Knowledge, practices, and determinants of malaria prevention in pregnancy: a cross-sectional study in Weija-Gbawe, Ghana

Abstract Malaria in pregnancy remains a significant public health challenge in sub-Saharan Africa, with adverse health outcomes for mothers and foetuses. This study assessed knowledge, attitudes, practices and factors associated with malaria preventive practices among antenatal care attendants in the Weija-Gbawe Municipality, Ghana. A cross-sectional study was conducted among 239 pregnant women attending ANC services. Data were collected using Kobo Collect as a data collection tool and analysed using Stata. Descriptive statistics and inferential statistics including frequencies, percentages, chi-square tests and logistic regression models were employed to identify factors associated with malaria prevention practices. Most participants demonstrated high knowledge, 209 (87.5%) and positive attitudes, 194 (81.2%) toward malaria prevention. However, only 74.5% reported good preventive practices. Only 48 (20%) always slept under the mosquito net. Majority, 165 (69.2%), took anti-malarial drugs to prevent malaria. Over 81 (34%) reported inconsistent use of mosquito nets, and stockouts of antimalarial drugs 29 (12.1%) were cited as barriers. Key factors significantly associated with improved practices included cohabiting marital status (AOR = 4.55; 95% CI: 1.01–20.43), prior malaria testing during pregnancy (AOR = 2.63; 95% CI: 1.09–6.28), and positive attitudes toward prevention (AOR = 7.54; 95% CI: 3.15–18.03). Despite high awareness, gaps persist in translating knowledge into consistent preventive practices. Interventions should prioritise addressing systemic barriers, enhancing partner support, and strengthening education programs to reinforce positive attitudes. These measures are critical to reducing the burden of malaria in pregnancy and achieving maternal health targets in malaria-endemic regions.