Malaria Prevalence and Risk Factors Among Pregnant Women: A Retrospective Record Review at the Buea Regional Hospital, South West Region of Cameroon

Malaria Prevalence and Risk Factors Among Pregnant Women: A Retrospective Record Review at the Buea Regional Hospital, South West Region of Cameroon | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Malaria Prevalence and Risk Factors Among Pregnant Women: A Retrospective Record Review at the Buea Regional Hospital, South West Region of Cameroon BUH ELVIS WUNG, ESUM EYONG MATHIAS, ROLAND NDIP NDIP This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8427956/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 12 You are reading this latest preprint version Abstract Background Notwithstanding global efforts to curb the spread of malaria, it has remained one of the most common public health challenges to mothers, foetuses, and neonates with devastating effects in pregnancy. The study, therefore, sought to determine the prevalence and risk factors of malaria in pregnancy among those who attended the antenatal clinic at the Buea Regional Hospital, South West region of Cameroon. Methods A five-year hospital-based retrospective study was carried out using ANC registration logbooks. Data was collected from January 2018 to December 2022. A total of 1,200 records meeting the inclusion criteria were assessed. Data on demographics such as age, marital status, gravidity, gestational age, malaria results and preventive factors were obtained and analyzed using SPSS version 25. Chi-square tests and Fisher’s Exact Test were used to evaluate associations, with a significance level of p < 0.05. Logistic regression was used to determine independent risk factors for malaria infection. Results The overall prevalence of malaria among pregnant women was 12.8% (153/1200). Prevalence rose from 14% in 2018 to a peak of 20.6% in 2019, then declined steadily to 8.1% by 2022. Women aged ≥ 35 years had significantly higher odds of infection compared to adolescents (OR = 1.98; p = 0.039). Multigravid women had 2.2 times higher odds of malaria compared to primigravid women (OR = 2.21; p = 0.020). Use of long-lasting insecticidal nets (LLINs) reduced infection odds by 55% (OR = 0.45; p = 0.001), and receipt of three IPTp doses reduced odds by 56% (OR = 0.44; p = 0.044). Married women had 29% lower odds of malaria as opposed to unmarried women (OR = 0.71; p = 0.006). Conclusions This study showed that malaria remains a significant threat to maternal health in Buea, despite recent declines in prevalence. Age ≥ 35 years, multigravidity, and unmarried status were major risk factors, while LLIN use and adequate IPTp dosing were protective. Despite these, there is still a call for scaled-up preventive and control strategies. Strengthening malaria prevention through expanded LLIN coverage, improved IPTp uptake, and strategies to maintain healthcare access during crises could substantially reduce malaria burden among pregnant women in this region. Malaria in pregnancy Pregnancy Prevalence Risk factors LLIN IPTp Cameroon Buea Regional Hospital Figures Figure 1 Figure 2 Figure 3 BACKGROUND Malaria is an ancient infectious disease caused by Plasmodium , a parasitic protozoan [ 1 ] . Plasmodium is transmitted through the bite of an infected blood-sucking arthropod insect, the female mosquito of the genus Anopheles [ 2 ] . Malaria remains a paramount challenge within the realm of public health in sub-Saharan Africa, particularly in Cameroon. It disproportionately affects vulnerable populations such as pregnant women, children, and immunosuppressed individuals, despite global efforts to curb the spread of the infection [ 3 ] . Pregnant women infected with malaria suffer enormous health outcomes such as maternal anaemia and mortality, foetal growth restriction, abortion, pre-term delivery, still birth and low birth weight (LBW) [ 4 ] . According to the World Health Organization (WHO), there were an estimated 247 million cases worldwide in 2021, with Africa accounting for 95% of cases and 80% of deaths among children under five years old [ 2 ] . While malaria incidence in Africa had a downward trajectory from 2000 to 2019, COVID-19 pandemic reversed this progress, leading to a surge in cases and fatalities [ 2 ] . Globally, malaria fatalities rose to 625000 in 2020 before dipping slightly to 619000 in 2021, underscoring the fragility of control measures amid overlapping health crisis [ 2 ] . Four nations: Nigeria, the Democratic Republic of the Congo, Tanzania, and Niger, shoulder over half of the world’s malaria death in 2021. This highlights that the disease has a concentrated impact in Central Africa, exacerbating maternal and fetal health complications in already disadvantaged communities [ 2 ] . As one of the countries with highest malaria burdens globally, Cameroon accounted for approximately 2.7% of all cases and 2.3% of deaths in 2021 [ 2 ] . Case numbers stagnated until 2017 but surged by 3.6% in 2020 compared to 2011 baselines, while mortality declined by 7% in 2021 from the prior year; yet the disease persists as a daily threat, with around 6 million cases and 11000 deaths annually [ 5 ] . 125 million women globally become pregnant per annum in malaria endemic regions of the world [ 6 ] . Particularly alarming is the erratic rise in prevalence among pregnant women in Cameroon, escalating from 13% in 2013 to 26% in 2021 [ 6 ] Malaria is endemic in Cameroon and exhibits significant regional variation, influenced by diverse ecological factors such as biotic and abiotic factors and socioeconomic factors such as education, age, income and housing conditions [ 7 , 8 ] . Environmental factors such as vegetation index, altitude and climate drive the variation of malaria in Cameroon [ 9 ] . Highland, forested, and high-altitude areas like Buea with high rainfall, humidity, and fluctuating temperatures foster ideal conditions for transmission, while urbanization and climate change further amplify endemicity [ 10 , 11 ] . The southern forested zones experience intense, year-round transmission, contrasting with seasonal patterns in the northern savannah [ 7 , 5 ] . Factors of malaria in pregnancy include, gravidity with primigravid women being the most vulnerable due to lack of immunity [ 12 ] . There is limited access to preventive measures like Insecticide treated nets (ITNs) and Intermittent preventive Treatment (IPTp) with sulfadoxine-pyrimethamine [ 6 ] . Lacking such adequate preventive interventions, nearly 45% of pregnant women in Africa are at risk of contracting malaria with approximately half developing placental malaria. This precipitates the devastating maternal and neonatal outcomes like infant anaemia, intrauterine growth restriction, preterm delivery, stillbirth and low birth weight [ 12 , 13 ] . Marital status is also a significant factor associated with the risk of malaria in pregnancy, whereby pregnant women who are married are less likely to get malaria compared to their unmarried counterparts [ 14 ] . Environmental conditions during the rainy season greatly increase mosquito breeding grounds. As a results, in settings where malaria transmission exhibit strong seasonality, pregnant women whose gestational period coincided predominantly with the rainy season are observed to have a significant higher likelihood of malaria infection than those whose pregnancies occurred mainly during the dry season [ 15 ] . Moreover, vegetation or bushy surroundings near a home constitute an independent risk factor for the likelihood of malaria during pregnancy [ 14 ] . Although overall malaria rates have declined in parts of Africa in recent years [ 16 ] , high transmission zones like Buea; a southern forested high-altitude town in Cameroon [ 17 ] , encounters distinctive impediments in the prevention and control of malaria. Also, where reliable data remains scarce, continue to endanger large numbers of expectant mothers, perpetuating cycles of malaria disease, morbidity, and mortality. Therefore, this study sought to determine the prevalence and risk factors of malaria in pregnancy among those who attended the antenatal clinic at the Buea Regional Hospital, South West region of Cameroon. METHODS Study Area This study was conducted at the Buea Regional Hospital found in the Buea Health District, Fako Division of the South-West Region of Cameroon. Buea harbours 85 villages with a population of 184,601. Buea Regional Hospital is situated at latitude 4.1482 o North and longitude 9.23653 o East of the Greenwich Meridian and lies at 900m above sea level [18] . Buea has a surface area of 870 square kilometres with a humid tropical climate characterised by an average annual rainfall of about 3000 to 5000 mm and an average annual temperature of 20 o C to 25 o C [18] . Study population This study examined archival records of attendees of antenatal clinics at Buea Regional Hospital for the period January 2018 to December 2022, regardless of gestation age. Ethical Statement: Ethical clearance was obtained from the Faculty of Health Sciences Institutional Review Board (FHSIRB) of the University of Buea, ref. No. 2023/2024-03/UB/SG/IRB/FHS with additional approvals from the South West Regional Delegation of Public Health and the Buea Regional Hospital. Informed consent was waived as this was a retrospective study. Steps were taken to ensure confidentiality: anonymous data entry, password-protected storage in computer, and access restricted to both digital and physical records. Study Design This hospital-based retrospective study analyzed ANC logbook records from January 2018 to December 2022. The data collected were demographic and clinical information, including season of diagnosis, maternal and gestational age, marital status, gravidity, LLIN possession, and IPTp doses in order to assess malaria trends. All pregnant women whose records met the inclusion criteria were chosen in order to present the prevalence of malaria among pregnant women who attended ANC at Buea Regional Hospital from 2018 to 2022. Study periods The study reviewed ANC logbook data from January 2018 to December 2022, assessing a five-year trend in malaria prevalence and risk factors among pregnant women at Buea Regional Hospital. Sample size determination This was an exhaustive review of records of all pregnant women registered in the ANC logbooks at Buea Regional Hospital from January 2018 to December 2022, who met the inclusion criteria. Inclusion and Exclusion Criteria Inclusion criteria: All pregnant women whose records were recorded in the ANC logbook at Buea Regional Hospital with complete and legible information from January 2018 to December 2022. Exclusion criteria: Pregnant women whose records were registered in the ANC logbooks with incomplete or illegible information during the same period were excluded from the study. Data Collection Procedures Malaria prevalence from January 2018 to December 2022 was obtained by extracting data from ANC logbooks at the Buea Regional Hospital using a Microsoft Excel 2013 data extraction sheet. Data on demography, malaria prevention, date of diagnosis, age, marital status, gravidity, gestational age, malaria results, LLIN possession, and IPTp doses were obtained. Data management and statistical analysis The data were entered daily into Microsoft Excel 2013. Consistency and accuracy checks were done periodically. The data was backed-up in external devices and sent through email. Data were analyzed using SPSS version 25. Inconsistencies, missing values, and proper coding of variables were checked. The maternal age, marital status, gravidity, gestational age, malaria results, and IPTp doses were considered in the analysis. The prevalence of malaria was calculated per year and overall. Fisher's Exact Test and Chi-Square (x 2 ), were used to determine associations at a significant level of P < 0.05. Logistic regression was used to calculate infection odds. RESULTS Malaria Prevalence and trends in pregnant women who attended antenatal clinic at the Buea Regional Hospital from 2018 - 2022 One thousand two hundred (1,200) pregnant women with complete records from the registration logbooks between January 2018 and December 2022 were included in this study. Of this number, 153 were diagnosed with malaria, giving an overall prevalence of 12.85%. The yearly prevalence calculated from the data showed that the prevalence was 14% (28/200) in 2018; 20.6% (40.7/198) in 2019; 15.7% (34/216) in 2020; 9% (25/266) in 2021 and 8% (25/308) in 2022. Malaria prevalence increased from 14% in 2018 to 21% in 2019 and steadily decreased to 8% in 2022 (figure 1) Risk factors associated with malaria in pregnant women who attended ANC at the Buea Regional Hospital (2018 -2022). Maternal age significantly influenced the prevalence of malaria as indicated in figure 2 and Table 1. Prevalence was highest among pregnant women aged 15-19 years (19.3%) and lowest among those 35years (8.8%) and above (X 2 = 10.13 a N =152, P = 0.038). The prevalence of malaria varied significantly by gestational age, with 15.1% (119/790) in the second trimester, compared to 10.3% (17/165) in the first trimester and 8.2% (17/207) in the third trimesters (X 2 = 8.113 a P = 0.017; Table 1, figure 3). Table 1: The Contingency Table of Bivariate Analysis of Association Between Maternal Characteristics and Percentage Positivity of Malaria Stratified by Year of Occurrence (2018–2022) Variable Total percentage (%) positivity of malaria Percentage (%) positivity of malaria per year of occurrence Pearson Chi Square test. 2018 2019 2020 2021 2022 Maternal age X 2 =10.13 a P = 0.038 n =152 df = 4 15-19 19.3(16/83) 25.0(3/12) 30.8(4/13) 21.4(3/14) 13.0(3/23) 14.3(3/21) 20-24 15.0(45/301) 17.3(9/52) 23.8(10/42) 21.8(12/55) 12.2(9/74) 6.4(5/78) 25-29 13.4(57/427) 15.8(12/76) 21.3(16/75) 13.5(10/74) 9.6(9/94) 9.3(10/108) 30-34 8.6(22/251) 9.3(4/43) 17.4(8/46) 8.5(4/47) 4.2(2/48) 6.0(4/67) >=35 8.8(12/136) 0.0(0/18) 12.5(3/24) 18.5(5/27) 3.8(1/26) 7.3(3/41) Total 12.7(152/1198) 13.9(28/201) 18.5(37/200) 15.7(34/217) 9.1(24/265) 7.9(25/315) Marital status X 2 =3.677 a P=0.452 n=149 df=1 Married 12.1(86/711) 10.2(13/128) 19.4(25/129) 16.2(22/136) 6.8(10/146) 9.3(16/172) Unmarried 14.5(63/434) 20.5(15/73) 21.0(13/62) 14.5(11/76) 13.8(15/109) 7.9(9/114) Total 13.0(149/1145) 13.9(28/201) 19.9(38/191) 15.6(33/212) 9.8(25/255) 8.7(25/286) Gravida χ² = 0.5633 p = 0.7545 n= 152 df=2 Primigravid 13.7(54/394) 15.9(11/69) 27.3(15/55) 15.5(11/71) 10.1(9/89) 7.3(8/110) Secundigravid 12.4(42/338) 9.5(6/63) 17.2(10/58) 17.2(11/64) 14.1(10/71) 6.1(5/82) Multigravid 12.0(56/465) 16.2(11/68) 18.4(16/87) 14.5(12/83) 4.8(5/104) 9.8(12/123) total 12.7(152/1197) 14(28/200) 20.5(41/200) 15.6(34/218) 9.1(24/264) 7.9(25/315) Gestational age χ² = 8.113 a p= 0.017 n = 153 df = 2 First trimester 10.3(17/165) 13.6(3/22) 16.7(4/24) 17.2(5/29) 5.6(2/36) 5.6(3/54) Second trimester 15.1(119/790) 17.0(24/141) 22.7(32/141) 14.6(21/144) 12.7(21/165) 10.6(21/199) Third trimester 8.2(17/207) 2.9(1/35) 15.6(5/32) 21.6(8/37) 3.5(2/57) 2.2(1/46) total 13.2(153/1162) 14.1(28/198) 23.4(46/197) 16.2(34/210) 9.7(25/258) 8.4(25/299) LLIN χ² =2.2137 p = 0.697 df=4 n = 1190 Yes 13.1(147/1125) 14.0(27/193) 21.1(41/194) 15.5(32/207) 9.8(23/234) 8.8(24/297) No 7.7(5/65) 12.5(1/8) 0.0(0/6) 18.2(2/11) 4.5(1/22) 5.6(1/18) Total 12.8(152/1190) 13.9(28/201) 20.5(41/200) 15.6(34/218) 9.4(24/256) 7.9(25/315) IPT χ² =24.709 p = 0.0017 df=8 n = 152 0 10.0 (9/91) 11.8(2/17) 5.9(1/7) 13.6(3/22) 6.7(1/15) 6.7(2/30) 1 12.8(22/172) 14.8(6/42) 26.3(10/38) 6.7(2/30) 9.7(3/31) 3.2(1/31) 2 15.0(35/234) 20.3(12/59) 16.1(9/56) 9.7(3/31) 7.7(3/39) 16.3(8/49) 3 12.9(56/435) 9.6(8/83) 23.6(21/89) 19.5(17/87) 5.8(6/104) 5.6(4/72) 4 12.6(29/230) 0 0 19.1(9/47) 17.8(10/57) 7.9(10/126) 5 3.7(1/27) 0 0 0.0(0/1) 5.3(1/19) 0.0(0/7) Total 12.7(152/1199) 13.9(28/201) 20.5(41/200) 15.6(34/218) 9.1(24/265) 7.9(25/315) Regression analysis. A multivariate logistic regression analysis revealed a significant effect on women aged 35 years and older had 98% higher adjusted odds of malaria infection compared to adolescents aged 15-19 years (OR=1.98, p=0.039). Multigravid women (≥3 pregnancies) had 2.2 times higher odds of malaria than primigravid women (first pregnancy) (OR=2.21, p=0.020). LLIN users had 55% lower odds of malaria infection compared to non-users (OR=0.45, p=0.001). Women receiving 3 IPTp doses had 56% lower odds of malaria than those receiving no doses (OR=0.44, p=0.044). Married women had 29% lower odds of malaria than unmarried women (OR=0.71, p=0.006). As for gestational age, though not statistically significant, the results indicates that pregnant women in the second (OR=0.794, p=0.462) and third trimester (OR=0.889, p=0.704) had approximately 20.6% and 11.1% lower odds of malaria infection compared to those of the first trimester respectively. Table 2: Multivariate Logistic Regression Analysis of Factors Associated with Malaria Positivity Among Pregnant Women (2018–2022) Variables Category B [95% CI for OR] S.E. (B) Wald Adjusted Odd Ratio Age (years) 15-19 - - - 1.000 20-24 0.152 [0.621-2.182] 0.321 0.224 1.164 25-29 0.287 [0.691-2.568] 0.335 0.734 1.332 30-34 0.403 [0.750-2.985] 0.352 1.313 1.496 ≥35 0.685 [1.037-3.797] 0.331 4.282* 1.984 Marital status Unmarried - - - 1.000 Married -0.338 [0.561-0.906] 0.122 7.672** 0.713 Gravidity Primigravid - - - 1.000 Secundigravid 0.412 [0.858-2.657] 0.288 2.046 1.510 Multigravid 0.793 [1.131-4.321] 0.342 5.374* 2.211 Gestational age 1st trimester - - - 1.000 2nd trimester (2) -0.231 [0.429-1.470] 0.314 0.541 0.794 3rd trimester (3) -0.118 [0.483-1.635] 0.311 0.144 0.889 LLIN possession No - - - 1.000 Yes -0.805 [0.280-0.714] 0.239 11.354*** 0.447 IPTp doses 0 - - - 1.000 1 -0.215 [0.358-1.818] 0.414 0.270 0.807 2 -0.458 [0.275-1.452] 0.424 1.168 0.632 3 -0.812 [0.201-0.979] 0.403 4.056* 0.444 4 -0.213 [0.210-1.052] 0.404 0.630 0.146 5 -0.713 [0.210-1.241] 0.413 2.018 0.035 Constant -2.105 0.612 11.823 0.122 Hosmer-Lemeshow Test: = 6.93, p = 0.543 R 2 = 0.078 (Cox and Snell), 0.192 (Negelkerke), -2 Log likelihood: 622.8 *P < 0.05, **P < 0.01, ***P < 0.001. +-95% C.I. for EXP (B DISCUSSIONS This study investigated malaria prevalence and its risk factors among pregnant women who attended antenatal care at Buea Regional Hospital, Cameroon. The findings indicated an overall malaria prevalence of 12.85% from 2018 to 2022, slightly exceeding the 12% reported in Nkongho-Mbeng [19] . The peak prevalence (20.6%) occurred in 2019, coinciding with the socio-political crisis, which likely disrupted malaria prevention and control measures. In contrast, during the same period, the prevalence of malaria in the Far North region declined [20] . The apparent rise in prevalence in Buea could be attributed to reduced access to health care facilities due to the insecurity as a result of the crisis. From 2019 onwards, malaria prevalence was on a declining trend, thus reaching 8.1% by the year 2022. The trend is consistent with the result obtained by Kamau et al. [16] , who recorded a decline in malaria across sub-Saharan Africa. The decline could be due to increased uptake of IPTp and usage of LLINs by pregnant women. This trend is also in line with the WHO's Global Technical Strategy for Malaria 2016–2030, which has the goal of reducing malaria incidence and mortality by 90% by the year 2030 [21] . This trend differs from the findings of the Institut National de la Statistique (INS) du Cameroun [6] , which reported an increase in malaria morbidity among pregnant women from about 13% in 2013 to 26% in 2021. This disparity may have stemmed from the circumstance that the research is confined to hospital-based observations rather than encompassing a comprehensive nationwide analysis. The bivariate analysis (Table 1), which assessed the relationship between maternal characteristics and malaria infection in this study showed a significant association between maternal age and malaria positivity. The youngest group of pregnant women (15-19 years) recorded the highest positivity rate at 19.3% (16/83), and ≥35 years of group recorded the lowest rate at 8.8% (12/136). Nonetheless, this type of analysis evaluated each variable in isolation and did not adjust for confounding factors. Therefore, multivariate logistic regression (Table 2) offered a more robust and realistic assessment as it controlled for multiple variables simultaneously of the independent effects of maternal age on malaria risk. The multivariate logistic regression analysis showed a significant effect on women aged 35 years and older had 98% higher odds of malaria infection compared to adolescents aged 15-19 years (OR=1.98, p=0.039). This may be possibly due to weakened immunity with age. This differs with reports from studies by Gontie et al . [22] , Abu Bonsra et al [23] and Yaro et al . [24] who stated that the rate of malaria is lower in older pregnant women than younger ones. Multigravid women (≥3 pregnancies) had 2.2 times higher odds of malaria than primigravid women (first pregnancy) (OR=2.21, p=0.020). Repeated pregnancies appear to increase susceptibility, possibly due to pregnancy-related immune modulation. This contradicts findings by Tadesse et al. [25] who reported highest prevalence of malaria in younger pregnant women in Ethiopia. This study highlights that LLIN users had 55% lower odds of malaria infection compared to non-users (AOR=0.45, p=0.001). And the study also revealed that LLINs reduce infection risk by >50%. This study is also in line with that conducted by Abu Bonsra et al [23] , who reported that women not sleeping under insecticide treated bed nets were 20 times more likely to have high prevalence of malaria than those who used them. Insecticide-treated nets remain highly effective prevention tools. Scaling up LLIN coverage could substantially reduce malaria burden in pregnant women. Women receiving 3 IPTp doses had 56% lower odds of malaria than those receiving no doses (OR=0.44, p=0.044) and complete IPTp (3 doses) provides similar protection magnitude. This study is in line with that carried out by Abu Bonsra et al [23] , which stated that malaria during pregnancy is significantly higher among women who had not receive any dose of IPTp (OR = 7.0, 95% CI [3.1-9.02], p=0.001; AOR=5.0, 95% CI [2.03-7.3], p=0.000). The logistic regression also revealed that married women had 29% lower oddsof malaria than unmarried women (AOR=0.71, p=0.006). this study is in line with that conducted elsewhere in Africa by Abu Bonsra et al [14, 23] , who reported that unmarried women were 3.17 time more likely to have malaria compared to married women. Marital status may serve as a proxy for socioeconomic stability, healthcare access, or household support systems that facilitate prevention behaviours. The contingency table showed that the prevalence of malaria in relation to the gestational age, was significantly higher in the second trimester at 15.1% (119/790) compared to 10.3% (17/165) in the first trimester and 8.2% (17/207) in the third trimesters (X 2 = 8.113 a P = 0.017; Table 1, figure 3) but adjusted odd ratio showed that gestational age was not statistically significant. The results indicates that pregnant women in the second (OR=0.794, p=0.462) and third trimester (OR=0.889, p=0.704) had approximately 20.6% and 11.1% lower odds of malaria infection compared to those of the first trimester respectively. Strengths and Limitations of the study. One of the strengths of this study is that the Buea Regional Hospital ANC clinic is attended by a large majority of pregnant women seeking antenatal care within the Buea Health District. The results obtained can be generalized. Secondly, women of all reproductive age groups (15 – 45) were represented in this study, thus, the results provide a general overview of malaria trends in the Health District and also provide a valuable local data on malaria prevalence and risk factors specific to pregnant women at Buea Regional Hospital. These findings can be useful in informing and modifying NMCP strategies for improved malaria control. These notwithstanding, this retrospective study is confined to hospital-based observations potentially limiting its generalizability compared to a comprehensive nationwide analysis. Secondly, the sample may not fully represent all pregnant women, as it focuses on those attending antenatal care, potentially missing those with limited access. The data presented here accurately reflect the ANC records at Buea Regional Hospital and provide useful lessons based on routine clinical observations within the limitations imposed. CONCLUSIONS The overall prevalence of malaria amongst the pregnant women who attended antenatal care at the Buea Regional Hospital for the five years (January 2018 to December 2022) was 12.85%. Malaria prevalence increased from 14% in 2018 and peaked at 20.6% in 2019, coinciding with sociopolitical crisis but decreased steadily to 8% in 2022. The key (major) risk factors were age (women over 35 had higher odds), and marital status (unmarried women had higher odds). Protective factors included LLIN use (55% lower odds) and IPTp with 3 doses (56% lower odds). This study suggests that scaling up LLIN coverage and IPTp could largely reduce malaria prevalence, though the crisis-related reduction in healthcare access likely contributed to the initial prevalence rise. Abbreviations ANC: Antenatal clinic; AOR: Adjusted Odd Ratio; FHSIRB: Faculty of Health Sciences Institutional Review Board; LLINs: Long lasting insecticidal nets; NMCP: National malaria control program; P: Plasmodium ; PMI: US President Malaria Initiative; SPSS: Statistical Package for the Social Sciences; VAR2CSA: Variant Surface Antigen; WHO: World Health Organisation Declarations Conflicts of Interest The authors declare no conflict of interest. Source of funding The authors received no financial support for the research, authorship, and/or publication of this article. Disclaimer The perspectives and opinions presented in this article are solely those of the authors and stem from rigorous academic research. They do not necessarily represent the official stance or policies of any affiliated institution, funding body, agency, or publisher. The authors assume full responsibility for the research outcomes, findings, and content of this article. Author Contribution Buh ELvis Wung (B.E.W.) wrote the main manuscript text and prepared figures 1-3 and tables 1-2.ESUM EYONG MATHIAS (E.M.E.) carefully reviewed the manuscript, provided constructive criticism, and made necessary corrections to ensure accuracy.ROLAND NDIP NDIP (R.N.N.) reviewed the manuscript.All authors read and approved the final manuscript. ACKNOWLEDGMENTS We are grateful to Dr. Ronald Gobina, the Medical Adviser of the Buea Regional Hospital for granting us permission to collect data for this study from his health facility. Data Availability The data that support the findings of this study were generated from antenatal clinic registration logbooks at Buea Regional Hospital, South West Region of Cameroon. Restrictions apply to the availability of these data due to patient privacy and ethical considerations, and so they are not publicly available. the data are however available from the corresponding author upon reasonable request and with permission from Buea Regional Hospital. References Cox F, E. History of the Discovery of the Malaria Parasites and their Vectors. Parasites Vectors. 2010;3(1):5. W.H.O [World Health Organisation]. (2022a). World Malaria Report 2022. Geneva: World Health Organisation. Available at www.who.int. Accessed 02nd February, 2023. Time 10:00 am. Jhpiego. 2021, Prevention and control of malaria during pregnancy: reference manuala. Chua C, L L, Khoo S, K M, Ong J, L E, Ramireddi G, Yeo K, T, W and, Teo A. Malaria in Pregnancy: from placental infection to its abnormal development and damage. Front Microbiol. 2021;12:777343. W.H.O [World Health Organisation]. (2022b) Mobilizing communities to help prevent and control malaria in Cameroon. Available at www.who.int. 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Centers for Disease Control and Prevention (CDC). (2020). Malaria. DPDx- Laboratory Identification of Parasites of Public Health Concern. Available at www.cdc.gov. Accessed on 04th January 2023. 01: 00 pm. Kabaria C, Gilbert W, Noor M, Snow AM, R, W. and, Linard C. The impact of urbanization and population density on childhood Plasmodium falciparum parasite prevalence rates in Africa. Malar J. 2017;16:49. Walker P, Ter Kuile G, Garske FO, Menendez T, Ghani C A, C. Estimated risk of placental infection and low birthweight attributable to Plasmodium falciparum malaria in Africa in 2010: a modelling study. Lancet Global Health. 2014;2:e460–7. Rogerson S, Desai J, Mayor M, Sicuri A, Taylor E, Van Eijk SM A, M. Burden, pathology, and costs of malaria in pregnancy: new developments for an old problem. Lancet Infect Disease. 2018;18:e107–18. Anchang Kimbi J, Nkweti K, Ntonifor VN, Apinjoh HN, Tata TO, Chi RB H, R., and, Achidi E, A. Plasmodium falciparum parasitaemia and malaria among pregnant women at first clinic visit in the mount Cameroon Area. BMC Infect Dis. 2015;15:439. Isha B, Patrick W, Harry T, Kalifa B, Sheick O, Kassoum C, John K, Abraham W, Paul O, Daniel M, Brian C G., and Matthew C. Seasonal Dynamics of Malaria in Pregnancy in West Africa: Evidence for Carriage of Infections Acquired Before Pregnancy Until First Contact with Antenatal Care. Am J Trop Med Hyg. 2017;4(2):534–42. Kamau A, Mogeni P, Okiro E, Snow A, R, W and, Bejon P. A systematic review of changing malaria burden in sub-Saharan Africa since 2000: comparing model predictions and empirical observations. BMC Med. 2020;18:94. Antonio-Nkondjio C, Ndo C, Njiokou F, Bigoga J, Awono D, Etang AP, Ekobo J., A, S. and, Wondji C, S. Review of malaria situation in Cameroon: technical viewpoint on challenges and prospects for disease elimination. Parasites Vectors. 2019;12:50125. Buea Regional Hospital. – Cameroon – Mapcarta . Available at mapcarta.com. Accessed on 24th May, 2023. Time 11: 59 am. Nyasa R, Awatboh B, Kwenti F, Titanji TE, P, K, V. and, Ayamba N, L M. The effects of climatic factors on the number of malaria cases in an inland and a costal setting from 2011 to 2017 in the equatorial rain forest of Cameroon. BMC Infect Dis. 2022;22:461. U.S. President’s Malaria Initiative [PMI}. Malaria Operational Plan Cameroon. USAID. Retrieved from www.pmi.gov. Accessed on 07th January 2023. Time. 2022;04:00am. W.H.O [World Health Organisation]. (2023) Malaria. Available at www.who.int. Accessed 09th May, 2023. Time 03: 40 am. Gontie G, Wolde B, Baraki HF, A, G. Prevalence and associated factors of malaria among pregnant women in Sherkole District, Benishangul Gumuz Regional state, West Ethiopia. BMC Infect Dis. 2020;20:573. Abu Bonsra E, Petra A, Adjei O, Adama KE, Akua S, G, S., and, Fafa E, K. Factors Associated with Malaria in Pregnancy Among Women Attending ANC Clinics in Selected Districts of the Ashanti Region, Ghana. Malar J. 2025;24:8. Yaro J, Ouedraogo B, Diarra A, Salif A, Ouedraogo S, Nébié AZ, Drakeley I, Sodiomon C, Tiono BS, Lindsay AB, S, T. and, Anne L, W. Risk factors for Plasmodium falciparum infection in pregnant women in Burkina Faso: a community-based cross-sectional survey. Malar J. 2021;20:362. Tadesse D, Eyob T, Dassalegn M, Asnake S. Malaria prevalence and risk factors among patients visiting Mizan Tepi University Teaching Hospital, Southwest Ethiopia. PLoS ONE. 2022;17(7):e02717. Additional Declarations No competing interests reported. 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1","display":"","copyAsset":false,"role":"figure","size":21971,"visible":true,"origin":"","legend":"\u003cp\u003eTrends of malaria prevalence in pregnant women who attended ANC at the Buea Regional Hospital from 2018-2022\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8427956/v1/fac2148a165da56b9e319a50.png"},{"id":99603190,"identity":"8dd7d9d2-1f19-4e9c-b683-06081d47602b","added_by":"auto","created_at":"2026-01-06 10:55:50","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":20698,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePrevalence of malaria with respect to maternal age.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8427956/v1/8c14767f5935ed4c4ccbc63a.png"},{"id":99792759,"identity":"def9f2b3-3b13-4548-8e8a-adfc499a622f","added_by":"auto","created_at":"2026-01-08 13:25:40","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":13170,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePrevalence of malaria with respect to gestational age.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-8427956/v1/7264e7a8db2cd256a6c84a83.png"},{"id":100356108,"identity":"0db4cec5-5379-4a88-af74-4a48b761b7c4","added_by":"auto","created_at":"2026-01-16 06:52:35","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1170080,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8427956/v1/bbd30f9a-f716-4134-804e-9553073cc966.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eMalaria Prevalence and Risk Factors Among Pregnant Women: A Retrospective Record Review at the Buea Regional Hospital, South West Region of Cameroon\u003c/p\u003e","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eMalaria is an ancient infectious disease caused by \u003cem\u003ePlasmodium\u003c/em\u003e, a parasitic protozoan \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. Plasmodium is transmitted through the bite of an infected blood-sucking arthropod insect, the female mosquito of the genus \u003cem\u003eAnopheles\u003c/em\u003e \u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. Malaria remains a paramount challenge within the realm of public health in sub-Saharan Africa, particularly in Cameroon. It disproportionately affects vulnerable populations such as pregnant women, children, and immunosuppressed individuals, despite global efforts to curb the spread of the infection \u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. Pregnant women infected with malaria suffer enormous health outcomes such as maternal anaemia and mortality, foetal growth restriction, abortion, pre-term delivery, still birth and low birth weight (LBW) \u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. According to the World Health Organization (WHO), there were an estimated 247\u0026nbsp;million cases worldwide in 2021, with Africa accounting for 95% of cases and 80% of deaths among children under five years old \u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. While malaria incidence in Africa had a downward trajectory from 2000 to 2019, COVID-19 pandemic reversed this progress, leading to a surge in cases and fatalities \u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. Globally, malaria fatalities rose to 625000 in 2020 before dipping slightly to 619000 in 2021, underscoring the fragility of control measures amid overlapping health crisis \u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. Four nations: Nigeria, the Democratic Republic of the Congo, Tanzania, and Niger, shoulder over half of the world\u0026rsquo;s malaria death in 2021. This highlights that the disease has a concentrated impact in Central Africa, exacerbating maternal and fetal health complications in already disadvantaged communities \u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. As one of the countries with highest malaria burdens globally, Cameroon accounted for approximately 2.7% of all cases and 2.3% of deaths in 2021 \u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. Case numbers stagnated until 2017 but surged by 3.6% in 2020 compared to 2011 baselines, while mortality declined by 7% in 2021 from the prior year; yet the disease persists as a daily threat, with around 6\u0026nbsp;million cases and 11000 deaths annually \u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. 125\u0026nbsp;million women globally become pregnant per annum in malaria endemic regions of the world \u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. Particularly alarming is the erratic rise in prevalence among pregnant women in Cameroon, escalating from 13% in 2013 to 26% in 2021\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eMalaria is endemic in Cameroon and exhibits significant regional variation, influenced by diverse ecological factors such as biotic and abiotic factors and socioeconomic factors such as education, age, income and housing conditions \u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e. Environmental factors such as vegetation index, altitude and climate drive the variation of malaria in Cameroon \u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e. Highland, forested, and high-altitude areas like Buea with high rainfall, humidity, and fluctuating temperatures foster ideal conditions for transmission, while urbanization and climate change further amplify endemicity \u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e. The southern forested zones experience intense, year-round transmission, contrasting with seasonal patterns in the northern savannah \u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. Factors of malaria in pregnancy include, gravidity with primigravid women being the most vulnerable due to lack of immunity \u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e. There is limited access to preventive measures like Insecticide treated nets (ITNs) and Intermittent preventive Treatment (IPTp) with sulfadoxine-pyrimethamine \u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. Lacking such adequate preventive interventions, nearly 45% of pregnant women in Africa are at risk of contracting malaria with approximately half developing placental malaria. This precipitates the devastating maternal and neonatal outcomes like infant anaemia, intrauterine growth restriction, preterm delivery, stillbirth and low birth weight \u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e. Marital status is also a significant factor associated with the risk of malaria in pregnancy, whereby pregnant women who are married are less likely to get malaria compared to their unmarried counterparts \u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e. Environmental conditions during the rainy season greatly increase mosquito breeding grounds. As a results, in settings where malaria transmission exhibit strong seasonality, pregnant women whose gestational period coincided predominantly with the rainy season are observed to have a significant higher likelihood of malaria infection than those whose pregnancies occurred mainly during the dry season \u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e. Moreover, vegetation or bushy surroundings near a home constitute an independent risk factor for the likelihood of malaria during pregnancy \u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eAlthough overall malaria rates have declined in parts of Africa in recent years \u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e, high transmission zones like Buea; a southern forested high-altitude town in Cameroon \u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e, encounters distinctive impediments in the prevention and control of malaria. Also, where reliable data remains scarce, continue to endanger large numbers of expectant mothers, perpetuating cycles of malaria disease, morbidity, and mortality. Therefore, this study sought to determine the prevalence and risk factors of malaria in pregnancy among those who attended the antenatal clinic at the Buea Regional Hospital, South West region of Cameroon.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003e\u003cstrong\u003eStudy Area\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted at the Buea Regional Hospital found in the Buea Health District, Fako Division of the South-West Region of Cameroon. Buea harbours 85 villages with a population of 184,601. Buea Regional Hospital is situated at latitude 4.1482\u003csup\u003eo\u003c/sup\u003e North and longitude 9.23653\u003csup\u003eo\u003c/sup\u003e East of the Greenwich Meridian and lies at 900m above sea level \u003csup\u003e[18]\u003c/sup\u003e. Buea has a surface area of 870 square kilometres with a humid tropical climate characterised by an average annual rainfall of about 3000 to 5000 mm and an average annual temperature of 20\u003csup\u003eo\u003c/sup\u003eC to 25\u003csup\u003eo\u003c/sup\u003eC \u003csup\u003e[18]\u003c/sup\u003e.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy population\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study examined archival records of attendees of antenatal clinics at Buea Regional Hospital for the period January 2018 to December 2022, regardless of gestation age.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Statement:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical clearance was obtained from the Faculty of Health Sciences Institutional Review Board (FHSIRB) of the University of Buea, ref. No. 2023/2024-03/UB/SG/IRB/FHS with additional approvals from the South West Regional Delegation of Public Health and the Buea Regional Hospital. Informed consent was waived as this was a retrospective study. Steps were taken to ensure confidentiality: anonymous data entry, password-protected storage in computer, and access restricted to both digital and physical records.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy Design\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis hospital-based retrospective study analyzed ANC logbook records from January 2018 to December 2022. The data collected were demographic and clinical information, including season of diagnosis, maternal and gestational age, marital status, gravidity, LLIN possession, and IPTp doses in order to assess malaria trends. All pregnant women whose records met the inclusion criteria were chosen in order to present the prevalence of malaria among pregnant women\u0026nbsp;who attended\u0026nbsp;ANC at Buea Regional Hospital from 2018 to 2022.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy periods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study reviewed ANC logbook data from January 2018 to December 2022, assessing a five-year trend in malaria prevalence and risk factors among pregnant women at Buea Regional Hospital.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample size determination\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis was an exhaustive review of records of all pregnant women registered in the ANC logbooks at Buea Regional Hospital from January 2018 to December 2022, who met the inclusion criteria.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion and Exclusion Criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInclusion criteria: All pregnant women whose records were recorded in the ANC logbook at Buea Regional Hospital with complete and legible information from January 2018 to December 2022.\u003c/p\u003e\n\u003cp\u003eExclusion criteria: Pregnant women whose records were registered in the ANC logbooks with incomplete or illegible information during the same period were excluded from the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Collection Procedures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMalaria prevalence from January 2018 to December 2022 was obtained by extracting data from ANC logbooks at the Buea Regional Hospital using a Microsoft Excel 2013 data extraction sheet. Data on demography, malaria prevention, date of diagnosis, age, marital status, gravidity, gestational age, malaria results, LLIN possession, and IPTp doses were obtained.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData management and statistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data were entered daily into Microsoft Excel 2013. Consistency and accuracy checks were done periodically. The data was backed-up in external devices and sent through email. Data were analyzed using SPSS version 25. Inconsistencies, missing values, and proper coding of variables were checked. The maternal age, marital status, gravidity, gestational age, malaria results, and IPTp doses were considered in the analysis. The prevalence of malaria was calculated per year and overall. Fisher's Exact Test and Chi-Square (x\u003csup\u003e2\u003c/sup\u003e), were used to determine associations at a significant level of P \u0026lt; 0.05. Logistic regression was used to calculate infection odds.\u0026nbsp;\u003c/p\u003e"},{"header":"RESULTS ","content":"\u003cp\u003e\u003cstrong\u003eMalaria Prevalence and trends in pregnant women who attended antenatal clinic at the Buea Regional Hospital from 2018 - 2022\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOne thousand two hundred (1,200) pregnant women with complete records from the registration logbooks between January 2018 and December 2022 were included in this study. Of this number, 153 were diagnosed with malaria, giving an overall prevalence of 12.85%. The yearly prevalence calculated from the data showed that the prevalence was 14% (28/200) in 2018; 20.6% (40.7/198) in 2019; 15.7% (34/216) in 2020; 9% (25/266) in 2021 and 8% (25/308) in 2022. Malaria prevalence increased from 14% in 2018 to 21% in 2019 and steadily decreased to 8% in 2022 (figure 1)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRisk factors associated with malaria in pregnant women who attended ANC at the Buea Regional Hospital (2018 -2022).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMaternal age significantly influenced the prevalence of malaria as indicated in figure 2 and Table 1. Prevalence was highest among pregnant women aged 15-19 years (19.3%) and lowest among those 35years (8.8%) and above (X\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e= 10.13\u003csup\u003ea\u0026nbsp;\u003c/sup\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003eN =152, P = 0.038).\u003c/p\u003e\n\u003cp\u003eThe prevalence of malaria varied significantly by gestational age, with 15.1% (119/790) in the second trimester, compared to 10.3% (17/165) in the first trimester and 8.2% (17/207) in the third trimesters (X\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e= 8.113\u003csup\u003ea\u003c/sup\u003e P = 0.017; Table 1, figure 3).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1: \u003cem\u003eThe Contingency Table of\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003eBivariate Analysis of Association Between Maternal Characteristics and Percentage Positivity of Malaria\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003eStratified by Year of Occurrence (2018\u0026ndash;2022)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"969\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003eTotal percentage (%) positivity of malaria\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 572px;\"\u003e\n \u003cp\u003ePercentage (%) positivity of malaria per year of occurrence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003ePearson Chi Square test.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e2018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e2019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e2020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e2022\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMaternal age\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"7\" valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003eX\u003csup\u003e2\u003c/sup\u003e=10.13\u003csup\u003ea\u0026nbsp;\u003c/sup\u003e\u003cstrong\u003eP = 0.038\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003en =152 df = 4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e15-19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e19.3(16/83)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e25.0(3/12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e30.8(4/13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e21.4(3/14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e13.0(3/23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e14.3(3/21)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e20-24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e15.0(45/301)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e17.3(9/52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e23.8(10/42)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e21.8(12/55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e12.2(9/74)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e6.4(5/78)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e25-29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e13.4(57/427)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e15.8(12/76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e21.3(16/75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e13.5(10/74)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e9.6(9/94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e9.3(10/108)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e30-34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e8.6(22/251)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e9.3(4/43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e17.4(8/46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e8.5(4/47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e4.2(2/48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e6.0(4/67)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e\u0026gt;=35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e8.8(12/136)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e0.0(0/18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e12.5(3/24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e18.5(5/27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e3.8(1/26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e7.3(3/41)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eTotal\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e12.7(152/1198)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e13.9(28/201)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e18.5(37/200)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e15.7(34/217)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e9.1(24/265)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e7.9(25/315)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003eX\u003csup\u003e2\u003c/sup\u003e=3.677\u003csup\u003ea\u0026nbsp;\u003c/sup\u003eP=0.452\u003c/p\u003e\n \u003cp\u003en=149 df=1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e12.1(86/711)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e10.2(13/128)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e19.4(25/129)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e16.2(22/136)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e6.8(10/146)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e9.3(16/172)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eUnmarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e14.5(63/434)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e20.5(15/73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e21.0(13/62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e14.5(11/76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e13.8(15/109)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e7.9(9/114)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e13.0(149/1145)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e13.9(28/201)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e19.9(38/191)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e15.6(33/212)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e9.8(25/255)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e8.7(25/286)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGravida\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u0026chi;\u0026sup2; = 0.5633 \u003cstrong\u003ep = 0.7545\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en=\u0026nbsp;\u003c/strong\u003e152 df=2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003ePrimigravid\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e13.7(54/394)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e15.9(11/69)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e27.3(15/55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e15.5(11/71)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e10.1(9/89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e7.3(8/110)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eSecundigravid\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e12.4(42/338)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e9.5(6/63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e17.2(10/58)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e17.2(11/64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e14.1(10/71)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e6.1(5/82)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eMultigravid\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e12.0(56/465)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e16.2(11/68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e18.4(16/87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e14.5(12/83)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e4.8(5/104)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e9.8(12/123)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003etotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e12.7(152/1197)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e14(28/200)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e20.5(41/200)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e15.6(34/218)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e9.1(24/264)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e7.9(25/315)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGestational age\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u0026chi;\u0026sup2; = 8.113\u003csup\u003ea\u003c/sup\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003cstrong\u003ep= 0.017\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003en = 153 df = 2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eFirst trimester\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e10.3(17/165)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e13.6(3/22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e16.7(4/24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e17.2(5/29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e5.6(2/36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e5.6(3/54)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eSecond trimester\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e15.1(119/790)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e17.0(24/141)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e22.7(32/141)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e14.6(21/144)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e12.7(21/165)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e10.6(21/199)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eThird trimester\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e8.2(17/207)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e2.9(1/35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e15.6(5/32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e21.6(8/37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e3.5(2/57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e2.2(1/46)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003etotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e13.2(153/1162)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e14.1(28/198)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e23.4(46/197)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e16.2(34/210)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e9.7(25/258)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e8.4(25/299)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLLIN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u0026chi;\u0026sup2; =2.2137 \u003cstrong\u003ep =\u0026nbsp;\u003c/strong\u003e0.697\u003c/p\u003e\n \u003cp\u003edf=4 n = 1190\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\u0026nbsp;\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e13.1(147/1125)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e14.0(27/193)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e21.1(41/194)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e15.5(32/207)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e9.8(23/234)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e8.8(24/297)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e7.7(5/65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e12.5(1/8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e0.0(0/6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e18.2(2/11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e4.5(1/22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e5.6(1/18)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e12.8(152/1190)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e13.9(28/201)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e20.5(41/200)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e15.6(34/218)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e9.4(24/256)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e7.9(25/315)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIPT\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"8\" valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u0026chi;\u0026sup2; =24.709 \u003cstrong\u003ep = 0.0017\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003edf=8 n = 152\u003c/p\u003e\u0026nbsp;\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e10.0 (9/91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e11.8(2/17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e5.9(1/7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e13.6(3/22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e6.7(1/15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e6.7(2/30)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e12.8(22/172)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e14.8(6/42)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e26.3(10/38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e6.7(2/30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e9.7(3/31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e3.2(1/31)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e15.0(35/234)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e20.3(12/59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e16.1(9/56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e9.7(3/31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e7.7(3/39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e16.3(8/49)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e12.9(56/435)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e9.6(8/83)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e23.6(21/89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e19.5(17/87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e5.8(6/104)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e5.6(4/72)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e12.6(29/230)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e19.1(9/47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e17.8(10/57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e7.9(10/126)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e3.7(1/27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e0.0(0/1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e5.3(1/19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e0.0(0/7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eTotal\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e12.7(152/1199)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e13.9(28/201)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e20.5(41/200)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e15.6(34/218)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e9.1(24/265)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e7.9(25/315)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eRegression analysis.\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA\u0026nbsp;multivariate logistic regression analysis revealed a significant effect on women aged 35 years and older had 98% higher adjusted odds of malaria infection compared to adolescents aged 15-19 years (OR=1.98, p=0.039). Multigravid women (\u0026ge;3 pregnancies) had 2.2 times higher odds of malaria than primigravid women (first pregnancy) (OR=2.21, p=0.020). LLIN users had 55% lower odds of malaria infection compared to non-users (OR=0.45, p=0.001). Women receiving 3 IPTp doses had 56% lower odds of malaria than those receiving no doses (OR=0.44, p=0.044). Married women had 29% lower odds of malaria than unmarried women (OR=0.71, p=0.006). As for gestational age, though not statistically significant, the results indicates that pregnant women in the second (OR=0.794, p=0.462) and third trimester (OR=0.889, p=0.704) had approximately 20.6% and 11.1% lower odds of malaria infection compared to those of the first trimester respectively.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2:\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003eMultivariate\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;Logistic Regression Analysis of Factors Associated with Malaria Positivity Among Pregnant Women\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003e(2018\u0026ndash;2022)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"711\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eB [95% CI for OR]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eS.E. (B)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eWald\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdjusted Odd Ratio\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e15-19\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e20-24\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.152 [0.621-2.182]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.321\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.224\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.164\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e25-29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.287 [0.691-2.568]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.335\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.734\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.332\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e30-34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.403 [0.750-2.985]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.352\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.313\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.496\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026ge;35\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.685 [1.037-3.797]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.331\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.282*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.984\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eUnmarried\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMarried\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-0.338 [0.561-0.906]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.122\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7.672**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.713\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eGravidity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePrimigravid\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSecundigravid\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.412 [0.858-2.657]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.288\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.046\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.510\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMultigravid\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.793 [1.131-4.321]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.342\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.374*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.211\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eGestational age\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1st trimester\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2nd trimester (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-0.231 [0.429-1.470]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.314\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.541\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.794\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3rd trimester (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-0.118 [0.483-1.635]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.311\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.144\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.889\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eLLIN possession\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-0.805 [0.280-0.714]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.239\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11.354***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.447\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIPTp doses\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e0\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-0.215 [0.358-1.818]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.414\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.270\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.807\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-0.458 [0.275-1.452]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.424\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.168\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.632\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-0.812 [0.201-0.979]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.403\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.056*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.444\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-0.213 [0.210-1.052]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.404\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.630\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.146\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-0.713 [0.210-1.241]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.413\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.035\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eConstant\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-2.105\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.612\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11.823\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.122\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eHosmer-Lemeshow Test:\u0026nbsp;\u003cimg width=\"15\" height=\"18\" src=\"data:image/png;base64,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\" alt=\"image\"\u003e\u0026nbsp;= 6.93, p = 0.543 \u0026nbsp; \u0026nbsp;R\u003csup\u003e2\u003c/sup\u003e =\u0026nbsp;0.078\u0026nbsp;(Cox and Snell), 0.192 (Negelkerke),\u0026nbsp;-2 Log likelihood: 622.8\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e*P \u0026lt; 0.05, **P \u0026lt; 0.01, ***P \u0026lt; 0.001.\u003c/p\u003e\n\u003cp\u003e+-95% C.I. for EXP (B\u003c/p\u003e"},{"header":"DISCUSSIONS","content":"\u003cp\u003eThis study investigated malaria prevalence and its risk factors among pregnant women who attended antenatal care at Buea Regional Hospital, Cameroon. The findings indicated an overall malaria prevalence of 12.85% from 2018 to 2022, slightly exceeding the 12% reported in Nkongho-Mbeng \u003csup\u003e[19]\u003c/sup\u003e. The peak prevalence (20.6%) occurred in 2019, coinciding with the socio-political crisis, which likely disrupted malaria prevention and control measures. In contrast, during the same period, the prevalence of malaria in the Far North region declined \u003csup\u003e[20]\u003c/sup\u003e. The apparent rise in prevalence in Buea could be attributed to reduced access to health care facilities due to the insecurity as a result of the crisis. From 2019 onwards, malaria prevalence was on a declining trend, thus reaching 8.1% by the year 2022. The trend is consistent with the result obtained by Kamau \u003cem\u003eet al.\u003c/em\u003e\u0026nbsp; \u0026nbsp;\u003csup\u003e[16]\u003c/sup\u003e, who recorded a decline in malaria across sub-Saharan Africa. The decline could be due to increased uptake of IPTp and usage of LLINs by pregnant women. This trend is also in line with the WHO's Global Technical Strategy for Malaria 2016–2030, which has the goal of reducing malaria incidence and mortality by 90% by the year 2030\u003csup\u003e[21]\u003c/sup\u003e. This trend differs from the findings of the Institut National de la Statistique (INS) du Cameroun \u003csup\u003e[6]\u003c/sup\u003e, which reported an increase in malaria morbidity among pregnant women from about 13% in 2013 to 26% in 2021. This disparity may have stemmed from the circumstance that the research is confined to hospital-based observations rather than encompassing a comprehensive nationwide analysis.\u003c/p\u003e\n\u003cp\u003eThe bivariate analysis (Table 1), which assessed the relationship between maternal characteristics and malaria infection in this study showed a significant association between maternal age and malaria positivity. The youngest group of pregnant women (15-19 years) recorded the highest positivity rate at 19.3% (16/83), and ≥35 years of group recorded the lowest rate at 8.8% (12/136). Nonetheless, this type of analysis evaluated each variable in isolation and did not adjust for confounding factors. Therefore, multivariate logistic regression (Table 2) offered a more\u0026nbsp;robust and realistic assessment as it controlled for multiple variables simultaneously of the independent effects of maternal age on malaria risk.\u0026nbsp;The\u0026nbsp;multivariate\u0026nbsp;logistic\u0026nbsp;regression analysis showed a significant effect on\u0026nbsp;women\u0026nbsp;aged\u0026nbsp;35\u0026nbsp;years and older had\u0026nbsp;98% higher odds\u0026nbsp;of malaria infection compared to adolescents aged 15-19 years (OR=1.98, p=0.039). This may be possibly due to weakened immunity with age. This differs with reports from studies by Gontie \u003cem\u003eet al\u003c/em\u003e. \u003csup\u003e[22]\u003c/sup\u003e, Abu Bonsra\u0026nbsp;\u003cem\u003eet al\u0026nbsp;\u003c/em\u003e\u003csup\u003e[23]\u003c/sup\u003eand Yaro \u003cem\u003eet al\u003c/em\u003e. \u003csup\u003e[24]\u0026nbsp;\u003c/sup\u003ewho stated that the rate of malaria is lower in older pregnant women than younger ones.\u0026nbsp;Multigravid women (≥3 pregnancies) had\u0026nbsp;2.2 times higher odds\u0026nbsp;of malaria than primigravid women (first pregnancy) (OR=2.21, p=0.020). Repeated pregnancies appear to increase susceptibility, possibly due to pregnancy-related immune modulation. This contradicts\u0026nbsp;findings by Tadesse \u003cem\u003eet al.\u003c/em\u003e \u003csup\u003e[25]\u003c/sup\u003e who reported highest prevalence of malaria in younger pregnant women in Ethiopia.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis study highlights that LLIN users had\u0026nbsp;55% lower odds\u003cstrong\u003e\u0026nbsp;of\u003c/strong\u003e malaria infection compared to non-users (AOR=0.45, p=0.001).\u0026nbsp;And\u0026nbsp;the study also revealed that LLINs reduce infection risk by \u0026gt;50%. This study is also in line with that conducted by Abu Bonsra \u003cem\u003eet al\u003c/em\u003e\u003csup\u003e\u0026nbsp;[23]\u003c/sup\u003e\u003cem\u003e,\u003c/em\u003e who reported that women not sleeping under insecticide treated bed nets were 20 times more likely to have high prevalence of malaria than those who used them. Insecticide-treated nets remain highly effective prevention tools. Scaling up LLIN coverage could substantially reduce malaria burden in pregnant women. \u0026nbsp;Women receiving 3 IPTp doses had\u0026nbsp;56% lower odds\u0026nbsp;of malaria than those receiving no doses (OR=0.44, p=0.044) and\u0026nbsp;complete IPTp (3 doses) provides similar protection magnitude. This study is in line with that carried out by Abu Bonsra\u0026nbsp;\u003cem\u003eet al\u003c/em\u003e\u003csup\u003e\u0026nbsp;[23]\u003c/sup\u003e\u003cem\u003e,\u003c/em\u003e which stated that malaria during pregnancy is significantly higher among women who had not receive any dose of IPTp (OR = 7.0, 95% CI [3.1-9.02], p=0.001; AOR=5.0, 95% CI [2.03-7.3], p=0.000).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe logistic regression also revealed that married women had\u0026nbsp;29% lower oddsof malaria than unmarried women (AOR=0.71, p=0.006). \u0026nbsp;this study is in line with that conducted elsewhere in Africa by Abu Bonsra \u003cem\u003eet al\u003c/em\u003e\u003csup\u003e\u0026nbsp;[14, 23]\u003c/sup\u003e\u003cem\u003e,\u003c/em\u003e who reported that unmarried women were 3.17 time more likely to have malaria compared to married women.\u0026nbsp;Marital status may serve as a proxy for socioeconomic stability, healthcare access, or household support systems that facilitate prevention behaviours.\u003c/p\u003e\n\u003cp\u003eThe contingency table showed that the prevalence of malaria in relation to the gestational age, was significantly higher in the second trimester at 15.1% (119/790) compared to 10.3% (17/165) in the first trimester and 8.2% (17/207) in the third trimesters (X\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e= 8.113\u003csup\u003ea\u003c/sup\u003e P = 0.017; Table 1, figure 3) but adjusted odd ratio showed that gestational age was not statistically significant. The results indicates that pregnant women in the second (OR=0.794, p=0.462) and third trimester (OR=0.889, p=0.704) had approximately 20.6% and 11.1% lower odds of malaria infection compared to those of the first trimester respectively.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStrengths and Limitations of the study.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOne of the strengths of this study is that the Buea Regional Hospital ANC clinic is attended by a large majority of pregnant women seeking antenatal care within the Buea Health District. The results obtained can be generalized. Secondly, women of all reproductive age groups (15 – 45) were represented in this study, thus, the results provide a general overview of malaria trends in the Health District and also provide a valuable local data on malaria prevalence and risk factors specific to pregnant women at Buea Regional Hospital. These findings can be useful in informing and modifying NMCP strategies for improved malaria control.\u003c/p\u003e\n\u003cp\u003eThese notwithstanding, this retrospective study is confined to hospital-based observations potentially limiting its generalizability compared to a comprehensive nationwide analysis. Secondly, the sample may not fully represent all pregnant women, as it focuses on those attending antenatal care, potentially missing those with limited access. The data presented here accurately reflect the ANC records at Buea Regional Hospital and provide useful lessons based on routine clinical observations within the limitations imposed.\u003c/p\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003eThe overall prevalence of malaria amongst the pregnant women who attended antenatal care at the Buea Regional Hospital for the five years (January 2018 to December 2022) was 12.85%. Malaria prevalence increased from 14% in 2018 and peaked at 20.6% in 2019, coinciding with sociopolitical crisis but decreased steadily to 8% in 2022. The key (major) risk factors were age (women over 35 had higher odds), and marital status (unmarried women had higher odds). Protective factors included LLIN use (55% lower odds) and IPTp with 3 doses (56% lower odds). This study suggests that scaling up LLIN coverage and IPTp could largely reduce malaria prevalence, though the crisis-related reduction in healthcare access likely contributed to the initial prevalence rise.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eANC: \u0026nbsp;Antenatal clinic; AOR: Adjusted Odd Ratio; FHSIRB: Faculty of Health Sciences Institutional Review Board; LLINs: Long lasting insecticidal nets; NMCP: National malaria control program; P:\u003cem\u003e\u0026nbsp;Plasmodium\u003c/em\u003e; PMI: US President Malaria Initiative; SPSS: Statistical Package for the Social Sciences; VAR2CSA: Variant Surface Antigen; WHO: World Health Organisation\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eConflicts of Interest\u003c/h2\u003e\n\u003cp\u003eThe authors declare no conflict of interest.\u003c/p\u003e\n\u003ch2\u003eSource of funding\u003c/h2\u003e\n\u003cp\u003eThe authors received no financial support for the research, authorship, and/or publication of this article.\u003c/p\u003e\n\u003ch2\u003eDisclaimer\u003c/h2\u003e\n\u003cp\u003eThe perspectives and opinions presented in this article are solely those of the authors and stem from rigorous academic research. They do not necessarily represent the official stance or policies of any affiliated institution, funding body, agency, or publisher. The authors assume full responsibility for the research outcomes, findings, and content of this article.\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eBuh ELvis Wung (B.E.W.) wrote the main manuscript text and prepared figures 1-3 and tables 1-2.ESUM EYONG MATHIAS (E.M.E.) carefully reviewed the manuscript, provided constructive criticism, and made necessary corrections to ensure accuracy.ROLAND NDIP NDIP (R.N.N.) reviewed the manuscript.All authors read and approved the final manuscript.\u003c/p\u003e\n\u003ch3\u003eACKNOWLEDGMENTS\u003c/h3\u003e\n\u003cp\u003eWe are grateful to Dr. Ronald Gobina, the Medical Adviser of the Buea Regional Hospital for granting us permission to collect data for this study from his health facility.\u003c/p\u003e\n\u003ch2\u003eData Availability\u003c/h2\u003e\n\u003cp\u003eThe data that support the findings of this study were generated from antenatal clinic registration logbooks at Buea Regional Hospital, South West Region of Cameroon. Restrictions apply to the availability of these data due to patient privacy and ethical considerations, and so they are not publicly available. the data are however available from the corresponding author upon reasonable request and with permission from Buea Regional Hospital.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eCox F, E. History of the Discovery of the Malaria Parasites and their Vectors. Parasites Vectors. 2010;3(1):5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eW.H.O [World Health Organisation]. (2022a). World Malaria Report 2022. Geneva: World Health Organisation. Available at www.who.int. Accessed 02nd February, 2023. Time 10:00 am.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJhpiego. 2021, Prevention and control of malaria during pregnancy: reference manuala.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChua C, L L, Khoo S, K M, Ong J, L E, Ramireddi G, Yeo K, T, W and, Teo A. Malaria in Pregnancy: from placental infection to its abnormal development and damage. Front Microbiol. 2021;12:777343.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eW.H.O [World Health Organisation]. (2022b) Mobilizing communities to help prevent and control malaria in Cameroon. Available at www.who.int. Accessed 10th December, 2022. Time 09: 20 am.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMalaria morbidity in pregnant women in Cameroon. (2023). \u003cem\u003eInstitute National de la Statistiques (INS) du Cameroun\u003c/em\u003e. Available at \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://ins-cameroun.cm|wp-content|uploads|2025|02|02_malariamorbility_ENG.pdf\u003c/span\u003e\u003cspan address=\"https://ins-cameroun.cm|wp-content|uploads|2025|02|02_malariamorbility_ENG.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTonye M, G S, Kouambeng C, Wounang R, Vounatsou P. Challenges of DHS and MIS to capture the entire pattern of malaria parasite risk and intervention effects in countries with different ecological zones: the case of Cameroon. Malar J. 2018;17(1):156.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMurray C, Ortblad J, Guinovart KF C., et al. Global, regional and national incidence and mortality for HIV, tuberculosis and malaria during 1990\u0026ndash;2013: a systematic analysis for the Global Burden of Disease study 2013. Lancet. 2014;384:1005\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMassoda T, Kouambeng SG, Wounang C R., and, Vounatsou P. DHS and MIS to capture the entire pattern of malaria parasite risk and intervention effect in countries with different ecological zones: the case of Cameroon. Malar J. 2018;6(1):156.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCenters for Disease Control and Prevention (CDC). (2020). Malaria. DPDx- Laboratory Identification of Parasites of Public Health Concern. Available at www.cdc.gov. Accessed on 04th January 2023. 01: 00 pm.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKabaria C, Gilbert W, Noor M, Snow AM, R, W. and, Linard C. The impact of urbanization and population density on childhood \u003cem\u003ePlasmodium falciparum\u003c/em\u003e parasite prevalence rates in Africa. Malar J. 2017;16:49.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWalker P, Ter Kuile G, Garske FO, Menendez T, Ghani C A, C. Estimated risk of placental infection and low birthweight attributable to Plasmodium falciparum malaria in Africa in 2010: a modelling study. Lancet Global Health. 2014;2:e460\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRogerson S, Desai J, Mayor M, Sicuri A, Taylor E, Van Eijk SM A, M. Burden, pathology, and costs of malaria in pregnancy: new developments for an old problem. Lancet Infect Disease. 2018;18:e107\u0026ndash;18.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAnchang Kimbi J, Nkweti K, Ntonifor VN, Apinjoh HN, Tata TO, Chi RB H, R., and, Achidi E, A. Plasmodium falciparum parasitaemia and malaria among pregnant women at first clinic visit in the mount Cameroon Area. BMC Infect Dis. 2015;15:439.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIsha B, Patrick W, Harry T, Kalifa B, Sheick O, Kassoum C, John K, Abraham W, Paul O, Daniel M, Brian C G., and Matthew C. Seasonal Dynamics of Malaria in Pregnancy in West Africa: Evidence for Carriage of Infections Acquired Before Pregnancy Until First Contact with Antenatal Care. Am J Trop Med Hyg. 2017;4(2):534\u0026ndash;42.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKamau A, Mogeni P, Okiro E, Snow A, R, W and, Bejon P. A systematic review of changing malaria burden in sub-Saharan Africa since 2000: comparing model predictions and empirical observations. BMC Med. 2020;18:94.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAntonio-Nkondjio C, Ndo C, Njiokou F, Bigoga J, Awono D, Etang AP, Ekobo J., A, S. and, Wondji C, S. Review of malaria situation in Cameroon: technical viewpoint on challenges and prospects for disease elimination. Parasites Vectors. 2019;12:50125.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBuea Regional Hospital. \u0026ndash; Cameroon \u0026ndash; \u003cem\u003eMapcarta\u003c/em\u003e. Available at mapcarta.com. Accessed on 24th May, 2023. Time 11: 59 am.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNyasa R, Awatboh B, Kwenti F, Titanji TE, P, K, V. and, Ayamba N, L M. The effects of climatic factors on the number of malaria cases in an inland and a costal setting from 2011 to 2017 in the equatorial rain forest of Cameroon. BMC Infect Dis. 2022;22:461.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eU.S. President\u0026rsquo;s Malaria Initiative [PMI}. Malaria Operational Plan Cameroon. USAID. Retrieved from www.pmi.gov. Accessed on 07th January 2023. Time. 2022;04:00am.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eW.H.O [World Health Organisation]. (2023) Malaria. Available at www.who.int. Accessed 09th May, 2023. Time 03: 40 am.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGontie G, Wolde B, Baraki HF, A, G. Prevalence and associated factors of malaria among pregnant women in Sherkole District, Benishangul Gumuz Regional state, West Ethiopia. BMC Infect Dis. 2020;20:573.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbu Bonsra E, Petra A, Adjei O, Adama KE, Akua S, G, S., and, Fafa E, K. Factors Associated with Malaria in Pregnancy Among Women Attending ANC Clinics in Selected Districts of the Ashanti Region, Ghana. Malar J. 2025;24:8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYaro J, Ouedraogo B, Diarra A, Salif A, Ouedraogo S, N\u0026eacute;bi\u0026eacute; AZ, Drakeley I, Sodiomon C, Tiono BS, Lindsay AB, S, T. and, Anne L, W. Risk factors for \u003cem\u003ePlasmodium falciparum\u003c/em\u003e infection in pregnant women in Burkina Faso: a community-based cross-sectional survey. Malar J. 2021;20:362.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTadesse D, Eyob T, Dassalegn M, Asnake S. Malaria prevalence and risk factors among patients visiting Mizan Tepi University Teaching Hospital, Southwest Ethiopia. PLoS ONE. 2022;17(7):e02717.\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":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"malaria-journal","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"malj","sideBox":"Learn more about [Malaria Journal](http://malariajournal.biomedcentral.com/)","snPcode":"12936","submissionUrl":"https://submission.nature.com/new-submission/12936/3","title":"Malaria Journal","twitterHandle":"@malariajournal","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Malaria in pregnancy, Pregnancy, Prevalence, Risk factors, LLIN, IPTp, Cameroon, Buea Regional Hospital","lastPublishedDoi":"10.21203/rs.3.rs-8427956/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8427956/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground\u003c/b\u003e\u003c/p\u003e \u003cp\u003eNotwithstanding global efforts to curb the spread of malaria, it has remained one of the most common public health challenges to mothers, foetuses, and neonates with devastating effects in pregnancy. The study, therefore, sought to determine the prevalence and risk factors of malaria in pregnancy among those who attended the antenatal clinic at the Buea Regional Hospital, South West region of Cameroon.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e \u003cp\u003eA five-year hospital-based retrospective study was carried out using ANC registration logbooks. Data was collected from January 2018 to December 2022. A total of 1,200 records meeting the inclusion criteria were assessed. Data on demographics such as age, marital status, gravidity, gestational age, malaria results and preventive factors were obtained and analyzed using SPSS version 25. Chi-square tests and Fisher\u0026rsquo;s Exact Test were used to evaluate associations, with a significance level of \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05. Logistic regression was used to determine independent risk factors for malaria infection.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe overall prevalence of malaria among pregnant women was 12.8% (153/1200). Prevalence rose from 14% in 2018 to a peak of 20.6% in 2019, then declined steadily to 8.1% by 2022. Women aged\u0026thinsp;\u0026ge;\u0026thinsp;35 years had significantly higher odds of infection compared to adolescents (OR\u0026thinsp;=\u0026thinsp;1.98; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.039). Multigravid women had 2.2 times higher odds of malaria compared to primigravid women (OR\u0026thinsp;=\u0026thinsp;2.21; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.020). Use of long-lasting insecticidal nets (LLINs) reduced infection odds by 55% (OR\u0026thinsp;=\u0026thinsp;0.45; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001), and receipt of three IPTp doses reduced odds by 56% (OR\u0026thinsp;=\u0026thinsp;0.44; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.044). Married women had 29% lower odds of malaria as opposed to unmarried women (OR\u0026thinsp;=\u0026thinsp;0.71; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.006).\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusions\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThis study showed that malaria remains a significant threat to maternal health in Buea, despite recent declines in prevalence. Age\u0026thinsp;\u0026ge;\u0026thinsp;35 years, multigravidity, and unmarried status were major risk factors, while LLIN use and adequate IPTp dosing were protective. Despite these, there is still a call for scaled-up preventive and control strategies. Strengthening malaria prevention through expanded LLIN coverage, improved IPTp uptake, and strategies to maintain healthcare access during crises could substantially reduce malaria burden among pregnant women in this region.\u003c/p\u003e","manuscriptTitle":"Malaria Prevalence and Risk Factors Among Pregnant Women: A Retrospective Record Review at the Buea Regional Hospital, South West Region of Cameroon","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-06 10:55:45","doi":"10.21203/rs.3.rs-8427956/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-23T16:30:18+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-23T16:19:02+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"255366045626678748276479688497238537129","date":"2026-03-23T16:15:08+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-23T15:14:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"25640984070758280558704328763285561678","date":"2026-03-23T14:05:55+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-29T01:00:34+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"296781459077160512070417793952422734918","date":"2026-01-15T11:42:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"254813864196435036413084604406120151986","date":"2026-01-15T11:35:35+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-02T14:30:35+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-28T14:43:14+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-23T15:35:09+00:00","index":"","fulltext":""},{"type":"submitted","content":"Malaria Journal","date":"2025-12-22T19:20:27+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":"5cca2035-15ab-4984-a0bc-e80ad339d5e7","owner":[],"postedDate":"January 6th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-27T15:25:43+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-06 10:55:45","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8427956","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8427956","identity":"rs-8427956","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}