Determinants of malaria recurrence among pregnant mothers attending antenatal clinic at Beletweyn referral hospital in Beleddweyn district, Somalia

Abstract

Malaria is a potentially life-threatening disease caused by the Plasmodium parasite, transmitted to humans through the bites of infected female Anopheles mosquitoes. The disease remains a major global health challenge, particularly in low-resource and conflict-affected regions. In areas such as Somaliland and Puntland, maternal healthcare is underdeveloped, with only 44% and 38% of births, respectively, attended by licensed birth attendants. This shortage of qualified health professionals poses additional risks to pregnant women, who are especially vulnerable to malaria.Malaria remains a major global health challenge, particularly in low-resource and conflict-affected regions. In Somalia, where maternal healthcare is underdeveloped, pregnant women face heightened risks due to limited access to skilled birth attendants and preventive measures. This study examines the factors influencing malaria recurrence among pregnant women in Beletweyn, focusing on malaria awareness, socioeconomic vulnerability, ITN usage, and malaria medicine resistance. Guided by the Health Belief Model, the study employed a mixed-methods approach, using standardized questionnaires and in-depth interviews. A sample of 424 pregnant women attending Beletweyn Hospital’s antenatal clinic was selected through stratified random sampling, while 15 nurses were purposively sampled as key informants. Data were analyzed using SPSS version 23, with descriptive and inferential statistics identifying relationships, and thematic analysis applied to qualitative data. Findings revealed that higher malaria awareness was linked to lower recurrence rates (β=0.147, p=0.000), suggesting that informed women adopt better preventive measures. Socioeconomic vulnerability significantly increased recurrence (β=0.342, p=0.000), underscoring the burden on lower-income women who lack access to healthcare and preventive tools. ITN usage was strongly associated with reduced recurrence (β=0.397, p=0.000), reaffirming their effectiveness in malaria prevention. Additionally, malaria medicine resistance (β=0.143, p=0.000) posed a growing challenge, making treatment less effective and increasing recurrence risks. These findings emphasize the urgent need for targeted interventions, including malaria education, improved ITN distribution, and stronger measures to combat drug resistance. Strengthening healthcare infrastructure and enhancing access to quality maternal care in resource-limited settings like Beletweyn are critical in mitigating malaria-related complications. Addressing socioeconomic disparities and investing in community-based malaria prevention programs will be essential in reducing recurrence. Future research should explore additional determinants of malaria recurrence and assess the long-term impact of targeted interventions. Reducing malaria recurrence among pregnant women will require sustained collaboration among policymakers, healthcare providers, and community stakeholders to improve maternal and neonatal health outcomes.