Zegeye Alebachew Ferede, Wassie Mulugeta, Tamir Tadesse Tarik, Tekeba Berhan, Mekonen Enyew Getaneh, Zeleke Gebreeyesus Abera, Gebrehana Deresse Abebe
Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
Department of Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
Infect Dis Poverty. 2025 Aug 13;14(1):86. doi: 10.1186/s40249-025-01357-x.
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.
背景：疟疾和贫血仍然是撒哈拉以南非洲地区的一个主要公共卫生问题，孕妇尤其容易受到其不利影响。尽管在控制疟疾和贫血方面做出了重大努力，但负担和不利影响仍然存在，特别是在发展中国家的孕妇中。现有研究分别调查了疟疾和贫血，并确定了个体层面的因素是导致疟疾或贫血的原因，但社区层面因素的影响仍未得到充分探索。本研究旨在评估撒哈拉以南非洲高疟疾风险和中度疟疾风险国家孕妇中疟疾-贫血合并症及其决定因素。 方法：使用2016年至2022年期间在17个撒哈拉以南非洲国家进行的疟疾指标调查（MIS）数据进行分析。该研究共包括50,545个加权样本。采用多水平逻辑回归来评估与疟疾-贫血合并症相关的个体和社区层面因素。与疟疾-贫血合并症相关的因素在P值<0.05时被认为具有显著性。选择偏差最低和对数似然比最高的模型作为最佳拟合模型。 结果：孕妇中疟疾-贫血合并症的合并患病率为39.00%（95%CI 29.00-49.00）。未接受正规教育（OR=1.43，95%CI 1.34-1.54）、使用未处理蚊帐（OR=1.23，95%CI 1.16-1.30）、财富指数低（OR=2.37，95%CI 2.18-2.57）、未使用室内滞留喷洒（OR=2.15，95%CI 1.87-2.48）、家庭没有电视（OR=1.33，95%CI 1.23-1.44）、农村居住（OR=2.73，95%CI 2.54-2.93）以及居住在撒哈拉以南非洲西部（OR=8.00，95%CI 7.47-8.57）、中部（OR=6.76，95%CI 76.03-7.57）和南部（OR=18.76，95%CI 17.3-20.4）是疟疾-贫血合并症的决定因素。 结论：本研究揭示了撒哈拉以南非洲高疟疾风险和中度疟疾风险国家孕妇中疟疾-贫血合并症的高患病率，个体和社区层面因素均为重要决定因素。卫生政策应优先针对孕妇进行有针对性的干预，特别是在农村地区，重点是增加未处理蚊帐的使用，以及制定针对特定地区的策略，特别是在疟疾-贫血合并症负担明显较高的撒哈拉以南非洲西部、中部和南部地区。
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