Abstract
<title>Abstract</title> <p>Background Malaria remains a major global public health challenge. The World Health Organization reported approximately 229 million new cases and 409,000 deaths worldwide in 2020, with Nigeria contributing 27% of all cases. Pregnant women in endemic regions are particularly vulnerable due to pregnancy-related immunosuppression, which increases the risk of severe and potentially fatal complications. Methods A hospital-based cross-sectional study was conducted at Specialist Hospital, Idah, Kogi State, to determine the prevalence and risk factors associated with malaria infection among pregnant women during their first antenatal visit. A total of 245 consenting participants were screened using Rapid Diagnostic Tests (RDTs). Demographic and environmental data were collected through structured questionnaires and analyzed using chi-square tests and logistic regression models. Results Logistic regression identified key behavioral and environmental predictors of Asymptomatic Malaria Infection (AMI). Residence in areas with stagnant water increased the odds of infection (OR = 1.93; 95% CI: 0.63–5.72), though not statistically significant. Preventive measures demonstrated strong protective effects: insecticide spray (OR = 0.15; 95% CI: 0.02–0.61) and insecticide-treated nets (OR = 0.20; 95% CI: 0.01–1.30) reduced infection risk, while combined use of both interventions offered the greatest protection (OR = 0.09; 95% CI: 0.02–0.33). Interaction effects, such as stagnant water residence combined with ITN use, were not statistically significant. Conclusion Asymptomatic malaria infection remains prevalent among pregnant women in Idah, with environmental exposure contributing to risk but not reaching statistical significance. Preventive behaviors—particularly the combined use of insecticide-treated nets and insecticide sprays—emerged as the most effective protective strategies. The predictive model demonstrated high reliability, with strong fit and minimal misclassification, underscoring its potential utility for guiding malaria control interventions in pregnancy.</p>