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. 2025 Aug 13;14(1):86.
doi: 10.1186/s40249-025-01357-x.

Malaria-anemia comorbidity and its determinants among pregnant women in high- and moderate-malaria-risk countries in Sub-Saharan Africa

Alebachew Ferede Zegeye  1 , Mulugeta Wassie  2 , Tadesse Tarik Tamir  3 , Berhan Tekeba  3 , Enyew Getaneh Mekonen  4 , Gebreeyesus Abera Zeleke  4 , Deresse Abebe Gebrehana  5
Affiliations

Malaria-anemia comorbidity and its determinants among pregnant women in high- and moderate-malaria-risk countries in Sub-Saharan Africa

Alebachew Ferede Zegeye et al. Infect Dis Poverty. .

Abstract

Background: Malaria and anemia remain a major public health problem in Sub-Saharan Africa, with pregnant women being particularly vulnerable to its adverse effects. Despite significant efforts to control malaria and anemia, the burden and adverse effects persist, especially in developing countries among pregnant women. Existing studies investigated malaria and anemia separately and identified individual-level factors as contributors to malaria or anemia, yet the influence of community-level factors remains underexplored. This study aimed to assess the malaria-anemia comorbidity and its determinants among pregnant women in high- and moderate-malaria-risk countries in Sub-Saharan Africa.

Methods: Data from the Malaria Indicator Surveys (MIS) conducted between 2016 and 2022 across 17 Sub-Saharan African countries were used for analysis. The study included a total of 50,545 weighted samples. Multilevel logistic regression was used to assess individual and community-level factors associated with malaria-anemia comorbidity. Factors associated with malaria-anemia comorbidity were considered significant at P-values < 0.05. A model with the lowest deviance and highest log-likelihood ratio was selected as the best-fit model.

Results: The pooled prevalence of malaria-anemia comorbidity among pregnant women was 39.00% (95% CI 29.00-49.00). No formal education (OR = 1.43, 95% CI 1.34-1.54), using untreated bed nets (OR = 1.23, 95% CI 1.16-1.30), poor wealth index (OR = 2.37, 95% CI 2.18-2.57), not using indoor residual spraying (OR = 2.15, 95% CI 1.87-2.48), households without a television (OR = 1.33, 95% CI 1.23-1.44), rural residence (OR = 2.73, 95% CI 2.54-2.93), and residing in West Sub-Saharan Africa (OR = 8.00, 95% CI 7.47-8.57), Central Sub-Saharan Africa (OR = 6.76, 95% CI 76.03-7.57), and South Sub-Saharan Africa (OR = 18.76, 95% CI 17.3-20.4) were determinants of malaria-anemia comorbidity.

Conclusions: This study revealed high malaria-anemia comorbidity among pregnant women in high- and moderate-malaria-risk countries in sub-Saharan Africa, with both individual- and community-level factors as significant determinants. Health policies should prioritize targeted interventions for pregnant women, especially in rural areas, with an emphasis on increasing untreated bed net use, and region-specific strategies, particularly in West, Central, and South Sub-Saharan Africa, where malaria-anemia comorbidity burden is notably high.

Keywords: Anemia; Comorbidity; Malaria; Pregnant women; Sub-Saharan Africa.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study is based on a secondary analysis of publicly available, de-identified data from the Malaria Indicator Surveys (MIS). Ethical approval for this specific analysis was not required. Permission to access and use the dataset was obtained through registration and approval from the DHS Program’s data repository. All data were fully anonymized by the original data collectors prior to public release, in accordance with ethical guidelines. Further information and access procedures can be found at: https://www.dhsprogram.com/data/dataset_admin/index.cfm . Consent to publication: Not applicable. Competing interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Sampling procedure for malaria-anemia comorbidity among pregnant women in high and moderate malaria risk countries in Sub-Saharan Africa
Fig. 2
Fig. 2
The pooled prevalence of malaria-anemia comorbidity among pregnant women in high and moderate malaria risk countries in Sub-Saharan Africa: Malaria Indicator Surveys 2016 − 2022
Fig. 3
Fig. 3
Prevalence of malaria-anemia comorbidity in relation to wealth quantiles among pregnant women in Sub-Saharan Africa: Malaria Indicator Survey 2016–2022
See this image and copyright information in PMC

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