An observational, cross-sectional, descriptive, and analytical study was conducted between June 23rd and August 14th, 2025.

The population involved in this study was pregnant women who attended antenatal consultations (CPN) at the maternity ward of the Hospital de l’Amitié Sino-Gabonese (HASG) located in the 2nd borough of Franceville city, the provincial capital of the Haut-Ogooué province in Gabon. The prenatal consultation service at the HASG maternity ward provides medical and educational care for women throughout their pregnancy and postpartum period. Only pregnant women who gave consent and agreed to participate were included. Women who came only to declare their pregnancy without effective follow-up were not included in the study.

A non-probability sampling method was used to select pregnant women. Due to time and funding constraints, and to ensure better patient accessibility, all pregnant women attending prenatal consultations during the study period were interviewed. The sample size was not calculated.

Knowledge: level of information about malaria and its consequences.

Attitudes: perception of risk and motivation.

Practices: actual behaviors (use of impregnated mosquito nets, taking SP).

Gravidity: number of pregnancies.

Parity: number of live births.

Knowledge, attitudes, and practices were measured with open (Example: What is malaria? During which period of pregnancy can SP be administered?...) and closed (Example: Are you aware of malaria prevention methods? Do you follow the dosage recommended in the prevention protocol?) questions in sections 4 and 5 of the questionnaire.

Data collection tool

A standardized questionnaire was designed for data collection by the Chronic Disease Epidemiology Research Unit, Environmental Health of the Department of Community and Social Medicine at the University of Health Sciences in Libreville. This questionnaire consisted of five (5) sections. The first section concerned the socio-demographic characteristics of the patients. The questions focused on age, place of residence, educational level, marital status, and occupation. The second part concerned the medical characteristics of the women. The questions focused on the women’s obstetric history and prenatal care. The third part concerned knowledge and questions focused on the definition of malaria, its mode of transmission, clinical signs, and consequences for pregnancy. The fourth part concerned attitudes and questions focused on women’s perceptions of recommendations, the severity of malaria, and the usefulness of preventive measures. Finally, the last part concerned practical, and the questions focused on actual behaviours, such as taking SP (IPT-SP) and using impregnated mosquito nets.

Data collection

On the day of the appointment, explanations of the objectives and conduct of the study were provided to all patients in order to obtain their consent. Once consent was obtained, data were collected during a face-to-face interview. Patient data were collected on the days of antenatal consultation.

All data were entered into an Excel spreadsheet and analyzed using STATA 14 software. Qualitative characteristics were described in terms of frequency (percentage) and quantitative characteristics in terms of mean (± standard deviation) and extreme values. The age variable was transformed into a binary categorical variable (age ≤ mean and age > mean). Comparison of proportions was performed using Pearson’s chi-2 test. The Mantel-Haenszel chi-2 test was used to investigate the association between general knowledge of malaria and socio-demographic characteristics, estimating the Odds Ratio (OR) and its 95% confidence interval. The significance threshold for all analyses was 0.05.

A total of 155 pregnant women were included. The average age was 27.9 ± 6.6 years. The proportion of women aged 29 or younger (≤29 years) was 52.9% (n = 82). More than half of the patients had a secondary education level, i.e., 63.9% (n = 99), and 60.6% (n = 94) lived with a partner. Pupils/students and women in employment accounted for 37.4% (n = 58) and 36.8% (n = 57) of the sample (Table 1).

In this study, the proportion of primigravidas was 35.5% (n = 55), that of multigravidas was 41.3% (n = 64), and that of multiparas was 32.9% (n = 51). Women between 1 and 3 antenatal care visits accounted for 67.1% (n = 104) of the sample. Most of the women included were in the second trimester (16 - 28 WA) and accounted for 40.0% (n = 62) of the sample (Table 2).

Table 1. Socio-demographic characteristics of pregnant women.

Table 2. Description of the obstetric characteristics of the pregnant women.

WA: Week Amenorrhea.

Figure 1 shows that the media (67.7%) and health personnel (52.3%) were the main sources of information on malaria for the study population. Table 3 describes the general knowledge of malaria gathered from the pregnant women surveyed. Only 38.1% (n = 59) of women claimed to know the definition of malaria. Among them, 59.3% (n = 35) defined malaria as a “disease caused bymosquitoes”.

As for the mode of transmission, most patients, 68.4% (n = 106), stated that they knew how malaria was transmitted, and among them, 93.4% (n = 99) stated that the disease was transmitted by “mosquito bites”.

Regarding clinical signs of disease, more than 75% (n = 118) of participants reported knowing the clinical manifestations of malaria; fever was the most widely known symptom of malaria (84.7%) (Figure 2).

Finally, 62.6% (n = 97) of participants stated that they had knowledge of the consequences of malaria during pregnancy. Miscarriage was the most frequently described consequence of malaria during pregnancy, at 81.4% (n = 79).

Figure 1. Participants’ main sources of information on malaria.

Table 3. Description of general knowledge (definition, transmission routes, and symptoms) of malaria.

Figure 2. Knowledge of malaria symptoms among women who reported having knowledge of malaria symptoms.

Analysis of the results summarized in Table 4 and Table 5 shows that general knowledge of malaria in terms of its definition, mode of transmission, clinical manifestations, and consequences for pregnancy differed significantly between educational levels (p < 0.05) (Table 4). Knowledge of the consequences of malaria on pregnancy differed significantly between age groups (p = 0.007). A statistical association was observed between knowledge of the consequences of malaria on pregnancy and women aged > 28 years (OR_95% = 2.5 [1.3 - 5.0], p = 0.007). No difference was observed between general knowledge of malaria and obstetric characteristics, particularly gestation and parity.

Table 4. Distribution of general knowledge about malaria according to socio-demographic characteristics.

*Consequences of pregnancy.

Table 5. Relationship between general knowledge about malaria and socio-demographic characteristics.

The description of patients’ knowledge of malaria prevention measures in Table 6 showed that most women (92.6%, n = 128) reported having knowledge of malaria prevention methods. All women (100%) who reported having knowledge of malaria prevention methods described the use of mosquito nets (sleeping under a mosquito net), the use of insecticide, and environmental sanitation as methods of preventing malaria (Figure 3).

The majority of participants, 94.2% (n = 146), stated that a Long-Lasting Insecticide-treated mosquito Net (LLIN) could be used during all seasons. However, 52.2% (n = 81) of women were unaware that LLINs were provided free of charge to pregnant women during antenatal consultations.

More than half, 62.6% (n = 97) of patients stated that IPT-SP could be administered during the first trimester of pregnancy, and 58.7% (n = 91) of women surveyed stated that SP could be administered until delivery. In addition, 43.9% (n = 68) of women did not know the minimum number of SP doses during pregnancy, and 29.7% of participants stated that the minimum number of SP doses during pregnancy was between 3 and 5. For 34.2% (n = 53) of women, the minimum interval between two doses of SP was one month, and 41.9% of women did not know the minimum interval between doses of SP. Finally, 57.4% (n = 89) of patients stated that the number of tablets per dose of SP was 3 tablets, while 31.0% (n = 48) stated that they did not know.

Table 6. Description of knowledge of malaria prevention measures

Figure 3. Description of malaria prevention methods among women who claim to have knowledge of malaria prevention methods.

Table 7 reports the attitudes and practices of the pregnant women surveyed regarding IPT-SP and the use of mosquito nets. It shows that 54.8% (n = 85) of women reported taking IPT-SP during pregnancy. Furthermore, 52.3% (n = 81) of these women reported not having followed the dosage recommended in the prevention protocol, and 95.9% (n = 71) of women who reported following the IPT-SP dosage said they had taken one tablet per dose of IPT-SP.

Regarding mosquito net use, 49.7% (n = 77) reported not sleeping under a mosquito net. Not receiving a mosquito net (41.4%) and discomfort (32.2%) were the main reasons given for not using a mosquito net.

Table 7. Attitudes and practices regarding IPT-SP during pregnancy.