Published in PLOS One on 2026-04-15, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Kassawmar Angaw Bogale, Kassahun Alemu, Kindie Fentahun Muchie, Mulusew Andualem Asemahagn, Hailemariam Awoke Engedaw, Muluken Azage Yenesew
Source: PLOS One • DOI 10.1371/journal.pone.0346831
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Malaria in pregnancy poses significant health risks to mothers and their, fetuses, and newborns children in Tropical and subtropical countries including Ethiopia. The delivery of integrating essential malaria services into routine antenatal care is crucial for effective prevention and control. However, evidence on the extent and determinants of this integration in Ethiopia remains limited.
This study aimed to assess the delivery of integrated malaria services during ANC visit and its determinants among pregnant women in Ethiopia.
We conducted a secondary analysis of the Ethiopia Service Provision Assessment Survey 2021/22, a nationally representative cross‑sectional study. The final sample included 4273 pregnant women nested across 662 health facilities. Factors were identified based on the WHO Malaria in Pregnancy framework. Multilevel logistic regression models were applied to identify significant factors influencing integrated service uptake.
Only 7.9% of pregnant women attended ANC visits where all components of integrated malaria services were delivered concurrently, with substantial regional disparities. At the client level, women with two previous pregnancies (AOR = 1.67, 95% CI: 1.06–2.62), attending three or more ANC visits (AOR = 1.58, 95% CI: 1.04–2.40) and client who received an Insecticide-Treated Net during ANC (AOR = 2.81, 95% CI: 1.29–6.12) were more likely to attend ANC visits in which integrated malaria services were delivered. Furthermore, clients attending facilities with malaria-trained providers were more likely to receive integrated malaria services during ANC than those attending facilities without such training (AOR = 4.24, 95% CI: 1.80–10.00). Rural facility attendance was also positively associated with integrated malaria service delivery compared with urban facility attendance (AOR = 2.73, 95% CI: 1.04–7.19).
Integrated malaria service delivery during ANC remains unacceptably low in Ethiopia, constrained by regional disparities and multilevel factors. Strengthen continuity of ANC follow up, updating policy on ITN distribution, strengthening providers’ capacity, and addressing geographic disparities to accelerate progress toward WHO maternal health targets.
Background
Malaria infection during pregnancy (MiP) continues to be a significant global public health concern, particularly in sub-Saharan Africa, Southeast Asia, and parts of Latin America. Its prevalence in sub-Saharan Africa is as high as 60%, with placental malaria affecting up to 28% of cases [1,2].
MiP poses a serious threat to the health of mothers, fetuses, and newborns ranging from asymptomatic cases to severe anemia and maternal death. Physiological changes during pregnancy increase vulnerability to malaria, leading to unique challenges and severe health risks [3,4]. Clinical manifestations in pregnant women include joint pain, fever, headaches, fatigue, nausea, and anemia, with complications varying across trimesters [3,5]. Beyond maternal health, MiP contributes to unfavorable birth outcomes, including miscarriage, premature delivery, and neonatal death. It can impair placental development and function, leading to poor fetal growth, intrauterine growth restriction, and long-term infant health problems. Even in areas with low-to-moderate transmission, MiP contributes significantly to adverse outcomes including stillbirth, neonatal death, and placental insufficiency [4,6,7].
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider financing & policy desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Kassawmar Angaw Bogale, Kassahun Alemu, Kindie Fentahun Muchie, Mulusew Andualem Asemahagn, Hailemariam Awoke Engedaw, Muluken Azage Yenesew. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
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- Evidence brief: Family planning service receipt during facility visits in Ethiopia: Evidence from the 2021–2022 service provision assessment survey
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- Evidence brief: Determinants of knowledge, attitudes and childbirth experiences related to obstetric violence among women who delivered in the public health facilities of Jimma Zone Southwest Ethiopia: A cross sectional study design
