Assessing the knowledge, attitudes and practices towards malaria prevention and determinants of antenatal care utilization among pregnant women in Sekyere South district, Ghana; a cross-sectional study

Malaria Journal (2025) 24:371 Zuuri et al. Malaria Journal https://doi.org/10.1186/s12936-025-05614-0 Open Access RESEARCH Assessing the knowledge, attitudes and practices towards malaria prevention and determinants of antenatal care utilization among pregnant women in Sekyere South district, Ghana; a cross‑sectional study Clement Naayaara Zuuri1,2*, Dominic Kofi Gyamah2, Loviah Buabeng2 and Ruth Mensah2 Abstract Background Malaria in pregnancy contributes significantly to poor maternal health outcomes, accounting for 17.6% of outpatient visits in Ghana. The Ashanti Region, particularly Sekyere South District, bears a high burden despite interventions, such as ITN distribution and intensified IPTp education. Limited evidence exists on how pregnant women’s knowledge, attitudes and practices (KAP) influence preventive behaviours and ANC use in this setting. Methods A cross-sectional survey was conducted among 422 pregnant women using structured questionnaires. Descriptive statistics and logistic regression were applied to assess predictors of malaria prevention behaviours and ANC attendance. Results Most respondents (78%) had adequate knowledge, though misconceptions persisted (56% believed malaria could spread person-to-person). Only 48% knew the recommended ≥ 3 IPTp doses, and ITN use was 63%, with nonuse linked to heat discomfort and unavailability. Knowledge of IPTp dosage was significantly associated with uptake (p < 0.001), but socio-demographic factors were not predictors of ANC attendance. Conclusion Gaps in malaria prevention stem from misconceptions, incomplete IPTp adherence, and inconsistent ITN use rather than supply shortages. Priorities include strengthening ANC counselling, correcting myths, introducing reminder prompts, and expanding outreach with ITN replacement. Enhancing implementation fidelity is critical to improving maternal health outcomes. Keywords Malaria, Pregnancy, Knowledge, Attitudes, Practices, Insecticide-treated nets, Antenatal care, Ghana, KAP, IPTp *Correspondence: Clement Naayaara Zuuri 1 College of Nursing and Midwifery, Tanoso‑Sunyani, Ghana 2 Withrow University College, Agona‑Asamang, Ghana Background Malaria remains one of the leading global public health challenges. The World Malaria Report 2024 estimates 263 million malaria cases and approximately 597,000 deaths in 2023, with the African Region accounting for about 94–95% of the burden [1]. © The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/. Zuuri et al. Malaria Journal (2025) 24:371 The burden of malaria is disproportionately concentrated in sub-Saharan Africa, which accounts for approximately 95% of all cases and deaths globally [2]. Among the vulnerable populations, pregnant women are particularly at high risk due to the immunological and physiological changes that occur during pregnancy, which increase susceptibility to malaria infection and its severe consequences [3–5]. Malaria in pregnancy (MiP) is strongly associated with maternal anaemia, placental parasitaemia, low birth weight, preterm birth, and stillbirth, with downstream effects on neonatal morbidity and mortality [6]. These outcomes not only affect the health and survival of the mother and infant but also contribute to increased neonatal morbidity and mortality, perpetuating cycles of poverty and poor health in endemic regions [7]. Ghana faces year-round malaria transmission and remains one of the high-burden countries in subSaharan Africa. In Ghana, malaria is prevalent yearround, accounting for approximately 30% of outpatient visits and 23% of inpatient hospital admissions [8]. The country’s control strategy follows WHO guidelines and is detailed in the National Malaria Strategic Plan (2021– 2025) and the more recent National Malaria Elimination Strategic Plan (2024–2028) [9]. The strategy emphasizes vector control methods, including insecticide-treated nets (ITNs) and indoor residual spraying (IRS), as well as intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP), case management, behaviour change initiatives, and targeted interventions at the sub-national level. Although coverage of the recommended IPTp-SP regimen (at least 3 doses) has increased, it remains below optimal levels nationwide, reaching about 60% by 2022 [10]. In the Sekyere enclave of the Ashanti Region, malaria continues to be one of the leading causes of morbidity, particularly among pregnant women who are highly vulnerable to its adverse outcomes [11]. Local challenges, including limited awareness, inconsistent use of preventive measures, and gaps in health service delivery, underscore the need to assess knowledge, attitudes, and practices related to malaria prevention in this setting. Within the Ashanti Region, where Sekyere South is situated, routine data indicate a consistent malaria burden in outpatient services [12]. Recent research from the nearby Sekyere East District also shows a relatively high prevalence of malaria in pregnancy (MiP) [11]. Furthermore, data from the Ghana Malaria Behaviour Survey 2022 reveal variation in malaria knowledge, perceptions, and care-seeking behaviours across different ecological zones, emphasizing the significance of considering local context [13]. Page 2 of 11 Antenatal care (ANC) is recognized as a crucial entry point for delivering malaria preventive interventions to pregnant women. Key strategies implemented during ANC visits include the distribution and promotion of insecticide-treated nets (ITNs) and the administration of intermittent preventive treatment in pregnancy (IPTp) using sulfadoxine-pyrimethamine (SP) [14]. These interventions have been demonstrated to significantly reduce the incidence of malaria infections and associated complications during pregnancy [15]. However, the success of these prevention measures is heavily dependent on pregnant women’s knowledge, attitudes and practices (KAP) regarding malaria prevention and control. Studies have shown that inadequate kno (...truncated)