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American Journal of  
Life Science and Innovation (AJLSI)

Malaria Prevalence and Associated Risk Factors among Pregnant Women Attending the 
Prenatal Care Unit of  the Ntoum Departmental Hospital (NDH), Northwest Gabon

Bourdettes Meye1*, Hilaire Moundounga Kenguele2, Ludjer Mpiga Ekambou3, Strédice Maguinga Guitouka4 , Robert Eya’ama 
Mve5, Kevin Alame Emane1, Joseph Privat Ondo1, Louis Clément Obame Engonga1

Volume 4 Issue 1, Year 2024
ISSN: 2833-1397 (Online)

DOI: https://doi.org/10.54536/ajlsi.v4i1.4680
https://journals.e-palli.com/home/index.php/ajlsi

Article Information ABSTRACT

Received: March 02, 2025

Accepted: April 10, 2025

Published: June 15, 2025

Malaria during pregnancy is a significant public health problem in endemic countries. This 
study aimed to determine the prevalence of  malaria and associated risk factors among 
pregnant women attending the Departmental Hospital of  Ntoum (Northwest Gabon) for 
prenatal care. A cross-sectional survey was conducted for 6 months (July to December 
2024), among pregnant women attending the prenatal care unit of  the Ntoum departmental 
Hospital (NDH). Pregnant women selected for the study were asked to complete a structured 
questionnaire. At the end of  the interview, a nurse drew a blood sample in an EDTA tube. 
Malaria was detected by thick blood smear using the WHO method. A P-value < 0.05 
was considered statistically significant. Blood samples were collected from 202 pregnant 
women. Malaria was diagnosed in 23.3%. Patients aged between 20 and 30 years (53.2%), 
with a gestation of  4 to 6 months (46.8%) and living in the first district of  Ntoum city 
(70.2%) were the most infected with the disease. Most of  these women had completed 
secondary education (87.2%) and were unemployed (68.1%). Fever and headache were the 
most frequently reported symptoms, accounting for 51.1% and 42.5% of  cases, respectively. 
Women who slept under an insecticide-treated net or used insecticide spray were less prone 
to malaria infection; but, the difference was not significant (P˃0.05) In contrast, pregnant 
women who reported episodes of  fever were significantly less likely to test positive to 
malaria (OR = 0.24 [0.09 - 0.61]; P =0.002). Among the women who tested positive, 83% 
had a low parasitemia. Plasmodium infection in the Komo Mondah department is high. The 
development of  a malaria vaccine would make it possible to immunize all participants and 
thus reduce the spread of  malaria worldwide.

Keywords

Gabon, Malaria, Ntoum, Pregnant 
Women, Prevalence

INTRODUCTION 
Worldwide, malaria is a major public health problem 
(Organization, 2023). In 2023, nearly 263 million cases 
and 597,000 deaths were recorded across the globe, with 
Africa remaining the continent most affected by the 
disease, accounting for 94% of  malaria cases and 95% 
of  deaths (Organization, 2024). Pregnant women and 
children under 5 are the most vulnerable group to the 
disease (Organization, 2019). The WHO’s 2021 World 
Malaria Report highlighted that one in three pregnancies 
is exposed to a malaria infection in the African region, 
and that the continent’s West Zone has the highest rate 
of  exposure to malaria (40%), followed by the Central 
Zone (39%) and the East and Southern Zone (22%) 
(Organization, 2022). Every year, nearly 25 million 
pregnant women are confronted with the consequences 
of  malaria, and the risk of  infestation is greatest during 
the first trimester of  pregnancy (Steketee et al., 2001). 
According to one study, a fifth (20%) of  all stillbirths 
and 11% of  all neonatal deaths are the result of  this 
disease (Obossou et al., 2024). Gabon, like most African 
countries, is aiming to achieve universal health coverage. 

In this Central African country crossed by the equator, 
the incidence of  malaria and its lethality fell in 2022 
(OMS Gabon, 2023). More than one household in five 
(21%) owns at least one insecticide-treated mosquito net 
(ITN), and the proportion of  households with an ITN is 
higher in rural compared to urban areas (29% versus 21%) 
(EDSG, 2022). Faced with the rapid spread of  mosquitoes 
worldwide, the use of  insecticides has become widespread 
(Fu & Guanli, 2024). Just over half  (51%) of  the population 
of  the communes of  Libreville, Owendo and Akanda use 
aerosol insecticides, and a quarter (25%) of  these households 
appreciate spiral fumigants (Pamba et al., 2021). In the south-
east of  the country, 47% of  people in Franceville city use 
indoor insecticide spraying, compared to 21.1% in Moanda 
city (Kenguele et al., 2022; Mabiala et al., 2021).
According to several publications, not sleeping under 
an insecticide-treated net, nor spraying one’s home with 
residual aerosol insecticides, contribute to the spread of  
malaria. Likewise, being unemployed, living in unhealthy 
neighborhoods and having a low level of  education are 
risk factors associated with malaria (Okiring et al., 2019; 
Rek et al., 2020; Ramharter et al., 2007).

1 Department of  Biochemistry, Laboratory of  Research in Biochemistry (LAREBIO), University of  Sciences and Techniques of  
  Masuku (USTM) Franceville, Gabon
2 Department of  Biology, Laboratory of  Molecular and Cellular Biology (LABMC), University of  Science and Techniques of  
  Masuku (USTM), Franceville, Gabon
3 Ntoum Departmental hospital (HDN), Ntoum, Gabon
4 Nkembo Specialist Hospital, Libreville, Gabon
5 University Hospital, Jeanne Ebori Foundation (CHUFJE), Libreville, Gabon
* Corresponding author’s e-mail: meyebourdettes@yahoo.fr



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The detection, identification and quantification of  malaria 
parasites are strategies advocated by the WHO to combat 
malaria worldwide (Organization, 2020) effectively. 
Microscopic observation of  parasites using thin and thick 
blood smears remains the reference method for adapting 
therapeutic management (Organization, 2014). This 
parasitological technique is sometimes combined with a rapid 
diagnostic test (RDT) based on immunochromatography 
(Al-Quhaiti et al., 2022; Bah et al., 2020).
The third demographic and health survey in Gabon 
indicated that the Estuary province, which includes seven 
communes, had a high prevalence of  malaria infection 
among pregnant women (EDSG, 2022). To the best 
of  our knowledge, no study of  gestational malaria has 
been carried out in the commune of  Ntoum. In order 
to address this problem, new reliable and accurate data 
on malaria prevalence and associated factors among 
pregnant women living in this commune are needed. This 
study will provide updated information on the extent 
of  malaria infection in this vulnerable group residing in 
north-west Gabon, in the Komo Mondah department.

MATERIAL AND METHODS
Study Setting and Location
A prospective, observational study was conducted at 
Ntoum Hospital for 6 months, from July to December 
2024. Ntoum Hospital is the only public health facility in 
the commune of  Ntoum, capital of  the Komo Mondah 
Department. The hospital operates every day of  the 
week, day and night. 
The town of  Ntoum is 34 km away from the capital city 
Libreville, and is geolocated at 0° 17′ 18″ North and 9° 
46′ 0″ East. It is a rural community estimated in 2012 to 
have 11,813 inhabitants (DGS, 2015). The region’s relief  
is made up of  flooded areas and numerous rivers. The 
vegetation is characterized by riparian forests, located in 
swampy areas, marked by a predominance of  mangroves, 
forests under fallow land located mainly along the main 
roads and dense evergreen rainforest located inland. 
The locality’s hot, humid conditions favor the life cycle 
of  Anopheles mosquitoes, the main vectors of  malaria 
in Gabon (Mbouloungou et al., 2019; Agyekum et al., 
2021). In the commune of  Ntoum, malaria transmission 
is intense and permanent (Meye et al., 2024).

Study Population and Inclusion Criteria
The study population consisted of  all pregnant women 
who had given informed consent to participate in the study 
and who, during the study period, had attended a prenatal 
consultation at Ntoum hospital. All pregnant women 
who had been screened for malaria during their antenatal 
visit were included in the study, and those who were not 
screened for malaria were excluded from the study.

Data and Biological Material Collection 
Pregnant women who signed the informed consent form 
were included in the study and interviewed by a midwife. 
The self-administered questionnaire asked about the 

respondent’s socio-demographic characteristics (age, 
level of  education, place of  residence, occupation, etc.), 
obstetrical factors (gestational age), malaria preventive 
measures (use of  insecticide-impregnated mosquito 
nets, use of  insecticide spray) and malaria symptoms. 
At the end of  the interview, the pregnant woman was 
taken to the sampling room, where a nurse performed a 
venipuncture on an EDTA tube.

Study Approval and Ethical Considerations 
The study was approved by the NDH General 
Management. All procedures contributing to this project 
comply with the ethical standards of  the relevant national 
and institutional committees on human experimentation, 
and with the Declaration of  Helsinki of  1975, as revised 
in 2008.

Statistical Analysis
The data collected were entered into a database using 
Microsoft Excel version 2016. All statistical analyses were 
performed using R software version 1.4.2. Descriptive 
statistics were used in the analysis of  sociodemographic 
characteristics, obstetric history, prevalence of  malaria 
infection and preventive measures for malaria infection, 
and variables were presented as frequencies and 
percentages. ODDS ratio and Pearson’s Chi square test 
used to determine the degree of  association between the 
disease and independent variables. A p-value < 0.05 was 
considered statistically significant. 

Biological Analysis and Measurements 
A microscopic blood test was carried out as a standard 
screening test on all participants. Parasitological 
examinations of  the thick blood smears were carried 
out by a trained laboratory technician. Briefly, after 
identifying the end of  an object slide, 5 µL of  whole 
blood was pipetted into the center of  the slide using a 
calibrated pipette. Using the corner of  another clean, 
degreased slide, the drop of  blood was spread evenly 
to form a circle approximately 12 mm in diameter. A 
hairdryer was then used to heat the spread. After cooling, 
the entire preparation was covered for 10 minutes with a 
10% solution of  Giemsa. The dye was then removed with 
a gentle trickle of  tap water, and the slide dried at room 
temperature. Slides were read using a light microscope 
(Leica DM500), and 200 microscopic fields were 
systematically examined for malaria hematozoa using a 
100X immersion objective. These were counted alongside 
leukocytes. The number of  parasites was reported per 
1 microliter of  blood (based on 8,000 leukocytes per 
microliter of  blood).

RESULTS AND DISCUSSION
Results
Sociodemographic and Obstetric Characteristics, 
Clinical Symptoms, and Preventive Measures of  
Study Participants
Two hundred and two (202) survey forms were completed 



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and used for data analysis, indicating a participation rate 
equal to 100%. At the time of  inclusion, the average 
age of  the participants was 27.5 years with an age range 
between 15 and 44 years. Patients aged 20 to 30 were 
the most represented (n = 117, 58%), followed by those 
over 30 (n = 57, 28.2%). The main clinical signs reported 
in the survey were headaches (n =71, 35.1%), cough (n 
=38, 18.8%), diarrhea (n =22, 10.8%) and general fever 
(n =58, 28.7%). Most participants (n =156, 77.2%) lived 
in the first district of  neighboring Ntoum commune. The 
remainder lived in the second district (n=24, 11.8%) and 

surroundings (Andem, Kango, Libreville and Cocobeach) 
(n=22, 11%). More than two-third (n=138, 68.3%) 
of  participants had completed secondary school, and 
a few hold a university degree (n=37, 18.3%).. A large 
number (139, 68.8%) were unemployed.. The majority of  
respondents (n= 105, 52%) were in their second trimester 
of  gestation, 24.7% were carrying a first-trimester 
pregnancy and 23.3% a third-trimester pregnancy. The 
survey revealed that more than half  the participants did 
not sleep under an ITN (52%) or use a mosquito repellent 
(58.4%) (Table 1).

Table 1: Sociodemographic and obstetric characteristics, clinical symptoms, and malaria preventive measures, of  
pregnant women attending the Ntoum Departmental Hospital
Measured variables (n) (%)
Age (years)
< 20 28 (13,8)
20 – 30 117 (58)
>30 57 (28,2)
Respiratory signs 
Dyspnea 03 (1,5)
suffocation 09 (4,5)
Cough 38 (18,8)
Choking/Fever 03 (1,5)
None 149 (73,7)
Neurological signs 
Dizziness 46 (22,7)
Headache 71 (35,1)
Asthenia 1 (0,6)
None 84 (41,6)
Digestive signs 
Diarrhea 22 (10,8)
Vomiting 21 (10,4)
Epigastralgia 12 (6,1)
Vomiting / headache 2 (1,0)
None 145 (71,7)
General signs 
Asthenia 54 (26,8)
Fever 58 (28,7)
None 90 (44,5
Place of  residence
1st district 156 (77,2)
2nd district 24 (11,8)
3rd district 00 (00)
Neighboring towns (Libreville, Kango, Cocobeach, Andem, Kougouleu, Donguila) 22 (11)
Education level
Primary 19 (9,4)
Secondary 138 (68,3)
University 37 (18,3)
Illiterate 8 (4,0)



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Occupation
Unemployed 139 (68,8)
Employed 63 (31,2)
month of  pregnancy
1 - 3 (1st trimester) 50 (24,7)
4 - 6 (2nd trimester) 105 (52)
7 - 9 (3rd trimester) 47 (23,3)
Insecticide-treated nets (ITN) 
Yes 97 (48,0)
No 105 (52,0)
Insecticide spray
Yes 84 (41,6)
No 118 (58,4)

Parasite Density 
Thick blood smears were used to assess parasite density in 
line with WHO recommendations (Organization, 2020). 
Plasmodium falciparum was the only plasmodial species 
observed in all examined biological samples. Among the 
pregnant women infected with this parasite, 83% (n = 
39) had a low parasite density (< 1,000 parasites/µL), 
12.8% (n = 6) a moderate parasitaemia (1,000 - 9,999 

parasites/µL) and 4.2% (n = 2) a high parasitaemia 
(≥ 10,000 parasites/µL). Of  the 39 patients with low 
parasitaemia, 42.6% were aged between 20 and 30, 23.4% 
were over 30 and 17% under 20. Among women with 
moderate parasitaemia, 8.6% were aged between 20 and 
30, and 4.2% were under 20. Two cases (4.2%) of  high 
parasitaemia were recorded, one in the age group 20 -30 
and the other in the over 30 (Table 2).

Table 2: Parasite density by age among pregnant women in the commune of  Ntoum (2024)
Age ( years) Low (< 1000 p/µL) Moderate (1000 – 9 999 p/µL) High (≥ 10 000 p/µL)

n % N % n %
< 20 8 17 2 4,2 0 0
20 – 30 20 42,6 4 8,6 1 2,1
>30 11 23,4 0 0 1 2,1
Total 39 83 6 12,8 2 4,2

Malaria Prevalence According to Sociodemographic 
and Obstetric Characteristics, Clinical Symptoms, 
and Preventive Measures among Pregnant Women 
Attending the Ntoum Departmental Hospital
All participants (n = 202) were tested for malaria. 
The results were positive in almost a quarter of  the 
participants, giving a prevalence of  malaria 23.3%. Of  
the 47 pregnant females with malaria hematozoa in 
their circulating blood, 53.2% were aged between 20 
and 30, and 25.5% were over 30. Plasmodium infection 
was diagnosed predominantly (46.8%) in women in 
their second trimester of  pregnancy, followed by those 

in their first and third trimesters (31.9% and 21.3%, 
respectively). Clinically, cough was encountered in one-
fifth (21.3%) of  them, and two-fifth (42.5%) complained 
of  headaches. Almost a sixth (15%) suffered from acute 
diarrhea, and over half  (51.1%) had a fever. The largest 
number of  participants (70.2%) lived in the first district 
of  Ntoum commune and had completed secondary 
school (87.2%)., Malaria was detected in the majority 
(68.1%) of  pregnant women with no income-generating 
activity. More than half  of  them did not use insecticide 
sprays or sleep under an insecticide-impregnated net 
(Table 3).

Table 3: Clinical symptoms, Preventives measures, Sociodemographic and obstetric characteristics
Variables (Frequency (%) Malaria + (%) Odd ratio 95% CI P-value
Age (years)
< 20 28 (13,8) 10 (21,3)
20 – 30 117 (58) 25 (53,2) 2.04 0.84 - 4.98 0.115
>30 57 (28,2) 12 (25,5) 2.08 0.76 - 5.67 0.150
Month of  pregnancy
1 - 3 (1st trimester) 50 (24,7) 15 (31,9)
4 - 6 (2nd trimester) 105 (52) 22 (46,8) 1.61 0.75 - 3.47 0.218



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7 - 9 (3rd trimester) 47 (23,3) 10 (21,3) 1.58 0.63 - 3.99 0.328
Respiratory signs 
Dyspnea 03 (1,5) 2 (4,3)
suffocation 09 (4,5) 4 (8,5) 2.50 0.16 - 38.60 0.511
Cough 38 (18,8) 10 (21,3) 5.60 0.45 - 68.68 0.178
Choking 03 (1,5) 1 (2,1) 4.00 0.13 - 119.23 0.423
None 149 (73,7) 30 (63,8) 7.66 0.67 - 87.42 0.100
Neurological signs 
Dizziness 46 (22,7) 9 (19,1)
Headache 71 (35,1) 20 (42,5) 0.62 0.25 - 1.51 0.294
Asthenia 1 (0,6) 00 (00) 0.76 0.03 - 20.17 0.869
None 84 (41,6) 18 (38,4) 0.89 0.36 - 2.18 0.802
Digestive signs 
Diarrhea 22 (10,8) 7 (15)
Vomiting 21 (10,4) 5 (10,6) 1.49 0.39 - 5.74 0.559
Epigastralgia 12 (6,1) 5 (10,6) 0.65 0.15 - 2.8 0.566
Vomiting 2 (1,0) 00 (00) 2.42 0.10 - 56.97 0.583
None 145 (71,7) 30 (63,8) 1.79 0.66 - 4.78 0.246
General signs 
Asthenia 54 (26,8) 8 (17)
Fever 58 (28,7) 24 (51,1) 0.24 0.09 - 0.61 0.002
None 90 (44,5 15 (31,9) 0.86 0.34 - 2.21 0.769
Place of  residence
1st district 156 (77,2) 33 (70,2)
2nd district 24 (11,8) 9 (19,1) 0.44 0.18 - 1.11 0.083
3rd district 00 (00) 00 (00) 0.27 0.005 - 13.92 0.516
Neighboring towns 22 (11) 5 (10,7) 0.91 0.31 - 2.65 0.866
Education level
Primary 19 (9,4) 3 (6,4)
Secondary 138 (68,3) 41 (87,2) 0.44 0.12 - 1.60 0.215
University 37 (18,3) 1 (2,1) 6.75 0.65 - 69.97 0.109
Illiterate 8 (4,0) 2 (4,3) 0.56 0.07 - 4.24 0.576
Occupation 
Unemployed 139 (68,8) 32 (68,1)
Employed 63 (31,2) 15 (31,9) 0.95 0.47 - 1.93 0.902
Use of  Insecticide Spray
Yes 84 (41,6) 19 (40,4)
No 118 (58,4) 28 (59,6) 0.94 0.48 - 1.82 0.854
Use of  Bed net
Yes 97 (48,0) 21 (44,7)
No 105 (52,0) 26 (55,3) 0.84 0.43 - 1.61 0.601

Factors Associated with Malaria Infection 
This study revealed that pregnant women aged 20-30 
and over 30 were two times more likely to test positive 
to malaria compared to those under 20. Likewise, women 
in their second trimester were more susceptible to 
malaria infection (OR = 1.61 [0.75 – 3.47]). Women with 
university education were nearly seven (7) times less prone 

to malaria infection compared to the other groups (OR = 
6.75 [0.65 – 69.97]). Employed women appeared to be 
less exposed to malaria infection than the unemployed 
ones (OR = 0.95 [0.47 – 1.93]). 
Neither the clinical manifestations, nor the obstetric or 
the preventive measures were significantly associated 
with malaria (P˃0.05). In contrast, women who reported 



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episodes of  fever during the survey were less prone to 
malaria infection, and the difference was found statistically 
significant (OR = 0.24 [0.09 - 0.61]; P =0.002).

Discussion
A six- month cross-sectional study was conducted at the 
departmental Hospital of  Ntoum to assess the prevalence 
and risk factors associated with malaria among pregnant 
women. Among participants in this study, the prevalence 
of  malaria infection was 23.3%. This is comparable to the 
prevalence of  malaria reported in north-west Ethiopia 
(Almaw et al., 2022) and Burkina Faso (Rouamba et al., 
2021), but these results are higher than those found in 
studies carried out in Kenya (Okoyo et al., 2021) and Nigeria 
(Oyerogba et al., 2023). Nevertheless, the prevalence 
among pregnant women in Komo Mondah is lower than 
that found in the San District of  Mali (Diarra et al., 2022), 
or that reported in south-east Nigeria (Okoroiwu, 2023) 
and Uganda (Mangusho et al., 2023). These discrepancies 
in prevalence observed in high-transmission countries 
justify the view that malaria prevalence is a function of  
sample size and socio-environmental factors.
In our study, the average age of  pregnant women surveyed 
was 27.4 years, with extremes of  15 and 44 years. These 
values are similar to those found in many African health 
facilities. Indeed, the average age of  pregnant women 
attending antenatal clinics were 27.3 years, 26, and 24.6 
years respectively in Cameroon, Burkina Faso, and Mali, 
(Nguefack, 2018; Yameogo,2023 ; Delbaere et al., 2020). 
These similar results are due to the fact that a woman’s 
fertility is at its peak between the end of  adolescence and 
the approach of  her thirties. After the age of  30, fertility 
begins to decline, collapsing around the age of  38 due to a 
decrease in the number and quality of  oocytes (Delbaere 
et al., 2020).
This study revealed that 21.3% of  pregnant women under 
20 suffered from malaria. These results are lower than 
those found in the peripheral maternity wards of  Parakou 
in Benin and at the Toamasina University Hospital in 
Madagascar, where malaria rates among pregnant women 
under 20 were 56.9% and 47.5% respectively (Obossou et 
al., 2024 ; Botolahy et al., 2011). Among pregnant women 
aged between 20 and 30, malaria prevalence was 53.2% 
in our study. These results are slightly lower than those 
observed in Benin (Obossou et al., 2024), but higher than 
those observed at the commune II reference health center 
in Bamako, Mali (Santara, 2024). In the case of  pregnant 
women over 30 years of  age, 25.5% of  our participants 
suffered from malaria, compared with 42.1% in the 
peripheral public maternity units of  Parakou, Benin. 
(Obossou et al., 2024). Younger women and primiparous 
women are traditionally considered to be at greater risk of  
malaria, as they do not benefit from sufficient immunity 
with age (Nankabirwa et al., 2014).
In our study, malaria was more frequent in pregnant 
women in their second trimester (46.8%) than in those 
in their first or third trimester (31.9% and 21.3% 
respectively). Our results are in line with those found in 

Ghana, and north-eastern Nigeria (Dwumfour et al., 2023; 
Ali, 2022). Where the categories of  pregnant women most 
affected were those in their second trimester, followed by 
those in their third trimester. Those in their first trimester 
had the lowest malaria prevalence. Nevertheless, our 
results contrast with those found in the Democratic 
Republic of  Congo (DRC) and eastern Sudan. Indeed, 
their work emphasizes that it is during the third trimester 
of  pregnancy that women are more likely to suffer from 
malaria (Bihingoyi, 2013; Idris Nour et al., 2023). Other 
studies carried out in southern Ghana and southern 
Malawi, on the other hand, showed that pregnant women 
were at greater risk of  contracting malaria during the 
first trimester of  pregnancy (Ahadzie-Soglie et al., 2022; 
Verhoeff  et al., 1999). These discrepancies could be 
explained by the fact that there is no significant association 
between gestational age and malaria, as highlighted by a 
study carried out in Burkina Faso (Tahita et al., 2013).
Level of  education also influenced the frequency of  
malaria in pregnant women. The highest incidence of  
malaria was found among pregnant women with secondary 
education (87.2%), followed respectively by primiparous 
(6.4%), illiterates (4.3%) and university graduates (2.1%). 
In general, the risk of  contracting malaria decreases with 
the level of  education, which is associated with better 
knowledge of  malaria prevention measures and better 
access to health services. However, significant disparities 
may exist within study groups (Salissou et al., 2016).
Most participants with malaria (70.2%) lived in the first 
district of  the Ntoum commune, followed by those living 
in the second district and neighboring towns; 19.2% and 
10.7% respectively. In addition, to the tropical climate 
that prevails throughout Gabon, the first district of  the 
commune of  Ntoum is a region rich in bodies of  water 
(inlets, mangroves, rivers and streams). The proximity 
habitations with watercourses and dense vegetation favors 
human contact with mosquitoes, and hence the occurrence 
of  malaria (Chaves et al., 2021; Dufera et al., 2020).
The study showed that the unemployment rate among 
participants was 68.8% (Tonda, 2024).]. In our study, the 
prevalence of  malaria among these unemployed people 
was equal to 68.1%. The low purchasing power of  the 
poor means that they cannot afford medical consultations 
in Gabonese hospitals, nor can they afford anti-mosquito 
bite tools (aerosol sprays, spiral fumigants) or antimalarial 
drugs. In most cases, the latter are forced to turn to cheaper 
traditional medicines, thus encouraging the transmission 
of  malaria (Diallo et al., 2007; Kodio et al., 2023).
In this study, clinical symptoms were dominated by fever 
(51.1%), followed by headache (42.5%). According to the 
results of  a study carried out in Malawi, the main clinical 
signs in favor of  malaria were headaches (24.3%) and 
chills (16.9%). Fever and muscle pain were less common, 
with 7.1% and 6.7%, respectively (Namwera et al., 2025). 
In another study, carried out in north-west Ethiopia, the 
clinical signs of  malaria encountered in pregnant women 
were mainly fever (91.8%) and headache (81.4%) (Almaw 
et al., 2024). The probability of  malaria was significantly 



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higher in pregnant women presenting with fever and 
headaches than in asymptomatic pregnant women. A 
study conducted in Burkina Faso also found that fever, 
history of  fever and headache were the most common 
malaria-related clinical signs in pregnant women (Tahita 
et al., 2013). On the basis of  these findings, the presence 
of  fever and headaches in pregnant women in tropical 
zones points to malaria and emphasizes the need for early 
detection. 
To protect themselves from mosquito bites in the mining 
town of  Moanda (south-east Gabon), 21.1% of  people 
used insecticide sprays (Nno Mabiala et al., 2021). This 
frequency of  chemical agent use is lower than that found 
in our study (41.6%), but higher in households in Niger 
(63%) (Mahaman Toudou et al., 2021). The proliferation 
of  insect pests on agricultural fields in Niger has prompted 
farmers to use large volumes of  synthetic insecticides on 
legumes and in irrigated perimeters, justifying the high 
use of  insecticides in this country (Abdou et al., 2024).
This study revealed that more than half  (59.6%) of  
malaria sufferers did not use chemical agents to protect 
themselves from mosquitoes, justifying that the risk of  
contracting malaria is lower when insecticides are used 
as an alternative to ITNs. However, the massive use of  
insecticides can, on the other hand, cause gene mutations 
in Anopheles gambiae strains, making them resistant 
to many insecticides (DDT and pyrethroids), as some 
studies have shown (Organization, 2023 ; Akono et al., 
2022). Sleeping under an insecticide-treated mosquito 
net to prevent insect bites is a practice recommended by 
the WHO [1]. In this study, 48.0% of  pregnant women 
declared sleeping under an ITN. Our results are similar 
to those found in Nigeria (42.2%) (Ogomaka, & Obeagu, 
2021); but, lower than those obtained in Rwanda (57.9%) 
(Kawuki et al., 2023). This discrepancy in results may be 
explained by the sample size and the study region, which 
differed from one study to another. Nevertheless, this 
study reveals that more than half  (55.3%) of  pregnant 
women who did not sleep under an ITN suffered from 
malaria. This finding is consistent with the fact that 
sleeping under an ITN reduce the incidence of  malaria 
(Organization, 2023).

Study Limitations
Our study has a number of  limitations which must be 
taken into account when interpreting the results. Indeed, 
the relatively small sample size, the absence of  data on 
intermittent preventive treatment during pregnancy 
(IPTp), and the lack of  explanatory variables such as 
the reasons why participants did not sleep under an 
insecticide-treated net, or did not use aerosol sprays may 
reduce the statistical power to detect a true association in 
the population.

CONCLUSION 
This study shows that the rate of  malaria during pregnancy 
is widespread among women consulting for antenatal 
care at Ntoum Hospital. The study also shows that 

regular use of  malaria control tools (insecticide-treated 
nets, indoor residual spraying) and early antenatal care 
visits can significantly reduce the risk of  malaria during 
pregnancy. To reduce the burden of  malaria in the region, 
we recommend the distribution of  free insecticide-
treated mosquito nets to all pregnant women attending 
antenatal care at Ntoum hospital. Biological diagnosis 
and early treatment of  malaria should be combined with 
the use of  insecticide-treated nets. Municipal authorities 
should implement environmental control measures to 
control the population of  Anopheles larvae. Finally, the 
Gabonese government should ensure the implementation 
of  vector control interventions based on entomological 
surveillance, the correct and rational use of  insecticides, 
and the monitoring and management of  insecticide 
resistance.

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