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 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 toolbox and analysed using Stata 17. Descriptive and inferential statistics including frequencies, percentages, chi-square tests, Fisher's exact test and logistic regression models were employed. Most participants demonstrated high knowledge 209 (87.5%) and positive attitudes 194 (81.2%) toward malaria prevention. The study identified married women (aOR = 3.16; 95% CI 0.94–10.65, p = 0.017), malaria testing (aOR = 8.74; 95% CI 3.23–23.62, p < 0.001) and preventive practices (aOR = 7.99; 95% CI 3.21–19.95, p < 0.001) as key factors associated with attitudes towards malaria prevention. However, 74.5% reported good preventive practices. Key factors significantly associated with improved practices included cohabiting marital status (aOR = 4.55; 95% CI 1.01–20.43, p = 0.048), prior malaria testing during pregnancy (aOR = 2.63; 95% CI 1.09–6.28, p = 0.030), and positive attitudes toward prevention (aOR = 7.54; 95% CI 3.15–18.03, p < 0.001). Although most pregnant women had good knowledge of malaria, this did not always translate into consistent preventive practices. Efforts should focus on reducing economic and access barriers, strengthening health literacy, and promoting regular malaria testing. Enhancing triage and ANC counselling capacity and advancing policies that ensure equitable access to preventive tools are essential for improving malaria prevention in pregnancy and achieving national health goals.