Malaria during pregnancy poses significant risks to both maternal and foetal health, including increased risks of maternal anaemia, preterm delivery, and low birth weight. Malaria even in mild to moderate parasitaemia leads to alteration in immune and haematological indices (Chukwuanukwu et al., 2025, new [18]). In Nigeria, where malaria is endemic, IPTp has been widely recommended to reduce malaria incidence during pregnancy. Despite these efforts, data on the effectiveness of IPTp and its association with HIV, hepatitis, preeclampsia, and premature rupture of membranes (PROM), remain scarce. The principal findings of the study are that 73.9% of the participants reported using intermittent preventive treatment for malaria. The prevalence of malaria was relatively low, with 5.97% (n = 8) of participants testing positive, which is lower than previously reported rates in the region [17, 19]. Additionally, 3.73% of the participants were HIV positive, 4.47% tested positive for hepatitis B, and 3.73% had preeclampsia. PROM occurred in 2.24% of the participants, whereas 5.2% of the deliveries were preterm.
In malaria-endemic areas, the WHO has recommended certain interventions for preventing and controlling malaria infection during pregnancy [1]. These recommendations include the use of insecticide-treated mosquito nets (ITNs) and intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine-pyrimethamine.
The WHO recommends that all pregnant women in malaria endemic regions of sub-Saharan Africa sleep under ITNs and take monthly doses of IPTp starting from the 2nd trimester of pregnancy [1]. ITN ownership has plateaued and begun to decrease in Nigeria [20]. The proportion of the population that sleep under the ITN has been decreasing [21]. Reports on the use of these interventions among pregnant women vary depending on the population and other factors. In our study, we found the use of ITNs among the study population to be rather low, with only 29.9% of the respondents reporting use. Previous studies conducted in the western and northern regions of Nigeria reported 24.1% and 12.4–24.5% use, respectively [22, 23]. Our findings are similar to those reported in these regions, showing relatively low usage among these pregnant women.
Nigeria has adopted the 2016 WHO ante-natal care model, which recommends a minimum of eight contacts during pregnancy [21], with a target of 63% of pregnant women receiving IPTp between 2021 and 2025. According to a previous report, the proportion of pregnant women who received at least three doses of sulfadoxine-pyrimethamine almost doubled between 2018 and 2021, from 16.6% in 2018 to 31% in 2021 [21]. Factors that hinder IPTp uptake among pregnant women include low antenatal care rates, restrictions that prevent nonpharmacy workers from dispensing sulfadoxine-pyrimethamine, missed opportunities during antenatal visits and nonavailability of the drug [21].
The findings from our study show that IPTp use was higher (73.9%) in our study population than 31% in a 2021 report [23]. However, among the primigravidae in this study, 65.7% used IPTp. These results show that compliance with the use of IPTp is better among these pregnant women than compliance with the use of ITNs. The much greater use in our study population is most likely because both health institutions from which our study participants were recruited have fully implemented IPTp in antenatal care. Another factor could also be the relatively urban nature of the study locations. There are significant regional, rural‒urban and socioeconomic differences in malaria incidence ranging from 16% in the southern and south-eastern zones to 34% in the north-western zone, with the prevalence in rural areas being 2.4 times greater than that in urban populations [22]. The lower prevalence of malaria in our study population is most likely a reflection of the above factors and the effect of IPTp uptake on this pregnant population.
Among our study population, 3.73% of the pregnant women were infected with HIV. A population-based survey conducted by the Nigeria HIV/AIDS Indicator and Impact Survey [24] reported a prevalence of 1.4% among those aged 15–64 years. The survey reported a prevalence of 1.8% among females and 1.0% among males in this age bracket. There was variation in location within the country, with a 2.2% prevalence in the state of our study. However, among pregnant women, the prevalence of HIV appears to be higher than that in the general population. According to a systematic review and meta-analysis, the pooled prevalence of HIV among pregnant women is 7.2% [7]. The relatively high disparity could be due in part to more testing among the pregnant population than among the general population. With improved coverage of HIV testing among pregnant women [25], detection among this group would be more efficient and well documented. In addition, during pregnancy, the combination of physiological and immunological changes contributes to the dampened immune response which could increase susceptibility to various infections, including malaria and HIV. HIV infection during pregnancy has an impact on both the mother and child if untreated and therefore requires prudent management antenatally, intrapartum and postpartum [26]. Some of the known associated poor outcomes if poorly managed include increased spontaneous miscarriages, stillbirths, increased perinatal mortality and low birth weight [27].
HBV is a leading cause of chronic hepatitis, maternal complications and neonatal deaths in sub-Saharan Africa [28]. HBV is the most significant form of viral hepatitis due to its high transmission potential through blood and body fluids [29]. The prevalence of HBV in Nigeria among pregnant women is reportedly 6.49% [10]. The findings from our study revealed that 4.47% of the participants were infected with HBV, which is lower than the national prevalence [10]. However, this could be due to regional differences, as the South-east region had a lower prevalence than the national average in the referenced study.
The incidence of preeclampsia in a study conducted in Jos, Nigeria, was 8.8% [13]. A more recent study reported a lower prevalence of 3.6% [30]. Preeclampsia is reported as a leading cause of maternal morbidity and mortality in Nigeria [15]. The findings from our study revealed a 3.7% prevalence in our study population. Previous reports reported a wide range of prevalence rates between 1.8% and 16.7% in developing countries. Factors that affect prevalence include access to adequate antenatal services and other associated healthcare and monitoring services.
Socioeconomic disparities are linked to low birth weight, with varying patterns and inequalities observed across nations [31]. Consistent with the literature, our findings indicate that increased socioeconomic status is positively correlated with increased birth weight. This association is intuitive, as improved socioeconomic standing directly influences maternal well-being, including access to adequate nutrition. Furthermore, our study revealed a significant relationship between socioeconomic status, birth weight, and mode of delivery. Notably, middle-income households presented reduced odds of emergency caesarean Sect. [32]. Additionally, a negative correlation between birth weight and mode of delivery was observed, suggesting that adverse maternal health outcomes may precipitate emergency interventions. This finding underscores the importance of addressing socioeconomic determinants to optimize birth outcomes and minimize the likelihood of complications requiring emergency surgical interventions.
We found that gestational age was associated with SCBU admission and was positively correlated with birth weight, socioeconomic status and SCBU admission. These findings are in line with the health and foetal maturity of the infant.
A limitation of the study was loss to follow up. Several of the pregnant women consented and were recruited during antenatal care visits but possibly delivered their babies elsewhere. Another limitation was that some women were excluded based on non-completion of the required IPTp doses.