Determinants of Malaria and Maternal and Fetal Outcomes among Pregnant Women in Lomami Province, Democratic Republic of the Congo

Abstract

Purpose: Malaria during pregnancy remains a major cause of maternal morbidity and adverse perinatal outcomes in sub-Saharan Africa. In the Democratic Republic of the Congo, particularly in Lomami Province, evidence on the determinants of malaria among pregnant women and its maternal and perinatal consequences remains limited. This study aimed to identify the determinants of malaria and assess its associated maternal and perinatal outcomes. Methods: An unmatched case–control study was conducted from October to November 2025 in the urban Mwene-Ditu and rural Kanda-Kanda health zones, with follow-up data on pregnancy outcomes collected in April–May 2026. Cases were defined as pregnant women with malaria confirmed by a rapid diagnostic test and/or thick blood smear, whereas controls tested negative for malaria. Data were collected using a structured questionnaire and medical-record review. Associations were assessed using bivariate analyses followed by multivariable logistic regression. Results: A total of 882 pregnant women were enrolled, including 294 cases of clinical malaria and 588 controls. After adjustment, factors associated with increased odds of malaria included non-attendance at antenatal care (adjusted odds ratio [aOR] = 2.41; p < 0.05), failure to receive intermittent preventive treatment with sulfadoxine–pyrimethamine (aOR = 1.87; p < 0.01), and proximity to mosquito breeding sites (aOR = 1.46; p < 0.05). Correct use of insecticide-treated nets was protective (aOR = 0.54; p < 0.001). Malaria was also associated with maternal anaemia (OR = 4.14; p < 0.001), maternal hospitalisation (OR = 10.50; p < 0.001), and low birth weight (OR = 2.99; p < 0.001). Unique Contribution to Theory, Practice and Policy: Malaria among pregnant women in Lomami Province is primarily driven by modifiable preventive and environmental factors. Strengthening antenatal care attendance, uptake of intermittent preventive treatment with sulfadoxine–pyrimethamine, correct use of insecticide-treated nets, and community-based vector control could reduce malaria and its adverse maternal and perinatal outcomes.