptomatic Plasmodium infection and maternal age, education level, marital status, employment status, gestational age, number of pregnancies, history of malaria, attendance at antenatal care, use of insecticide-treated nets, indoor residual spraying, uptake of intermittent preventive treatment during pregnancy with sulfadoxine-pyrimethamine, or malaria education. Although some factors, such as ANC attendance (OR = 4.30) and IPTp-SP availability (OR = 1.03), presented elevated odds ratios, the wide confidence intervals and nonsignificant p-values indicated a lack of reliable associations in this sample (Table 4 ). Table 4 Association Between Socio-Demographic, Environmental, and Clinical Factors and Asymptomatic Plasmodium Infection Among Pregnant Women in Mogadishu, Somalia Variables N (%) Asymptomatic Plasmodium status OR (95%CI) P-value Positive Negative Age group 18–24 years 85 (49.7) 1 (20.0) 84 (50.6) 0.24 (0.03–2.23) 0.178 > 24 years 86 (50.30) 4 (80.0) 82 (49.4) Educational status Non-Formal 87 (50.9) 3 (60.0) 84 (50.6) 1.46 (0.24–8.99) 0.679 Formal 84 (49.1) 2 (40.0) 82 (49.4) Residence Urban 165 (96.5) 4 (80.0) 161 (97.0) 0.124 (0.01–1.322) 0.042* Rural 6 (3.5) 1 (20.0) 5 (3.0) Occupational Status Employed 12 (7.0) 0 (0.0) 12 (7.2) 1.032 (1.00-1.062) 0.533 Un -employed 159 (93.0) 5 (100.0) 154 (92.8) Marital status Married 155 (90.6) 5 (100.0) 150 (90.5) 0.96 (0.94–0.996) 0.466 Widowed/Divorced 16 (9.4) 0 (0.0) 16 (9.6) Gestational age First trimester 29 (17.0) 2 (40.0) 27 (16.3) - 0.358 Second trimester 63 (36.8) 1 (20.0) 62 (37.3) Third trimester 79 (46.2) 2 (40.0) 77 (46.4) Gravidity status One time 43 (25.1) 0 (0.0) 43 (25.9) 1.04 (1.00-1.005) 0.188 More than one time 128 (74.9) 5 (100.0) 123 (74.1) History of Malaria infection within previous year Yes 63 (36.8) 1 (20.0) 62 (37.3) 0.41 (0.46-0046) 0.428 No 108 (63.2) 4 (80.0) 104 (62.7) ANC attending Yes 84 (49.1) 4 (80.0) 80 (48.2) 4.30 (0.47–39.3) 0.161 No 87 (50.9) 1 (20.0) 86 (51.8) ITNs ownership Yes 28 (16.4) 1 (20.0) 27 (16.3) 1.28 (0.14–11.96) 0.824 No 143 (83.6) 4 (80.0) 139(83.7) ITN utilization Yes 148(86.50) 5 (100.0) 143(86.1) 0.96 (0.94–0.99) 0.371 No 23 (13.5) 0 (0.0) 23 (13.9) IRS usage Yes 124 (72.5) 5 (100.0) 119(71.7) 0.96 (0.93–0.99) 0.162 No 47 (27.5) 0 (0.0) 47 (28.3) IPTPsp Free availability in the clinic Yes 4 (2.3) 0 (0.0) 4 (2.4) 1.03 (1.004–1.059) 0.725 No 167 (97.7) 5 (100.0 162(97.6) Household mosquito presence Yes 130 (76.0) 5 (100.0) 125(75.3) 0.96 (0.929–0.995) 0.202 No 41 (24.0) 0 (0.0) 41 (24.7) Malaria Education in the clinic Yes 14 (8.2) 0 (0.0) 14 (8.4) 1.03 (1.004–1.063) 0.498 No 157 (91.8) 5 (100.0) 152(91.6) Discussion This study assessed the prevalence of asymptomatic malaria and its correlated risk factors in pregnant women. Both Giemsa-stained smears and rapid diagnostic testing revealed that 2.9% of these women had asymptomatic Plasmodium parasitemia. These results agree with the findings of other studies conducted in the Oromia Region of Ethiopia (2.74%) (14), Bangladesh (2.3%) (15), North-Shoa, Ethiopia (3.4%) (16), the Merti District, Ethiopia (3.6%) (7), and Colombia (4.2%) (17) . Nevertheless, this figure is lower than that reported in other studies conducted in the Republic of Congo (7%) (18), Ethiopia (7.2%) (19), Southern Laos (8.3%) (20), Nigeria (9.2%) (21), Burkina Faso (11%) (6), the Jawi District, Northwest Ethiopia (11.2%) (22), the Gurage Zone in Southern Ethiopia (15.2%) (23), in the Majang Zone, Gambella Region, Southwest Ethiopia (15.3%) (5), Guinea (15.8%) (24), and in the West Guji Zone, Ethiopia (24.1%) (25). Significant climatic changes, including variations in temperature, precipitation, and humidity, as well as patterns of human settlement and population movement, could also account for the observed differences in prevalence rates. The reduced occurrence of asymptomatic parasitemia among pregnant women observed in this study might be attributed to the limited sample size, the timing of the research during a period of low malaria transmission, and variations in malaria epidemiology across the study locations. The results of this study indicate that Plasmodium falciparum was the sole species detected among the malaria-positive cases in the study area, representing 100% of the infections. This suggests that P. falciparum is the most prevalent Plasmodium species in this region. These results align with the WHO 2023 report that stated that P. falciparum accounted for approximately 92% of all malaria cases in Somalia. The slight discrepancy in percentages could be due to variations in study design, sample size, and the timing or season of data collection; however, both sources clearly demonstrate the dominance of P. falciparum in the country (26). Conversely, research conducted in other parts of East Africa has revealed a more varied distribution of Plasmodium species. For example, a study from the West Guji Zone in Ethiopia found P. vivax to be more common, accounting for 54.5% of cases, whereas P. falciparum was responsible for 45.5% (25). Similarly, a study in the Majang Zone of the Gambella Region in Southwest Ethiopia reported P. falciparum as the predominant species, accounting for 55.4% of the malaria cases (5). These differences underscore the regional variations in malaria epidemiology, which may be affected by ecological factors, vector species distributions, and local malaria control measures. Residential setting, specifically whether individuals resided in urban or rural areas, was the sole factor found to have a statistically significant association with asymptomatic Plasmodium infections (p = 0.042). This observation implies that women living in rural areas may be at increased risk. While the other variables did not reach statistical significance, some suggested potential trends that deserve further exploration with a larger sample size. The findings of this study partially align with research conducted in the Jawi District, Northwest Ethiopia, where factors such as residence, gravidity, and IRS usage were significantly associated with API. Specifically, this study indicated that individuals residing in rural areas had a 4.51 times higher likelihood of contracting the infection, corroborating our conclusion that living in rural areas increases the risk of asymptomatic malaria (22). However, unlike the Jawi study, our analysis did not find any significant associations between gravidity, IRS use, and malarial infection. This discrepancy could be attributed to differences in sample size, study design, or malaria transmission intensity across regions. In contrast, a study from North-Shoa, Ethiopia, identified only ITN usage as significantly linked to malarial infection. Although our study noted a protective trend for ITN use (OR, < 1), this association was not statistically significant (p = 0.371). This could be due to differences in ITN coverage, proper usage, or recall bias in self-reported ITN use (16). Further differences were evident in a study of the West Guji Zone, which identified several significant factors, including proximity to stagnant water, history of malaria, lack of IRS, and non-use of ITNs (25). These factors were not significant in our study although they were evaluated. The broader range of significant factors in the West Guji study might indicate a greater transmission area or greater statistical power owing to the larger number of positive cases. Additionally, in the Majang Zone, asymptomatic malaria during pregnancy was significantly linked to not using ITNs (AOR = 9.43), the absence of an IRS in the previous year (AOR = 3.00), a past history of malaria (AOR = 2.26), and having fewer than two ANC visits (AOR = 4.28) (5). This again contrasts with our results, in which ITN use did not achieve statistical significance. Several factors may account for the inconsistencies across studies. The sample size limitations in the current study may have reduced the ability to detect statistically significant associations. Regional differences in malaria transmission intensity, vector species, and environmental exposures. Variations in data collection methods may affect the accuracy of ITN or IRS reporting. The consistent finding across multiple studies that rural residence increases the risk of asymptomatic malaria underscores the need for targeted intervention in these areas. Although this study did not find statistically significant associations between IRS or ITN use, these interventions are still supported by broader evidence and should remain central to malaria prevention strategies. One drawback of the study was its cross-sectional nature, which limited the ability to establish causal links between the variables. Additionally, the data collection took place during the dry season, a period typically linked to a low rate of malaria transmission. This seasonal aspect might have resulted in an underestimation of the actual prevalence of asymptomatic malaria within the study group. Conclusions This study revealed a low rate of asymptomatic Plasmodium falciparum infections among pregnant women, indicating possibly diminished hidden malaria transmission in this group. Interestingly, the only factor significantly linked to infection was residential location, emphasizing the role of geographic elements in assessing malaria risk. The consistent screening and prompt treatment of those who test positive are crucial for malaria prevention. Future research should use highly sensitive molecular diagnostic techniques to accurately determine the true extent of asymptomatic malaria and guide effective public health measures. Abbreviations ANC: Antenatal care anti-HRP-II: Anti-Histidine-Rich Protein II anti-LDH: Anti-Lactate Dehydrogenase API: Asymptomatic infection EDTA: Ethylenediaminetetraacetic acid IPT-SP: Sulfadoxine-pyrimethamine IRS: Indoor residual spray ITN: Insecticide-treated bed net Pf: Plasmodium falciparum Pv : Plasmodium vivax RDTs: Rapid diagnostic tests WHO: World Health Organization Declarations Ethics approval and consent to participate Ethical approval for this study was obtained from the ethics committee of the SIMAD University Institutional Review Board (Ref: 2025/SU-IRB/FMHS/P00). Additionally, permission was obtained from the selected health institution. The participants were asked to sign a written informed consent form after the purpose of the study was explained. The midwives were notified of the positive results, and the patients received treatment for malaria. Consent for publication Not applicable. Availability of data and materials The data upon which the results are based are available from the corresponding author on request. Competing interests The authors declare that they have no competing interests. Funding Not applicable. Author Contributions Each author has made substantial contributions to the work presented, encompassing planning, design, execution, data collection, analysis, and interpretation, or a combination thereof. They have engaged in drafting, revising, or critically evaluating the manuscript, have provided their final approval for the version to be published, have concurred on the journal for submission, and accept responsibility for all aspects of the work. Acknowledgments We extend our profound appreciation to the personnel of the collaborating healthcare facility for their invaluable assistance in facilitating the successful execution of this investigation. 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Malaria in Pregnancy in Endemic Regions of Colombia: High Frequency of Asymptomatic and Peri-Urban Infections in Pregnant Women with Malaria. 2020;2020(1):2750258. https://doi.org/10.1155/2020/2750258 Francine N, Damien B, Anna F, Michael K, Christevy VJ, Felix K-KJA. Characterization of asymptomatic Plasmodium falciparum infection and its risk factors in pregnant women from the Republic of Congo. 2016;153:111–5. https://doi.org/10.1016/j.actatropica.2015.10.009 Duguma T, Tekalign E, Kebede SS, Bambo GMJFRH. Prevalence of asymptomatic malaria and associated factors among pregnant women in Ethiopia: systematic review and meta-analysis. 2023;5:1258952. https://doi.org/10.3389/frph.2023.1258952 Briand V, Le Hesran J-Y, Mayxay M, Newton PN, Bertin G, Houzé S et al. Prevalence of malaria in pregnancy in southern Laos: a cross-sectional survey. 2016;15:1–11. https://doi.org/10.1186/s12936-016-1492-2 Obebe OO, Falohun OO, Olajuyigbe OO, Lawani MA, Ajayi OAJTJHR. Impact of asymptomatic Plasmodium falciparum on haematological parameters of pregnant women at first antenatal visit in South-western Nigeria. 2018;20(2). https://doi.org/10.4314/thrb.v20i2.4 Tilahun A, Yimer M, Gelaye W, Tegegne BJPO. Prevalence of asymptomatic Plasmodium species infection and associated factors among pregnant women attending antenatal care at Fendeka town health facilities, Jawi District, North west Ethiopia: a cross-sectional study. 2020;15(4):e0231477. https://doi.org/10.1371/journal.pone.0231477 Solomon A, Kahase D, Alemayhu MJTD, Travel, Medicine. Vaccines. Prevalence of placental malaria among asymptomatic pregnant women in Wolkite health center, Gurage zone. South Ethiopia. 2020;6:1–8. https://doi.org/10.1186/s40794-020-00121-3 . Touré AA, Doumbouya A, Diallo A, Loua G, Cissé A, Sidibé S et al. Malaria-Associated Factors among Pregnant Women in Guinea. 2019;2019(1):3925094. https://doi.org/10.1155/2019/3925094 Gemechu T, Dedecha W, Gelchu M, Husen O, Jarso HJI, Resistance D. Asymptomatic malaria during pregnancy: prevalence, influence on anemia and associated factors in West Guji Zone, Ethiopia–a Community-Based Study. 2023:6747–55. https://doi.org/10.2147/IDR.S431877 World Health Organization. (2023, April 25). World Malaria Day 2023: Zeroing in on malaria. WHO Regional Office for the Eastern Mediterranean. Retrieved August 16, 2025, from https://www.emro.who.int/somalia/news/world-malaria-day-2023-zeroing-in-on-malaria.html Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 24 Nov, 2025 Read the published version in Malaria Journal → Version 1 posted Editorial decision: Revision requested 22 Sep, 2025 Reviews received at journal 14 Sep, 2025 Reviews received at journal 08 Sep, 2025 Reviewers agreed at journal 02 Sep, 2025 Reviewers agreed at journal 31 Aug, 2025 Reviewers invited by journal 29 Aug, 2025 Editor assigned by journal 22 Aug, 2025 Submission checks completed at journal 22 Aug, 2025 First submitted to journal 19 Aug, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7411565","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":510199415,"identity":"c108aecf-721a-4847-a388-1a2c675f683f","order_by":0,"name":"Faiso Aweis Mohamud","email":"","orcid":"","institution":"SIMAD University","correspondingAuthor":false,"prefix":"","firstName":"Faiso","middleName":"Aweis","lastName":"Mohamud","suffix":""},{"id":510199416,"identity":"b16d91da-59e0-4c6e-a72c-c8608516ecfd","order_by":1,"name":"Mohamad Yusuf Abdi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA80lEQVRIiWNgGAWjYFACHgYJCSDF3t7AcICBgRnITCBSC8+ZA6RoAVM3wCqJ0KLb3nvwhkVFnRyP5POHh27UWDPws+cYMP6owK3F7My5ZAuJM2zGPNI5BodzjqUzSPa8MWDmOYNHy40cMwnJNp7E/dI5DIdz2A4zGNzIMWBmbCOoRaK+R/L4g8M5/w4z2AO1MP4krMUggUeCweBwbhvQFokcAwZefFrOnDEG+iXBsIcH6JfcvnQeiTPPCg7j9cvxHsPbEhV18jzsxx9/zvlmLcffnrzxIb4QAwFmCSQOD4g4gF8DAwPjB0IqRsEoGAWjYGQDAJHJTso+1wxoAAAAAElFTkSuQmCC","orcid":"","institution":"SIMAD University","correspondingAuthor":true,"prefix":"","firstName":"Mohamad","middleName":"Yusuf","lastName":"Abdi","suffix":""},{"id":510199417,"identity":"5bf5c6de-651a-433d-b59c-4d00650ee371","order_by":2,"name":"Suweyda Abdiaziz Abdullahi","email":"","orcid":"","institution":"SIMAD University","correspondingAuthor":false,"prefix":"","firstName":"Suweyda","middleName":"Abdiaziz","lastName":"Abdullahi","suffix":""}],"badges":[],"createdAt":"2025-08-19 20:23:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7411565/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7411565/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12936-025-05665-3","type":"published","date":"2025-11-24T15:57:21+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":97179680,"identity":"a1a76f96-ad80-4e0c-93cb-58a588e2b83d","added_by":"auto","created_at":"2025-12-01 16:16:45","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1502681,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7411565/v1/64a5cdf2-c776-4458-b7dd-b2ac48b062e7.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Prevalence of Asymptomatic Malaria and Associated Factors among Pregnant Women in Mogadishu, Somalia: A Cross-Sectional Study","fulltext":[{"header":"Background","content":"\u003cp\u003eMalaria remains a critical health concern, predominantly impacting sub-Saharan Africa, which bears the brunt of morbidity and mortality. The illness is induced by five distinct Plasmodium species, which are transmitted primarily to humans via the bites of infected female Anopheles mosquitoes (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe World Malaria Report 2023 presents a comprehensive overview of the global malaria situation in 2022. This reveals a concerning increase in prevalence, with 249\u0026nbsp;million cases recorded across 85 countries, marking a 5\u0026nbsp;million rise from the previous year. While there was a slight decrease in the mortality rate from 14.5 to 14.3 per 100,000 individuals, and a marginal reduction in total deaths from 610,000 to 608,000 individuals, these improvements were minimal. Africa bears the brunt of the disease burden, accounting for 93.6% (233,000) of global cases and 95.4% (580,000) of deaths (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe complex interaction between spatial variations in malaria transmission, parasite diversity, and acquired immunity levels engenders a multifaceted public health conundrum regarding gestational malaria manifestations, warranting focused investigation (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe term 'asymptomatic malaria' refers to the presence of Plasmodium parasites in the bloodstream without any noticeable clinical symptoms (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). In regions where malaria is endemic, asymptomatic Plasmodium infections are frequently observed among pregnant women. This phenomenon is attributed primarily to the sequestration of the pathogen in the placenta, which allows it to evade detection by the immune system. Inadequate access to healthcare, combined with a reluctance to seek treatment and the decreased effectiveness of standard diagnostic methods, this condition often remains untreated (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Consequently, subclinical malarial infection in gravid women may lead to substantial risks to both maternal and fetal well-being. One prevalent complication is maternal anaemia, which arises from haemolysis caused by Plasmodium and results in a reduced oxygen supply to both the mother and the developing foetus (\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Additionally, fetal and neonatal outcomes are frequently adversely affected, with an increased probability of preterm birth, low birth weight, and infants being smaller than anticipated for their gestational age. These factors collectively contribute to elevated rates of neonatal morbidity and mortality. Furthermore, placental malaria can hinder the transport of nutrients and interfere with placental formation, which in turn can negatively impact fetal development (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). From a public health perspective, asymptomatically infected pregnant women serve as reservoirs for malaria transmission, thereby complicating efforts to control and eliminate the disease in endemic regions (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eMitigating the detrimental impact of gestational malaria necessitates the integration of prophylactic measures into prenatal healthcare protocols within endemic regions, notably across sub-Saharan Africa (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). The World Health Organization (WHO) is currently endeavoring to augment the accessibility of intermittent preventive treatment with sulfadoxine‒pyrimethamine (IPT-SP) administration for expectant mothers in African regions with moderate to elevated malaria transmission rates. This initiative is being implemented through incorporation into existing prenatal healthcare services (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). However, efforts to eradicate malaria continue to face challenges in achieving the level of effectiveness anticipated by the WHO and key collaborators. National-level data on malaria incidence and associated risk factors are variable. Despite this, a significant knowledge gap exists regarding subclinical malarial infections in gravid females within community settings, especially in the region where this investigation was undertaken. Thus, this study aimed to elucidate the burden of asymptomatic malaria and its associated factors in pregnant women residing in Mogadishu, Somalia.\u003c/p\u003e"},{"header":"Methodology","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy Area and Period\u003c/h2\u003e\u003cp\u003eThis study was conducted at Ayaan Hospital in Mogadishu, Somalia, between February and March 2025. Ayan Hospital is a private, multispecialty institution located in the Banaadir region of Mogadishu that serves a densely populated urban community with limited access to public healthcare services. The facility is composed of 120 beds and includes departments such as internal medicine, obstetrics and gynecology, surgery, and pediatrics. In addition, it provides specialized services, including dialysis and diagnostic imaging. The hospital predominantly caters to low- to middle-income patients, with a particular focus on women and children, addressing medical conditions, such as infections, chronic diseases, and trauma.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eStudy Design and Population\u003c/h3\u003e\n\u003cp\u003eThis hospital-based cross-sectional study included asymptomatic healthy pregnant women who exhibited no signs or symptoms of malaria within the preceding 48-hour period and provided informed consent. The exclusion criteria included recent antimalarial usage, psychiatric conditions, severe comorbidities, chronic therapy, and refusal to participate.\u003c/p\u003e\n\u003ch3\u003eSample size determination and sampling technique\u003c/h3\u003e\n\u003cp\u003eThe sample size for prevalence estimation was determined using a single-population proportion formula. The calculation incorporated the following parameters: a previously documented 12.7% prevalence of asymptomatic malaria in pregnant women in Burkina Faso (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e), a 95% confidence interval and a 5% margin of error. This computation gave a requisite sample of 171 subjects. Participant selection employed a simple random sampling methodology.\u003c/p\u003e\n\u003ch3\u003eSociodemographic, obstetric and other associated factor data collection\u003c/h3\u003e\n\u003cp\u003eA semi-structured interviewer-administered questionnaire was used to collect data on sociodemographic factors (age, residence, marital status, educational level, and occupational status), obstetric factors (gravidity, trimester, and previous history of Plasmodium infection within the previous year), behavioral factors (antenatal care visits, possession and use of insecticide-treated bed net (ITN), and indoor residual spray (IRS) usage), and environmental and clinic-related factors (living near stagnant water, household mosquito presence, intermittent preventive treatment availability and giving to pregnant women, and education about prevention methods for malaria). The interviews were conducted in the Somali language, and the responses of each participant were recorded using a questionnaire according to the instructions. To ensure the accuracy of data collection, the questionnaire was subjected to a preliminary test before the commencement of actual data gathering. Additionally, training was provided to personnel responsible for data and sample collection to ensure adherence to appropriate procedures.\u003c/p\u003e\n\u003ch3\u003eBlood specimen collection\u003c/h3\u003e\n\u003cp\u003e Following the interviews, approximately 2 ml of blood was drawn from the study participants via the peripheral vein into an ethylenediaminetetraacetic acid (EDTA) tube. The samples were then labelled, stored in cool boxes, and transported to the Microbiology Laboratory, Faculty of Medicine and Health Sciences, SIMAD University Mogadishu, Somalia, for diagnosis.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eLaboratory investigation\u003c/h2\u003e\u003cp\u003eTo detect Plasmodium infections, both rapid diagnostic tests (RDTs) and microscopic examination of stained blood smears were used as diagnostic methods.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eRapid Diagnostic Tests (RDTs)\u003c/h3\u003e\n\u003cp\u003e Parasite detection using Malaria Pf/Pv (anti-HRP-II/anti-LDH) Ag Combo RDTs (Hangzhou Yicare Biotech Co., Ltd, China) was conducted according to the manufacturer's guidelines. A micropipette was used to add ten microliters of blood to the sample well, and then three drops (80 \u0026micro;l) of buffer solution were added to the buffer well. After 10\u0026ndash;15 minutes wait, the results were recorded according to the manufacturer's instructions (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eMalaria microscopy\u003c/h3\u003e\n\u003cp\u003eFor each participant, two glass slides were used to prepare the thick (6 \u0026micro;L) and thin (2 \u0026micro;L) blood films. The thin film was fixed in absolute methanol for 10\u0026ndash;15 seconds prior to staining both films with 10% Giemsa stain for 10 minutes. Subsequently, the films were examined at 1000X magnification using an Olympus CX23 light microscope (Olympus, Japan) by a trained medical laboratory technologist. The diagnostic protocol involved examining blood films to identify Plasmodium parasites, determine their species, and assess their developmental stage. The specimens were deemed uninfected if no parasites were observed across 200 high-power fields (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eData analysis\u003c/h2\u003e\u003cp\u003eThe data were gathered and analysed utilizing the Statistical Package for Social Sciences version 20. Data refinement and organization were conducted. Frequency analyses were employed to determine the prevalence of subclinical malaria in gravid females. Potential correlates were identified through odds ratio calculations, incorporating 95% confidence intervals, and chi-square analyses. Statistical significance was established at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 for predictive variables.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cb\u003eSociodemographic and obstetric characteristics of pregnant women in Mogadishu, Somalia.\u003c/b\u003e\u003c/p\u003e\u003cp\u003eIn a survey of 171 pregnant women, nearly half (49.7%) were aged between 18 and 24 years, 39.2% were aged between 25 and 34 years, and 11.1% were older than 34 years. Most participants were married (90.6%) and predominantly resided in urban areas (96.5%). More than half (50.9%) had not received formal education, 18.1% had completed primary education, 25.1% had completed secondary education, and 5.8% had attained diploma-level education. The majority of the participants were unemployed (93%). Regarding obstetric characteristics, 46.2% were in the third trimester, 36.8% were in the second trimester, and 17.0% were in the first trimester. Most participants (74.9%) had experienced multiple pregnancies. Additionally, 63.2% of the women reported having malaria, indicating prior exposure to the disease (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSociodemographic and Obstetric Characteristics of Pregnant Women in Mogadishu, Somalia.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFrequency\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePercent (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eAge category\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e18\u0026ndash;24 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e49.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e25\u0026ndash;34 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e39.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;34 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMarital status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e155\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e90.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWidowed/Divorced\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eResidence\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUrban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e165\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e96.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRural\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEducation level\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo Formal Education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e50.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrimary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSecondary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCollege and above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eOccupational Status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmployed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUn -employed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e169\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e93.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGestational age\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFirst trimester\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSecond trimester\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e36.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThird trimester\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e46.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGravidity status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOne time\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMore than one time\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e128\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e74.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePrevious History of Malaria infection\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e108\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e63.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e36.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eBehavioural characteristics related to malaria prevention and antenatal care services among pregnant women in Mogadishu, Somalia.\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA study of behavioral patterns indicated that 69.1% of pregnant women had never engaged in antenatal care (ANC), whereas only 4.1% had attended ANC more than four times. Insecticide-treated net (ITN) ownership was notably low, with only 16.4% of women reporting that they owned one, and a substantial majority (86.5%) mentioned that they never used an ITN during their pregnancy. Indoor residual spraying (IRS) was relatively well covered, with 72.4% of participants reporting their homes being sprayed. However, the adoption of intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP) was exceedingly rare: 96.5% had not received any dose, and only 0.6% had received the recommended two doses (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBehavioural characteristics related to Malaria Prevention and Antenatal Care Services Among Pregnant Women in Mogadishu, Somalia.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFrequency\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePercent (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eANC follow up\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNever\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e69.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u0026ndash;2 times\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e35.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3 times\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eInsecticide-treated bed net (ITN) ownership\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e143\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e83.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eITN utilization\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNever\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e148\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e86.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u0026ndash;2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3 times\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;4 times\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eIndoor residual spray (IRS) usage\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e124\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e72.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e27.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSulfadoxine-pyrimethamine (IPT-SP) received dose in the clinic\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e165\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e96.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1 time\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2 time\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eEnvironmental and clinical characteristics related to malaria prevention and antenatal care services among pregnant women in Mogadishu, Somalia.\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAmong the 171 individuals surveyed, a significant majority (97.7%) did not have access to free IPTp-SP, with only 2.3% confirming the receipt of this intervention at no cost. A considerable proportion (76%) of the respondents reported the presence of mosquitoes in their environment, whereas 24% did not. Regarding malaria education, only 8.2% of the women had received any information, leaving 91.8% without such educational exposure. Additionally, only 14.6% of the participants indicated that IPTp-SP was available at their health facility during their visit, underscoring a potential deficiency in access to preventive care (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eEnvironmental and clinical characteristics related to Malaria Prevention and Antenatal Care Services Among Pregnant Women in Mogadishu, Somalia.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFrequency\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePercent (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eIPTPsp Free availability in the clinic\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e167\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e97.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHousehold mosquito presence\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e130\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e76.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMalaria Education in the clinic\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e157\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e91.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003ePrevalence of asymptomatic Plasmodium species infection among pregnant women in Mogadishu, Somalia\u003c/h2\u003e\u003cp\u003eThis study revealed a 2.9% prevalence of asymptomatic Plasmodium species infection in pregnant women, with P.falciparum accounting for all cases. The remaining 97.1% of the participants tested negative.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eFactors associated with asymptomatic Plasmodium species infection among pregnant women in Mogadishu, Somalia\u003c/h2\u003e\u003cp\u003eThis study assessed 171 pregnant women with asymptomatic Plasmodium infection, considering various sociodemographic, obstetric, and malaria prevention factors. Among these participants, only five (2.9%) were identified as asymptomatic carriers of the Plasmodium parasite without symptoms. Of all the variables analysed, district of residence demonstrated a statistically significant association with asymptomatic malaria status (p\u0026thinsp;=\u0026thinsp;0.042). Pregnant women residing in urban areas were significantly less likely to have asymptomatic Plasmodium infections than those residing in rural areas were (OR\u0026thinsp;=\u0026thinsp;0.124, 95% CI: 0.01\u0026ndash;1.32), suggesting a potential protective effect of living in urban areas, possibly attributable to improved access to preventive interventions. No statistically significant associations were observed between asymptomatic Plasmodium infection and maternal age, education level, marital status, employment status, gestational age, number of pregnancies, history of malaria, attendance at antenatal care, use of insecticide-treated nets, indoor residual spraying, uptake of intermittent preventive treatment during pregnancy with sulfadoxine-pyrimethamine, or malaria education. Although some factors, such as ANC attendance (OR\u0026thinsp;=\u0026thinsp;4.30) and IPTp-SP availability (OR\u0026thinsp;=\u0026thinsp;1.03), presented elevated odds ratios, the wide confidence intervals and nonsignificant p-values indicated a lack of reliable associations in this sample (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAssociation Between Socio-Demographic, Environmental, and Clinical Factors and Asymptomatic Plasmodium Infection Among Pregnant Women in Mogadishu, Somalia\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eN (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003eAsymptomatic Plasmodium status\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eOR (95%CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePositive\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNegative\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003eAge group\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e18\u0026ndash;24 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e85 (49.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (20.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e84 (50.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.24 (0.03\u0026ndash;2.23)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.178\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;24 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e86 (50.30)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (80.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e82 (49.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEducational status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNon-Formal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e87 (50.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (60.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e84 (50.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e1.46 (0.24\u0026ndash;8.99)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.679\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFormal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e84 (49.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (40.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e82 (49.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eResidence\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUrban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e165 (96.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (80.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e161 (97.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.124 (0.01\u0026ndash;1.322)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.042*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRural\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6 (3.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (20.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5 (3.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eOccupational Status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmployed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12 (7.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12 (7.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e1.032 (1.00-1.062)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.533\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUn -employed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e159 (93.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (100.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e154 (92.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMarital status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e155 (90.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (100.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e150 (90.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.96 (0.94\u0026ndash;0.996)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.466\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWidowed/Divorced\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e16 (9.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16 (9.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGestational age\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFirst trimester\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e29 (17.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (40.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e27 (16.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.358\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSecond trimester\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e63 (36.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (20.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e62 (37.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThird trimester\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e79 (46.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (40.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e77 (46.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGravidity status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOne time\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e43 (25.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e43 (25.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e1.04 (1.00-1.005)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.188\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMore than one time\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e128 (74.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (100.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e123 (74.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHistory of Malaria infection within previous year\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e63 (36.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (20.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e62 (37.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.41 (0.46-0046)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.428\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e108 (63.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (80.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e104 (62.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eANC attending\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e84 (49.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (80.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e80 (48.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e4.30 (0.47\u0026ndash;39.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.161\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e87 (50.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (20.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e86 (51.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eITNs ownership\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e28 (16.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (20.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e27 (16.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e1.28 (0.14\u0026ndash;11.96)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.824\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e143 (83.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (80.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e139(83.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eITN utilization\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e148(86.50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (100.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e143(86.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.96 (0.94\u0026ndash;0.99)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.371\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23 (13.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e23 (13.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eIRS usage\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e124 (72.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (100.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e119(71.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.96 (0.93\u0026ndash;0.99)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.162\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e47 (27.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e47 (28.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eIPTPsp Free availability in the clinic\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 (2.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4 (2.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e1.03 (1.004\u0026ndash;1.059)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.725\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e167 (97.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (100.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e162(97.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHousehold mosquito presence\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e130 (76.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (100.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e125(75.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.96 (0.929\u0026ndash;0.995)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.202\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e41 (24.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e41 (24.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMalaria Education in the clinic\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14 (8.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14 (8.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e1.03 (1.004\u0026ndash;1.063)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.498\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e157 (91.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (100.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e152(91.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study assessed the prevalence of asymptomatic malaria and its correlated risk factors in pregnant women. Both Giemsa-stained smears and rapid diagnostic testing revealed that 2.9% of these women had asymptomatic Plasmodium parasitemia. These results agree with the findings of other studies conducted in the Oromia Region of Ethiopia (2.74%) (14), Bangladesh (2.3%) (15), North-Shoa, Ethiopia (3.4%) (16), the Merti District, Ethiopia (3.6%) (7), and Colombia (4.2%) (17) .\u003c/p\u003e\n\u003cp\u003eNevertheless, this figure is lower than that reported in other studies conducted in the Republic of Congo (7%) (18), Ethiopia (7.2%) (19), Southern Laos (8.3%) (20), Nigeria (9.2%) (21), Burkina Faso (11%) (6), the Jawi District, Northwest Ethiopia (11.2%) (22), the Gurage Zone in Southern Ethiopia (15.2%) (23), in the Majang Zone, Gambella Region, Southwest Ethiopia (15.3%) (5), Guinea (15.8%) (24), and in the West Guji Zone, Ethiopia (24.1%) (25). Significant climatic changes, including variations in temperature, precipitation, and humidity, as well as patterns of human settlement and population movement, could also account for the observed differences in prevalence rates. The reduced occurrence of asymptomatic parasitemia among pregnant women observed in this study might be attributed to the limited sample size, the timing of the research during a period of low malaria transmission, and variations in malaria epidemiology across the study locations.\u003c/p\u003e\n\u003cp\u003eThe results of this study indicate that Plasmodium falciparum was the sole species detected among the malaria-positive cases in the study area, representing 100% of the infections. This suggests that P. falciparum is the most prevalent Plasmodium species in this region. These results align with the WHO 2023 report that stated that P. falciparum accounted for approximately 92% of all malaria cases in Somalia. The slight discrepancy in percentages could be due to variations in study design, sample size, and the timing or season of data collection; however, both sources clearly demonstrate the dominance of P. falciparum in the country (26). Conversely, research conducted in other parts of East Africa has revealed a more varied distribution of Plasmodium species. For example, a study from the West Guji Zone in Ethiopia found P. vivax to be more common, accounting for 54.5% of cases, whereas P. falciparum was responsible for 45.5% (25). Similarly, a study in the Majang Zone of the Gambella Region in Southwest Ethiopia reported P. falciparum as the predominant species, accounting for 55.4% of the malaria cases (5). These differences underscore the regional variations in malaria epidemiology, which may be affected by ecological factors, vector species distributions, and local malaria control measures.\u003c/p\u003e\n\u003cp\u003eResidential setting, specifically whether individuals resided in urban or rural areas, was the sole factor found to have a statistically significant association with asymptomatic Plasmodium infections (p = 0.042). This observation implies that women living in rural areas may be at increased risk. While the other variables did not reach statistical significance, some suggested potential trends that deserve further exploration with a larger sample size. The findings of this study partially align with research conducted in the Jawi District, Northwest Ethiopia, where factors such as residence, gravidity, and IRS usage were significantly associated with API. Specifically, this study indicated that individuals residing in rural areas had a 4.51 times higher likelihood of contracting the infection, corroborating our conclusion that living in rural areas increases the risk of asymptomatic malaria (22). However, unlike the Jawi study, our analysis did not find any significant associations between gravidity, IRS use, and malarial infection. This discrepancy could be attributed to differences in sample size, study design, or malaria transmission intensity across regions. In contrast, a study from North-Shoa, Ethiopia, identified only ITN usage as significantly linked to malarial infection. Although our study noted a protective trend for ITN use (OR, \u0026lt; 1), this association was not statistically significant (p = 0.371). This could be due to differences in ITN coverage, proper usage, or recall bias in self-reported ITN use (16). Further differences were evident in a study of the West Guji Zone, which identified several significant factors, including proximity to stagnant water, history of malaria, lack of IRS, and non-use of ITNs (25). These factors were not significant in our study although they were evaluated. The broader range of significant factors in the West Guji study might indicate a greater transmission area or greater statistical power owing to the larger number of positive cases. Additionally, in the Majang Zone, asymptomatic malaria during pregnancy was significantly linked to not using ITNs (AOR = 9.43), the absence of an IRS in the previous year (AOR = 3.00), a past history of malaria (AOR = 2.26), and having fewer than two ANC visits (AOR = 4.28) (5). This again contrasts with our results, in which ITN use did not achieve statistical significance. Several factors may account for the inconsistencies across studies. The sample size limitations in the current study may have reduced the ability to detect statistically significant associations. Regional differences in malaria transmission intensity, vector species, and environmental exposures. Variations in data collection methods may affect the accuracy of ITN or IRS reporting.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe consistent finding across multiple studies that rural residence increases the risk of asymptomatic malaria underscores the need for targeted intervention in these areas. Although this study did not find statistically significant associations between IRS or ITN use, these interventions are still supported by broader evidence and should remain central to malaria prevention strategies.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOne drawback of the study was its cross-sectional nature, which limited the ability to establish causal links between the variables. Additionally, the data collection took place during the dry season, a period typically linked to a low rate of malaria transmission. This seasonal aspect might have resulted in an underestimation of the actual prevalence of asymptomatic malaria within the study group.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study revealed a low rate of asymptomatic Plasmodium falciparum infections among pregnant women, indicating possibly diminished hidden malaria transmission in this group. Interestingly, the only factor significantly linked to infection was residential location, emphasizing the role of geographic elements in assessing malaria risk. The consistent screening and prompt treatment of those who test positive are crucial for malaria prevention. Future research should use highly sensitive molecular diagnostic techniques to accurately determine the true extent of asymptomatic malaria and guide effective public health measures.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eANC:\u003c/em\u003e\u003c/strong\u003e\u0026nbsp; Antenatal care\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eanti-HRP-II:\u003c/em\u003e\u003c/strong\u003e Anti-Histidine-Rich Protein II\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eanti-LDH:\u003c/em\u003e\u003c/strong\u003e Anti-Lactate Dehydrogenase\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAPI:\u003c/em\u003e\u003c/strong\u003e Asymptomatic infection\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEDTA:\u003c/em\u003e\u003c/strong\u003e Ethylenediaminetetraacetic acid\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eIPT-SP:\u003c/em\u003e\u003c/strong\u003e\u0026nbsp; Sulfadoxine-pyrimethamine\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eIRS:\u003c/em\u003e\u003c/strong\u003e Indoor residual spray\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eITN:\u003c/em\u003e\u003c/strong\u003e Insecticide-treated bed net\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003ePf:\u003c/em\u003e\u003c/strong\u003e Plasmodium falciparum\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003ePv\u003c/em\u003e\u003c/strong\u003e: Plasmodium vivax\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eRDTs:\u003c/em\u003e\u003c/strong\u003e\u0026nbsp; Rapid diagnostic tests\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eWHO:\u003c/em\u003e\u003c/strong\u003e World Health Organization\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval for this study was obtained from the ethics committee of the SIMAD University Institutional Review Board (Ref: 2025/SU-IRB/FMHS/P00). Additionally, permission was obtained from the selected health institution. The participants were asked to sign a written informed consent form after the purpose of the study was explained. The midwives were notified of the positive results, and the patients received treatment for malaria.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\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 data upon which the results are based are available from the corresponding author on 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\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor\u003c/strong\u003e \u003cstrong\u003eContributions\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEach author has made substantial contributions to the work presented, encompassing planning, design, execution, data collection, analysis, and interpretation, or a combination thereof. They have engaged in drafting, revising, or critically evaluating the manuscript, have provided their final approval for the version to be published, have concurred on the journal for submission, and accept responsibility for all aspects of the work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;We extend our profound appreciation to the personnel of the collaborating healthcare facility for their invaluable assistance in facilitating the successful execution of this investigation. Furthermore, we acknowledge with gratitude the research subjects for their voluntary participation and engagement in this scholarly endeavor.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors and affiliations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDepartment of Microbiology and Laboratory Sciences, Faculty of Medicine and Health Sciences, SIMAD University, Mogadishu, Somalia.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMohamad Y. Abdi, Faiso A. Mohamud \u0026amp; Suweyda A. Abdullahi\u003cbr\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKassie GA, Azeze GA, Gebrekidan AY, Lombebo AA, Adella GA, Haile KE et al. 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Retrieved August 16, 2025, from \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.emro.who.int/somalia/news/world-malaria-day-2023-zeroing-in-on-malaria.html\u003c/span\u003e\u003cspan address=\"https://www.emro.who.int/somalia/news/world-malaria-day-2023-zeroing-in-on-malaria.html\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\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":"Prevalence, Asymptomatic Malaria, Pregnant Women, Somalia","lastPublishedDoi":"10.21203/rs.3.rs-7411565/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7411565/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eAsymptomatic Plasmodium infections during pregnancy can cause serious complications such as stillbirths, abortions, premature deliveries, and low birth weight infants. Furthermore, these silent infections hinder malaria control efforts as asymptomatic individuals can unknowingly transmit Plasmodium within communities. This study aimed to assess the prevalence of asymptomatic malaria and its associated factors in pregnant women in Mogadishu, Somalia.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA cross-sectional investigation was conducted at Ayaan Hospital in Mogadishu, Somalia, involving 171 asymptomatic expectant mothers selected via random sampling between February and March 2025. The data collection methods included the use of questionnaires, rapid diagnostic tests (RDTs), and microscopic examinations of blood samples. The statistical analysis employed descriptive statistics, chi-square tests, and odds ratios, with statistical significance established at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eOf the 171 asymptomatic pregnant women enrolled in the study, 5 (2.9%) had asymptomatic Plasmodium infections according to RDTs and microscopy, and all Plasmodium species identified were P. falciparum. Among the variables analysed, only residence in urban areas was significantly associated with a decreased risk of infection (OR, 0.124; 95% CI: 0.01\u0026ndash;1.32; p\u0026thinsp;=\u0026thinsp;0.042).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eThis study revealed a low occurrence of subclinical Plasmodium falciparum parasitemia in pregnant women. Among the numerous factors examined, only the participants' residential location was significantly associated with asymptomatic Plasmodium infection. This finding suggests that where pregnant women live may play a crucial role in their risk of carrying the malaria parasite without showing symptoms.\u003c/p\u003e","manuscriptTitle":"Prevalence of Asymptomatic Malaria and Associated Factors among Pregnant Women in Mogadishu, Somalia: A Cross-Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-05 11:26:39","doi":"10.21203/rs.3.rs-7411565/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-09-22T13:47:17+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-14T15:52:16+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-08T23:14:29+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"323038974776967925863866396870108644903","date":"2025-09-02T14:24:56+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"142107719633284792409467715554613875592","date":"2025-08-31T09:10:04+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-29T09:06:24+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-22T08:27:57+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-22T08:27:53+00:00","index":"","fulltext":""},{"type":"submitted","content":"Malaria Journal","date":"2025-08-19T20:08:01+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":"b423f4da-c4b8-42d3-b306-ae383be89433","owner":[],"postedDate":"September 5th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-12-01T16:14:01+00:00","versionOfRecord":{"articleIdentity":"rs-7411565","link":"https://doi.org/10.1186/s12936-025-05665-3","journal":{"identity":"malaria-journal","isVorOnly":false,"title":"Malaria Journal"},"publishedOn":"2025-11-24 15:57:21","publishedOnDateReadable":"November 24th, 2025"},"versionCreatedAt":"2025-09-05 11:26:39","video":"","vorDoi":"10.1186/s12936-025-05665-3","vorDoiUrl":"https://doi.org/10.1186/s12936-025-05665-3","workflowStages":[]},"version":"v1","identity":"rs-7411565","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7411565","identity":"rs-7411565","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}