Prevalence of Malaria among Pregnant Women: A Narrative Review of Epidemiology, Pathophysiology, and Prevention Strategies, with Emphasis on Sub-Saharan Africa and Nigeria
S. K. Bello *
Department of Public Health, Institute of Global Health and Infectious Diseases Control, Nasarawa State University, Keffi, Nigeria.
A. Nyamve
Department of Public Health, Institute of Global Health and Infectious Diseases Control, Nasarawa State University, Keffi, Nigeria.
S. C. Tama
Centre for Vaccine Research and Biotechnology, Federal University Teaching Hospital, Lafia, Nigeria.
S. C. Hassan
Department of Public Health, Institute of Global Health and Infectious Diseases Control, Nasarawa State University, Keffi, Nigeria.
I. H. Nkene
Department of Public Health, Institute of Global Health and Infectious Diseases Control, Nasarawa State University, Keffi, Nigeria.
*Author to whom correspondence should be addressed.
Abstract
Aims: To synthesise current evidence on the burden, pathophysiology, risk factors, and prevention of malaria in pregnancy, with particular emphasis on sub-Saharan Africa and Nigeria, and to identify priorities for research and programme strengthening.
Study Design: Structured narrative review of peer-reviewed literature, systematic reviews, meta-analyses, World Health Organization (WHO) reports, and national survey data published principally between 2000 and 2026.
Place and Duration of Study: Global literature, with a primary focus on moderate- to high-transmission settings in the WHO African Region and on Nigeria; literature search and synthesis conducted in 2025–2026.
Methodology: PubMed/MEDLINE, Google Scholar, the WHO Global Malaria Programme repository, and the Demographic and Health Surveys (DHS) Program repository were searched for evidence on malaria in pregnancy, placental malaria, VAR2CSA, intermittent preventive treatment (IPTp), insecticide-treated nets (ITNs), and antimalarial resistance. Priority was given to systematic reviews, meta-analyses, randomised trials, WHO reports, and national surveys. The review was structured with reference to the SANRA quality criteria for narrative reviews.
Results: In 2024, WHO estimated that about 36 million pregnancies occurred in moderate- to high-transmission countries of the WHO African Region, of which about 13 million (36 %) were exposed to malaria infection. A meta-analysis of 178 studies (93,809 parturient women, 23 sub-Saharan African countries) reported a pooled placental malaria prevalence of 25.1 %, rising to 34.8 % by histopathology; placental malaria was associated with maternal anaemia (OR 2.18) and low birth weight (OR 1.71). More than half of PCR-detected infections in pregnancy are submicroscopic. Sequestration mediated by VAR2CSA underpins these outcomes, and the risk is highest in primigravidae and women living with HIV. Coverage of three or more IPTp doses was only 45 % across 34 African countries in 2024 (target 80 %) and 31 % in Nigeria in 2021. Sulfadoxine-pyrimethamine (SP) resistance erodes parasitological efficacy, yet SP retains benefits for birth weight; dihydroartemisinin-piperaquine is a superior antimalarial but has not improved birth outcomes over SP. Community delivery of IPTp more than doubled coverage in Nigerian project areas, and VAR2CSA-based vaccines remain in early clinical development.
Conclusion: Malaria in pregnancy continues to impose a large and preventable burden on maternal and newborn health. Closing delivery gaps for IPTp and ITNs (including through community-based delivery), preserving the effectiveness of existing tools against drug resistance, improving diagnosis of low-density infection, and funding pregnancy-specific innovation are priorities, particularly in Nigeria, where the national burden is greatest.
Keywords: Malaria in pregnancy, placental malaria, VAR2CSA, intermittent preventive treatment, sulfadoxine-pyrimethamine, sub-Saharan Africa, Nigeria