Submicroscopic malaria infections and inadequate IPTp-SP coverage among pregnant women in rural Burkina Faso: An observational study

BACKGROUND: Malaria in pregnancy is a major cause of maternal and neonatal morbidity in sub-Saharan Africa. Intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP), reduces malaria-associated adverse outcomes but routine diagnostics miss low-density infections, and coverage remains suboptimal in many endemic settings. METHODS: We conducted an observational study (June 2023-June 2024) at a health centre in Koubri, central Burkina Faso, combining a cross-sectional assessment at the first antenatal care (ANC) visit with retrospective abstraction of routine ANC and delivery records. At enrolment, pregnant women were tested by real-time PCR; microscopy and rapid diagnostic test (RDT) were performed when available. IPTp-SP doses, follow-up testing, and birth outcomes were extracted from facility registers. Modified Poisson regression with robust variance was used to identify predictors of PCR-confirmed infection, factors associated with low birthweight (LBW,