Introduction

Malaria is a life-threatening disease caused by parasites that is transmitted to people through the bites of infected female Anopheles mosquitoes [1]. Around half of the world's population is at risk of malaria but most malaria cases and deaths occur in sub-Saharan Africa. Despite malaria infection can affect all ages and sexes, morbidity and mortality related to malaria are very common in pregnant women and children less than five years of age [2,3]. According to Center for Disease Control (CDC), pregnant women lose some of their immunity and are prone to malaria infection because of the changes in women’s immune systems during pregnancy and the presence of placenta with new places for parasites to bind [4,5].

Despite the incidence of malaria and deaths due to malaria from 1995 to 2015 decreased in Ethiopia, the morbidity and mortality of the population due to malaria is still a major health problem that needs to be solved timely [6]. As malaria is preventable and curable, increased malaria prevention and control measures are dramatically reducing the malaria burden in many places[7].

Additionally; malaria causes significant economic losses, and can decrease the gross domestic product (GDP) by as much as 1.3% in countries with high levels of transmission [4]. In the long run,there will be substantial differences in GDP between countries with and without malaria, particularly in Africa [2, 3]. According to WHO, in some heavy-burden countries, the disease accounts for up to 40% of public health expenditures, 30% to 50% of inpatient hospital admissions, up to 60% of outpatient health clinic visits [1, 5].

Moreover; malaria infection during pregnancy remains a preventable cause of maternal mortality and morbidity globally, including in Ethiopia [8]. According to EDHS 2016, maternal mortality is a major public health problem which shows that the maternal mortality ratio is 412 per 100, 000 live births and malaria contributes as a cause for maternal mortality [8,9]. Malaria infection during pregnancy can have adverse effects on both the mother and fetus, including maternal anemia, maternal mortality, fetal loss, premature delivery, intrauterine growth retardation, and delivery of low birth-weight infants (<2500 g or <5.5 pounds), a risk factor for death which implies a major health problem for newborn and mother [10–13].

Every year in Sub-Saharan Africa there are about 25 million pregnancies which are at risk for malaria infection[14, 15]. In Ethiopia, the burden of malaria during pregnancy remains a public health importance, including its complication for the newborn and mother. Studies done in southern Ethiopian and northwestern Ethiopia revealed that the prevalence of malaria among pregnant women was 9.7 and 10.4% respectively [16, 17].

Studies done in Sub-Saharan Africa including Ethiopia showed that women’s knowledge regarding malaria remains low [18–23]. Studies done in Nigeria [18], BurkinFaso[19], and Sudan [20] revealed that 64.9%, 56.1% and 55.9% of participants had good knowledge on malaria respectively.

Cross-sectional studies were done in Ethiopia especially in Shahsango [24], Bonke [25], and Tepi [26] to assess knowledge on malaria among pregnant women showed that 74.1%, 16.5%and 17.7% of the respondents had good knowledge respectively. However; different studies reveal that practice of malaria preventive measure and health-seeking behavior of the community are related to the level of knowledge. Having a good knowledge regarding malaria cause, mode of transmission, sign and symptom, the effect of malaria on pregnancy and prevention of malaria leads to use malaria prevention mechanism and increase health-seeking behavior [23–24, 27–30]. In Ethiopia, women’s level of practice on malaria preventive measure is too poor [23,24,26,29]. Therefore, determining women’s knowledge on malaria is an important solution.

Different articles revealed that knowledge of pregnant women on malaria is influenced by socio-demographic characteristics like education status, occupation, residence, ownership of television or radio, religion, ethnicity, age, and family monthly income[18–23].

As there is a high burden of malaria, low knowledge of malaria and studies done in Ethiopia are limited; this study was conducted in Adis Zemen primary hospital to assess knowledge on malaria and its associated factors of among pregnant woman. So this study will be helpful in guiding policymakers and concerned bodies and will be used as baseline information for other investigators.

Methods and materials

Result

Socio-demographic characteristics

From a total of the required 236 respondents, two hundred thirty-five mothers participated which made the response rate 99.6%. One hundred thirty-two mothers (56.2%) were in the age group of 25–34. All of the respondents (100%) were Amhara and the mean age of the participants was 28.1 years (SD ±4.8 years). One hundred sixty-six mothers (70.6%) were from urban and most of the participants (95.3%) were married. More than three-fourths of participants (81.3%) were orthodox Christian and around one-sixth of participants (15.7) were governmental employee. One fourth 59(25.1%) of participants couldn’t able to read and write. Most of participants 214 (91.1%) had at least one type of means of communication. Of them who had at least one type of communication, 211 (89.9%) of respondents had mobile Table 1.

Download:

• PPT
  PowerPoint slide
• PNG
  larger image
• TIFF
  original image

Table 1. Socio-demographic characteristic of respondents in Addis zemen primary hospital, north- western, of Ethiopia 2018 (n = 235).

https://doi.org/10.1371/journal.pone.0210221.t001

Malaria knowledge score

Of all a total of 235 subjects, 217 (91.6%) of the participants mentioned fever as a symptom of malaria and headache was mentioned by 183 (81%) of women. All of participants 235 (100%) said malaria can be transmitted through mosquito biting whereas 8 (3.4%) women said that malaria can be transmitted through direct contact. Two hundred four (86.8%) of participants listed abortion as a complication of malaria on pregnancy whereas, 156 (66.4%) of women listed stillbirth. When women asked to list the prevention mechanism of malaria all of the participants (100%) listed using ITN whereas, aminority of participants (1.3%) listed taking medicine as prevention mechanism of malaria Table 2. Overall women’s knowledge on malaria was measured based on correct response using five malaria knowledge questions and the question was scored out of 22 points. The minimum and maximum score of participants were 8 and 18 respectively. One hundred seventy-two (73.2%) of participants hadgood knowledge on malaria whereas, the rest 63 (26.8%) of participants had poor knowledge.

Download:

• PPT
  PowerPoint slide
• PNG
  larger image
• TIFF
  original image

Table 2. Respondents knowledge on malaria in Addis zemen primary hospital, north- western, of Ethiopia 2018 (n = 235).

https://doi.org/10.1371/journal.pone.0210221.t002

Associated factors

The and multivariate logistic regression. First eight variables were tested in binary logistic regression. Variables which had a P value of <0.25 were transferred to multivariate logistic regression to control the confounding variables. Educational status, income, and residence were significantly associated with women’s knowledge on malaria. Women who were from urban were more knowledgeable than women who were from rural (AOR; 2.4: CI; 1.8, 5.7). Mothers who had family monthly income of 101–150 US dollars were more knowledgeable than mothers had family monthly income of 50 US dollars or less (AOR;3.4: CI; 2.7, 3.8). Participants who attended primary education were more knowledgeable than who could not able to read and write (AOR; 1.8: CI; 1.4, 3.5) Table 3.

Download:

• PPT
  PowerPoint slide
• PNG
  larger image
• TIFF
  original image

Table 3. Factors associated with women’s knowledge on malaraia in Adis Zemen Hospital, North western Ethiopia, 2018(n = 235).

https://doi.org/10.1371/journal.pone.0210221.t003

Discussion

In this hospital-based cross-sectional study, we assessed women’s knowledge on malaria and associated factors among mothers attending antenatal clinics of Adis Zemen primary hospital and we found that 172 pregnant women (73.2%) had good knowledge on malaria. Assessing pregnant women’s knowledge on malaria and associated factors is very helpful for policymakers and stakeholders in planning maternal and child health care services. The figure of this study is lower than studies done in Nigeria (83.9%) [32]. This difference may be due to the fact that in the previous study all of the participants attended primary education and above. Educational status affects women’s knowledge so, the lower figure of women’s knowledge in the current study than the previous one may be due to this reason. This figure also lower than a study done in Cameroon (88%) [33]. This difference may be due to the fact that the study setting and sample size difference.

The finding of this study is comparable to studies done in Nigeria (71.5%) [21] and Ethiopia (73.4%) [24]. However, the finding of this study is higher than a study done in Nigeria, which showed that 64.9%[18] of the participants had good knowledge on malaria. This higher figure in the current the study may be due to the fact that the time variation between the two studies. The result of this study is also higher than studies done in Sudan (55.9%) [20]. This difference may be due to the study design and sampling procedure diffrenece which means in the current study, we have used hospital-based and probability sampling whereas in the previous Sudan study, they have used communitybased study design and non-probability sampling. This finding is also higher than a study done in Burkina Faso which revealed that 56.1% [19] of mothers had good knowledge. The difference may be due to the fact study population difference; in our study the study populations were pregnant women whereas in Burkina Faso study, the study populations were all reproductive age group women. This difference may be due to the fact that in the current study,we have used primary data whereas in previous study, they have used secondary data from Burkina Faso malaria indicator survey.

After controlling confounding factors in multivariate logistic regression; educational status, monthly income, and residence were found to be significantly associated with women’s knowledge on malaria.This finding revealed that living in the urban parts of the country increase the level of knowledge on malaria. Women who were from urban were 2.4 times more likely knowledgeable than women who were from rural. The association may be explained by women who are from urban may be more exposed for information like mass media and other health-related meeting than rural. This finding is supported by studies done in Nigeria [18] and Burkina Faso [19] which show that women from urban were more knowledgeable than rural. This result is also in line with a study done in Pawe, Ethiopia [34].

This finding indicated that monthly income was positively associated with women’s knowedge on malaria. Women who had family monthly income of 101–150 US dollars were 3.4 times more likely knowledgeable than mothers who had family monthly income of 50 US dollars or less. Mothers who had family monthly income of 151or more US dollars were2.7 times more likely knowledgeable than mothers had family monthly income of 50 US dollars or less. This association may be due to the fact that mothers who have better income may easily access information regarding malaria. In addition to this, the association may be due to the fact that women who have better income may visit health institutions while they are sick and may get information regarding to malaria. This is similar to studies done in Nigeria [21] and Ethiopia [34] as the studies revealed than mothers who had better family monthly income were more knowledgeable than mothers who had less family monthly income.

The other most important variable which was significantly associated with knowledge on malaria was women’s educational status. According to this study, educated women were more knwoledgeable than those who were not educated. Participants who attended primary education were 1.8 times more likely knowledgeable than who could not able to read and write respectively. Participants who attended college and above were 2.3 times more likely knowledgeable than who could not able to read and write.The finding of this study is similar to studies done inUganda [22], Cameroon [33], and Nigeria [18]. The finding of this study is also similar to studies done in Sudan [20]and Ethiopia [34]. The association may be due to that fact that educated mothers may easily read and understand information regarding malaria.

The current study was conducted among mothers who had antenatal visit and there might be a limitation of knowledge difference between women who had one ANC visit and woman who had three or four ANC visit. Since this study was a hospital based study design, the true figure of women’s knowledge on malaria might not be studied. Another limitation of this study was participants’ feeling about preconception care was not studied.

Conclusion

Pregnant women’s knowledge on malaria is relatively high in Addis zemen hospital when it compares to most other similar studies. In this study, women’s educational status, income, and residence were predictor variables knowledge on malaria.This study confirmed that having a high educational status, having better income, being from urban lead to having good knowledge. Despite women’s knowledge is relatively high in Adis Zemen, increasing women’s knowledge about malaria via health education especially for those who are from rural, have no education, and have low month incomeis needed.

Supporting information

Acknowledgments

Firstly, wewould like to thanks Debre Tabor University for the approval of the Ethical Clearance, and for its financial support for the study. Our sincere appreciations also go to data collectors and supervisors for their timely and honestly collect the required data. Finally,we would like to express our heartfelt thanks to the participants for their willingness to participate in the study, without whom this research would be impossible.