Socioecological risk factors associated with Malaria in Pregnancy in an endemic state of India: a retrospective study

Introduction Malaria in Pregnancy (MiP) has significant adverse effects on both mother and fetus. Pregnant women in regions with unstable malaria transmission are three times more vulnerable to infection. This study analysed malaria prevalence among pregnant women in Odisha, India from 2016 to 2020 and compared it with overall malaria rates. Socioecological factors potentially influencing MiP prevalence were also examined. Methods District-wise cases of malaria-positive pregnant women were analysed using a prevalence index named Malaria in Pregnancy rate (MiPr). The association of MiP with multidimensional poverty, forest cover and tribal population was studied. These three socioecological variables were compared with high and low MiPr (MiPr ≥1 or <1) respectively. Results A strong positive association was observed between the Annual Parasite Index (API) and the MiPr in 2016 (0.95), 2017 (0.97), 2018 (0.88), 2019 (0.97) and 2020 (0.97). The districts comprising a multidimensionally poor population of 45% or more accounted for 67% of the MiP cases in 2020. The odds of getting MiP (MiPr ≥1) were 82.5 times higher in the districts where the tribal population was ≥50% and 3.39 times higher in the districts where the forest cover was ≥40%. In 2020, two districts with high MiPr, Malkangiri (MiPr=5.61) and Rayagada (MiPr=3.24), were above the threshold for all three variables. Conclusions This work highlights an urgent need to increase awareness by the national control programme and the community in vulnerable regions through control and protection measures for pregnant women at higher risk of severe disease.