Malaria in pregnancy across Sub-Saharan Africa: A scoping review of prevalence, risk factors, and preventive interventions.

BACKGROUND

Malaria in pregnancy (MiP) is a major cause of maternal anemia, adverse birth outcomes, and neonatal mortality in sub-Saharan Africa (SSA). Despite preventive efforts, the burden remains high and geographically variable.

OBJECTIVE

This scoping review mapped the prevalence, risk factors, and preventive interventions for MiP in SSA.

METHODS

Following PRISMA-ScR guidelines, peer-reviewed and grey literature published between 2010 and 2025 were searched across global databases and institutional sources.

RESULTS

Evidence shows persistently high exposure with regional heterogeneity. Key individual risk factors include primigravidity, adolescent pregnancy, and HIV co-infection, while health system barriers involve poor antenatal care attendance and low uptake of intermittent preventive treatment in pregnancy (IPTp). Socio-economic disadvantage and environmental determinants further shape vulnerability. Preventive strategies such as IPTp with sulfadoxine-pyrimethamine (SP), insecticide-treated or long-lasting insecticidal nets (ITNs/LLINs), and indoor residual spraying (IRS) demonstrate variable coverage and effectiveness. Emerging data highlight the potential of dihydroartemisinin-piperaquine (DP) and community-delivered IPTp (c-IPTp).

CONCLUSION

Scaling proven interventions is critical, but innovations are required to address persistent gaps. Priorities include evaluating alternative chemoprevention, expanding adolescent-focused antenatal services, and integrating malaria prevention with HIV programs. Further research gaps remain in implementation science for c-IPTp, adolescent ANC uptake, and understanding climate-related shifts in malaria transmission and pregnancy outcomes.