Kassawmar Angaw Bogale

Abstract

Background: Malaria in pregnancy remains a major equity and health challenge in Ethiopia, with marked geographical and service disparities. Understanding the spatial, temporal, and environmental dynamics of malaria among pregnant women is vital for equitable and targeted interventions. This study examined geographical distribution and service-related determinants of malaria among pregnant women in the Amhara region from 2018 to 2024.

Methods: A retrospective spatiotemporal analysis was conducted using malaria surveillance data from 2018 to 2024. Purely spatial, temporal, and space–time clusters were identified using SaTScan based on a discrete Poisson model. Environmental and service-related factors—including rainfall, temperature, NDVI, soil moisture and antenatal care (ANC) coverage—were analyzed using spatial error models to adjust for spatial autocorrelation. Global Moran’s I was applied to assess residual clustering.

Results: During the study period, 5.8 million pregnant women were under surveillance, and 53,478 malaria cases were reported, yielding an annual incidence of 9.2 per 1,000. Seven significant spatial clusters were detected, with the strongest hotspot located in the Quara–Jawi–Metema zone (RR = 8.65, p < 0.001). The primary temporal cluster occurred between 2022 and 2024 (RR = 3.73, p = 0.001). Spatiotemporal analysis identified seven significant clusters concentrated in western Amhara (RR = 7.12, p < 0.001). Spatial regression indicated higher malaria clustering was associated with fewer ANC4 visits, lower soil moisture, and reduced API, while higher ANC1 coverage was positively associated with clustering.

Conclusion: Geographical and service inequities contribute to malaria clustering among pregnant women in the Amhara region. Strengthening ANC service coverage and addressing environmental vulnerabilities in high-risk areas are critical for achieving equitable malaria control and prevention outcomes.