Malaria in pregnancy: a holistic exploration of synergistic association through environmental, sociocultural, and socioeconomic lenses in Pru east municipality, Ghana.

Abstract

Background: Malaria in pregnancy (MiP) is responsible for several maternal and neonatal complications. Despite the renewed dedication towards elimination and eradication, it is still endemic in Ghana. Although previous studies have examined MiP from clinical or epidemiological standpoints, gaps remain in understanding the interactions between determinants of transmission. This study examined the synergistic association between environmental, sociocultural, and socioeconomic determinants of MiP.

Methods: A cross-sectional study was conducted among 456 pregnant women in the Pru East Municipality from April to August 2024. Data were collected using serological screening and a structured, closed-ended questionnaire and were analysed with STATA 17 and IBM SPSS AMOS 29. Descriptive statistics, chi-square tests, logistic regression, confirmatory factor analysis (CFA) and structural equation modelling (SEM) were employed as part of statistical analyses. CFA and SEM were employed to validate multidimensional latent constructs and assess their interdependent and synergistic association within a single analytical framework. A significant level was set at (p < 0.05) at a 95% confidence interval (CI).

Results: Overall, the prevalence of MiP was 21.5% (95% CI 17.7-25.3), with Plasmodium falciparum (14.7%) being the most prevalent species. A co-infection by Plasmodium falciparum and Plasmodium malariae was also found at 3.5%. High Plasmodium parasitaemia was observed in 6.4% of infected women. Moreover, all factor loadings for the three determinants showed significance (p < 0.001) and a high internal consistency. The SEM also yielded good fitness (NFI 0.998, GFI 0.994, AGFI 0.996, CFI 0.984, RMSEA 0.048). Key environmental (proximity to stagnant water, refuse sites, Volta Lake, livestock shelters), sociocultural (spiritual attribution, illness confusion, plant repellents, outdoor sleeping), and socioeconomic (rural residence, delayed ANC initiation, limited media exposure, LLIN use, IPTp-SP uptake, health insurance) factors were strongly associated with MiP. Importantly, the structural model showed that these three domains were moderately to strongly correlated, confirming their synergistic influence on MiP.

Conclusion: Malaria control strategies should go beyond biomedical interventions to incorporate community-based environmental management, sociocultural engagement, and socioeconomic empowerment. Such a multidimensional approach is essential to achieving sustainable reductions in malaria burden among vulnerable populations and improving health outcomes.