Project – Assessment of Knowledge, Attitudes and Practices Regarding Malaria Prevention among Pregnant Women: A Study of Women Attending Antenatal Clinics at Lagos State University Teaching Hospital (LASUTH), Lagos State

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Malaria remains one of the most important public health problems in tropical and subtropical regions of the world, particularly in sub-Saharan Africa. It is a life-threatening disease caused by Plasmodium parasites and transmitted predominantly through the bites of infected female Anopheles mosquitoes. Although malaria is preventable and curable, its continued transmission imposes substantial health, social and economic burdens on affected populations. The World Health Organization (WHO, 2025) estimates that malaria remains concentrated in the African Region, which accounted for approximately 94% of global malaria cases and 95% of malaria deaths in 2024. These figures demonstrate that malaria continues to constitute a major challenge to health systems in Africa.

Nigeria occupies a particularly important position in the global malaria situation because of its exceptionally high burden of the disease. The WHO World Malaria Report 2024 indicates that Nigeria accounted for approximately 26% of estimated global malaria cases in 2023, making it the country with the largest estimated malaria burden globally. The WHO’s 2024 Nigeria country profile estimated approximately 68.1 million malaria cases and 184,700 malaria deaths in 2023. The magnitude of this burden makes malaria prevention a critical component of public health policy and practice in Nigeria.

Malaria is particularly important among pregnant women because pregnancy alters women’s susceptibility to malaria infection and increases the potential severity of its consequences. The WHO identifies pregnant women as a population at increased risk and notes that malaria during pregnancy can result in maternal anaemia, severe illness and death, while also increasing the risks of spontaneous abortion, stillbirth, premature delivery and low birth weight. The consequences therefore extend beyond the pregnant woman to the fetus and newborn child.

The relationship between malaria and pregnancy is complex. During pregnancy, physiological and immunological changes can reduce a woman’s ability to control malaria infection effectively. In areas where malaria transmission is intense, pregnant women may experience repeated infections and may develop placental malaria. Such infections can affect maternal health and fetal development. Consequently, prevention during pregnancy is not merely a matter of avoiding discomfort from a common febrile illness; it is an important maternal and fetal health intervention.

The WHO recommends an integrated package of interventions for malaria prevention and management during pregnancy. These include the use of insecticide-treated mosquito nets, intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) in malaria-endemic areas, and prompt diagnosis and effective treatment of malaria illness. The WHO’s updated recommendations provide for IPTp to begin as early as possible in the second trimester, not before 13 weeks, with doses administered at least one month apart and the objective of achieving at least three doses.

Antenatal care (ANC) represents a particularly important platform for delivering these malaria-prevention interventions. Antenatal clinics provide repeated contact between pregnant women and healthcare professionals, creating opportunities for health education, distribution or promotion of insecticide-treated nets, administration of IPTp-SP, diagnosis of malaria-related conditions and reinforcement of preventive behaviours. WHO recommendations identify IPTp in endemic areas as an antenatal intervention beginning in the second trimester and continuing through subsequent contacts.

The effectiveness of malaria prevention, however, depends not only on the availability of preventive interventions but also on women’s knowledge, attitudes and practices. Knowledge refers to what pregnant women understand about malaria, including its causes, mode of transmission, symptoms, complications during pregnancy and available preventive measures. Attitude concerns their perceptions, beliefs, acceptance, confidence and willingness regarding malaria-prevention measures. Practice refers to the actual behaviours adopted, such as sleeping under an insecticide-treated net, accepting IPTp-SP at ANC visits, seeking appropriate treatment when symptoms occur and following health workers’ advice.

The relationship among knowledge, attitudes and practices is important because knowledge does not automatically result in appropriate behaviour. A pregnant woman may know that malaria is transmitted by mosquitoes but may not consistently sleep under an insecticide-treated net. Similarly, a woman may understand that IPTp is recommended during pregnancy but may fail to receive the recommended doses because of late ANC attendance, concerns about medicines, missed appointments, inadequate counselling or other barriers.

Evidence from Nigeria demonstrates this knowledge-practice gap. The 2021 Nigeria Malaria Indicator Survey reported that only 50% of pregnant women aged 15–49 slept under an insecticide-treated net the night before the survey. The same survey reported that only 31% of women with a recent live birth received three or more doses of sulfadoxine-pyrimethamine during their last pregnancy. These findings indicate that possession of knowledge or access to malaria-prevention interventions does not necessarily translate into optimal preventive practice.

The national evidence also reveals that malaria-prevention coverage has not consistently progressed. The Nigeria Malaria Indicator Survey showed that insecticide-treated-net use among pregnant women decreased from 58% in 2018 to 50% in 2021. This decline is important because sustained use of insecticide-treated nets is a central component of malaria prevention during pregnancy.

A similar challenge exists with IPTp. WHO identifies IPTp-SP as an effective and cost-effective intervention for reducing malaria-related disease and adverse pregnancy outcomes. Nevertheless, Nigeria’s 2021 survey indicated that only 31% of women with a recent live birth reported receiving at least three doses of SP during their last pregnancy. The difference between recommended preventive practices and observed uptake demonstrates the importance of investigating the factors influencing women’s behaviour.

Knowledge is one of the potentially important factors. Pregnant women who understand how malaria is transmitted and the consequences of infection may be more likely to adopt appropriate preventive behaviours. However, knowledge may be incomplete or inaccurate. A Nigerian study by Onwujekwe et al. (2005) found that although many pregnant women recognised malaria as a health problem, their understanding of its management and preventive measures was inadequate. Such findings demonstrate that general awareness of malaria does not necessarily mean comprehensive knowledge of malaria prevention during pregnancy.

The importance of health education is further supported by a study conducted in southwestern Nigeria. The researchers found that knowledge significantly influenced the uptake of insecticide-treated nets and intermittent preventive treatment in pregnancy. They recommended intensified health education concerning malaria and its prevention among pregnant women. This evidence suggests that strengthening women’s understanding may be an important pathway for improving malaria-prevention behaviour.

Lagos State provides an important context for studying these issues. As one of Nigeria’s most populous and economically significant states, Lagos has a highly urbanised population and a large concentration of healthcare facilities. Despite its urban character, malaria remains an important public health concern. Environmental conditions, population density, rainfall, drainage patterns and other factors can sustain mosquito breeding and malaria transmission. The existence of advanced healthcare facilities does not necessarily eliminate the need for malaria-prevention interventions.

Previous research conducted among pregnant women attending antenatal care in metropolitan Lagos provides direct evidence of the relevance of this problem. Ekejindu et al. (2011) examined knowledge, attitudes, perceptions and home-management practices among 350 pregnant women attending ANC clinics in Lagos. The researchers reported that 78.9% identified infected mosquitoes as the cause of malaria, while 86% identified stagnant water as a mosquito breeding site. However, knowledge of the benefits of insecticide-treated nets was less prominent, with respondents identifying cost as a barrier. The study also detected malaria parasitaemia among 27.4% of the participants and anaemia among 25.7%.

More recent research from Lagos also demonstrates persistent gaps. Okafor et al. (2019) conducted a community-based study involving 422 Nigerian women and found that while almost all respondents were aware of malaria and most recognised infected mosquito bites as the cause, only 55.5% demonstrated good knowledge of malaria in pregnancy. Furthermore, 27% did not know any maternal complications of malaria, while 51.6% did not know complications for the fetus. Only 36.9% reported using intermittent preventive treatment and 24.1% used insecticide-treated nets; almost one-fifth reported using no malaria-prevention measure.

These findings are significant because they demonstrate that awareness of malaria may coexist with inadequate understanding of its consequences and inadequate preventive practices. They also suggest that the problem cannot be addressed simply by assuming that pregnant women already possess sufficient knowledge because malaria is common in Nigeria.

Research conducted elsewhere in Nigeria provides similar evidence. A 2022 study assessing knowledge, attitudes and practices concerning long-lasting insecticidal nets and IPTp-SP among 384 pregnant women reported that most participants understood the basic cause and transmission of malaria, but knowledge and attitudes concerning symptoms, complications, benefits of nets and chemoprevention were inadequate. Although approximately 80% owned LLINs, only 41.5% had slept under one the previous night, while only 31% had received IPTp-SP doses under direct observation. Only 35.9% demonstrated good understanding of IPTp-SP during pregnancy.

The findings of these studies illustrate the importance of distinguishing between knowledge, attitudes and practices. Knowledge is necessary but may be insufficient to produce preventive behaviour. Attitudes such as perceived susceptibility, perceived severity, confidence in preventive measures and concerns about adverse effects may influence whether a woman acts on what she knows. Practices then represent the observable outcome of these knowledge and attitudinal factors, although they are also influenced by access, cost, healthcare services and environmental conditions.

Pregnant women’s perceptions concerning the severity of malaria are particularly important. If malaria is perceived as an ordinary illness that can be managed easily at home, a woman may be less motivated to adhere to preventive recommendations. Conversely, understanding the potential consequences for both mother and fetus may increase motivation to use preventive measures and seek prompt treatment.

Beliefs about preventive medicines can also influence practice. Some pregnant women may have concerns about taking medicines during pregnancy because of fears of harming the fetus. Such concerns can influence acceptance of IPTp. Effective ANC counselling is therefore important in helping pregnant women understand the purpose, safety and timing of recommended preventive treatment.

The role of healthcare workers is consequently central. Antenatal-care providers are positioned to provide accurate information, correct misconceptions, encourage the use of insecticide-treated nets, administer or promote IPTp-SP and advise women on prompt care-seeking. However, the effectiveness of such counselling may depend on the amount of time available, the quality of communication, availability of commodities and the consistency of health education messages.

The 2024 WHO World Malaria Report highlights several barriers to malaria prevention during pregnancy, including distance and transport costs associated with ANC attendance, stock-outs of IPTp-SP and insufficient information provided by health workers. This is important because it demonstrates that inadequate malaria prevention cannot be attributed solely to individual women’s knowledge or attitudes. Health-system and access factors can also affect preventive practices.

The urban setting of Lagos introduces additional considerations. Pregnant women attending a major tertiary healthcare institution may have relatively better access to qualified healthcare professionals than women in remote rural communities. However, access to a tertiary facility does not automatically guarantee consistent preventive behaviour. Women may still miss ANC visits, delay booking, fail to take prescribed preventive medication or inconsistently use mosquito nets.

Educational attainment may also influence malaria-related knowledge and practices. Okafor et al. (2019) found that respondents with higher educational attainment had significantly better knowledge of malaria in pregnancy. Education may increase the ability to understand health information, assess risks and make informed decisions. Nevertheless, even highly educated women may encounter practical barriers that affect malaria-prevention behaviour.

Socioeconomic factors may similarly influence practice. The cost of transportation, availability of suitable sleeping arrangements, access to mosquito nets and ability to attend repeated ANC appointments can affect the implementation of recommended preventive measures. In the earlier Lagos study, respondents identified the cost of insecticide-treated nets as a concern. This demonstrates that knowledge and positive attitudes must be supported by practical access to preventive resources.

The issue of ANC attendance is particularly important. ANC provides opportunities for IPTp administration, health education and monitoring. The 2021 Nigeria Malaria Indicator Survey found that 63% of women aged 15–49 who had given birth in the preceding two years received ANC from a skilled provider, while 52% had at least four ANC visits. These figures indicate that a significant proportion of women may still have limited contact with ANC services, reducing opportunities for preventive interventions.

The WHO has emphasised that ANC contacts remain an important platform for delivering IPTp, although alternative delivery mechanisms may be considered where inequities in ANC access exist. For a tertiary institution such as Lagos State University Teaching Hospital, this reinforces the importance of understanding what women attending ANC know, believe and actually do concerning malaria prevention.

Lagos State University Teaching Hospital (LASUTH) is an important setting for this investigation because it is a major tertiary healthcare institution serving patients from Lagos State and beyond. Women attending its antenatal clinics may represent a diverse population with different educational, socioeconomic, occupational and reproductive backgrounds. This diversity provides an opportunity to examine variations in malaria-related knowledge, attitudes and practices.

The antenatal clinic also provides a practical setting for assessing whether women are translating health information into behaviour. Since pregnant women attending ANC have repeated opportunities to receive malaria-prevention education, the study can examine whether their knowledge and attitudes correspond with recommended preventive practices.

Another important issue is the persistence of malaria despite the availability of effective prevention tools. Insecticide-treated nets, IPTp-SP and appropriate malaria case management are established interventions. If malaria continues to affect pregnant women despite the availability of these measures, attention must be paid not only to service availability but also to utilisation and adherence.

The KAP approach is therefore appropriate because it enables the study to examine three related but distinct dimensions of malaria prevention. First, it assesses what pregnant women know. Second, it examines how they perceive and respond to malaria-prevention measures. Third, it assesses their actual preventive behaviours. Examining all three dimensions provides a more comprehensive understanding than examining knowledge alone.

The distinction is especially relevant because previous Nigerian evidence has repeatedly shown that relatively high awareness can coexist with inadequate preventive practices. Okafor et al. (2019), for instance, found widespread awareness of malaria but unsatisfactory knowledge of complications and low use of IPTp and insecticide-treated nets. Similarly, the 2022 Nigerian study found substantial awareness of malaria but important gaps in attitudes and practices.

There is therefore a need for facility-specific evidence. National surveys provide valuable population-level information, while earlier Lagos studies provide important contextual evidence. However, patterns may change over time because malaria-control policies, health education, access to preventive commodities and women’s awareness can change. A study specifically among women currently attending ANC at LASUTH can provide more recent and institution-specific evidence.

The study is also important in view of ongoing malaria-control efforts. The WHO’s 2024 report emphasises the need to address inequities in access to life-saving malaria interventions and to ensure that vulnerable populations receive appropriate preventive services. Pregnant women constitute one of the groups requiring particular attention.

Consequently, assessing knowledge, attitudes and practices among pregnant women at LASUTH can identify areas where existing health education and preventive services may be strengthened. If knowledge is high but practice is low, interventions may need to focus more on access, counselling, beliefs and behavioural barriers. If knowledge itself is inadequate, additional education may be necessary. If attitudes are negative, targeted counselling and communication strategies may be required.

The study therefore seeks to assess the knowledge, attitudes and practices regarding malaria prevention among pregnant women attending antenatal clinics at Lagos State University Teaching Hospital (LASUTH), Lagos State. The study is expected to generate evidence that can assist healthcare providers and public-health stakeholders in improving malaria-prevention education and practices among pregnant women.

1.2 Statement of the Problem

Malaria in pregnancy remains an important maternal and public-health problem despite the availability of effective preventive interventions. Pregnancy increases women’s vulnerability to malaria and exposes the mother and fetus to potentially serious consequences, including maternal anaemia, severe illness, adverse birth outcomes and, in severe cases, death. The continued occurrence of malaria among pregnant women therefore represents a significant challenge to maternal health services.

The problem is particularly important in Nigeria because the country continues to carry the largest share of the global malaria burden. WHO estimates indicate that Nigeria accounted for about 26% of global malaria cases in 2023, with an estimated 68.1 million cases and 184,700 deaths. Although these figures concern the general population, they demonstrate the scale of the malaria environment in which pregnant Nigerian women receive maternal healthcare.

Nigeria has adopted malaria-prevention interventions for pregnant women, including insecticide-treated nets and intermittent preventive treatment with sulfadoxine-pyrimethamine. WHO recommends IPTp-SP during pregnancy in malaria-endemic settings and identifies ANC as an important platform for delivering the intervention. Yet national coverage remains below desirable levels.

The 2021 Nigeria Malaria Indicator Survey reported that only 50% of pregnant women slept under an insecticide-treated net the night before the survey. It also found that only 31% of women with a recent live birth had received at least three doses of SP during their last pregnancy. These figures indicate a substantial gap between recommended malaria-prevention interventions and actual uptake.

The problem is not simply a lack of awareness. Evidence suggests that many Nigerian women know that malaria is transmitted by mosquitoes but may have inadequate knowledge concerning the consequences of malaria during pregnancy and the benefits of preventive measures. Okafor et al. (2019), in a study involving Nigerian women, found that although 96.2% knew that malaria was caused by infected mosquito bites, only 55.5% had good knowledge of malaria in pregnancy. More than half did not know the fetal complications of malaria.

Similarly, research among pregnant women in Nigeria has found that awareness of malaria does not necessarily translate into appropriate preventive behaviour. A 2022 study found that although approximately 80% of participating pregnant women owned LLINs, only 41.5% had slept under one the previous night, while only 31% had received IPTp-SP doses under direct observation. This demonstrates a clear knowledge-to-practice gap.

Evidence from Lagos is also concerning. A study of 350 pregnant women attending ANC clinics in metropolitan Lagos found malaria parasitaemia in 27.4% of participants and anaemia in 25.7%. Although most participants recognised infected mosquitoes as the cause of malaria, knowledge of the benefits of insecticide-treated nets was less prominent. The findings suggest that knowledge and preventive behaviour require continued attention even in an urban setting with relatively developed healthcare infrastructure.

Another Lagos-based study found that only 36.9% of women used intermittent preventive treatment and only 24.1% used insecticide-treated nets, while nearly 20% reported using no malaria-prevention method. Although this evidence was collected from a community-based population rather than specifically from LASUTH ANC attendees, it highlights the persistence of malaria-prevention gaps within Lagos.

The persistence of these gaps raises an important question: why do some pregnant women fail to adopt recommended malaria-prevention measures despite having access to antenatal care and health information? One possible explanation is inadequate knowledge. Another is negative attitudes or misconceptions concerning malaria, mosquito nets or preventive medicines. Other explanations may include cost, availability, side-effect concerns, forgetfulness, late ANC booking, missed appointments and health-system barriers.

The problem is further complicated by the fact that knowledge, attitudes and practices do not necessarily move together. A woman can possess adequate knowledge but demonstrate poor practice. She may know that mosquitoes transmit malaria but fail to sleep under an LLIN because of heat, discomfort, inadequate sleeping space or inconsistent access. Likewise, she may know that IPTp is recommended but fail to receive all required doses because of late attendance, missed appointments or concerns about medication.

Health-system factors can also influence malaria-prevention practices. The WHO’s World Malaria Report 2024 identifies barriers such as transport costs, distance to ANC facilities, stock-outs of IPTp-SP and inadequate information from health workers. These factors indicate that malaria-prevention practices should not be interpreted solely as matters of individual responsibility.

There is also a problem concerning the adequacy of health education. Pregnant women may receive information during ANC, but the content, frequency, clarity and effectiveness of such education may vary. If health messages do not adequately address misconceptions and practical barriers, women may understand the basic cause of malaria without understanding why preventive interventions should be consistently used.

The problem is particularly relevant to LASUTH because a tertiary hospital provides an important opportunity for malaria prevention through ANC. Women attending the facility are expected to receive professional maternal healthcare and relevant preventive counselling. However, there is a need to determine whether women attending these clinics actually possess adequate malaria-related knowledge, hold favourable attitudes and practise recommended preventive behaviours.

Another concern is that national and regional malaria statistics cannot fully explain the KAP profile of women attending a particular tertiary health facility. National surveys describe broad population patterns, while earlier Lagos studies may reflect different populations, periods and healthcare settings. Consequently, current evidence specifically concerning women attending LASUTH ANC is required.

The absence of current facility-specific KAP evidence creates a practical information gap. Healthcare providers may provide malaria-prevention education without knowing precisely which areas of knowledge are deficient, which misconceptions are prevalent or which preventive practices are least frequently adopted among their ANC clients.

The problem is therefore multidimensional. At the knowledge level, women may not fully understand the causes, symptoms, complications and prevention of malaria in pregnancy. At the attitudinal level, some women may underestimate the seriousness of malaria, doubt the usefulness of preventive measures or have concerns about preventive medicines. At the practice level, women may inconsistently use LLINs, fail to complete recommended IPTp doses or delay seeking professional care when malaria symptoms occur.

These gaps can undermine malaria-control efforts and potentially expose pregnant women and their unborn children to avoidable risks. The availability of effective malaria-prevention interventions will have limited impact if they are not understood, accepted and consistently used by the women for whom they are intended.

The central problem addressed by this study is therefore the insufficient current evidence on the level of knowledge, attitudes and practices regarding malaria prevention among pregnant women attending antenatal clinics at LASUTH. While previous research in Lagos and Nigeria has identified important malaria-prevention gaps, there remains a need for facility-specific assessment that can provide evidence relevant to the current ANC population at LASUTH.

The study consequently seeks to assess the knowledge, attitudes and practices of pregnant women attending antenatal clinics at LASUTH regarding malaria prevention. The findings are expected to provide evidence for improving ANC health education, strengthening preventive counselling and identifying behavioural or service-related gaps that may hinder malaria prevention among pregnant women.

1.3 Aim of the Study

The main aim of this study is to assess the knowledge, attitudes and practices regarding malaria prevention among pregnant women attending antenatal clinics at Lagos State University Teaching Hospital (LASUTH), Lagos State.

1.4 Objectives of the Study

The specific objectives are to:

1. assess the level of knowledge of malaria prevention among pregnant women attending antenatal clinics at LASUTH;
2. determine the attitudes of pregnant women towards malaria-prevention measures at LASUTH;
3. assess the malaria-prevention practices of pregnant women attending antenatal clinics at LASUTH;
4. determine the relationship between pregnant women’s knowledge and their malaria-prevention practices; and
5. examine the relationship between pregnant women’s attitudes and their malaria-prevention practices.

1.5 Research Questions

The following research questions will guide the study:

1. What is the level of knowledge of malaria prevention among pregnant women attending antenatal clinics at LASUTH?
2. What are the attitudes of pregnant women towards malaria-prevention measures at LASUTH?
3. What malaria-prevention practices are adopted by pregnant women attending antenatal clinics at LASUTH?
4. What relationship exists between pregnant women’s knowledge and their malaria-prevention practices?
5. What relationship exists between pregnant women’s attitudes and their malaria-prevention practices?

1.6 Research Hypothesis

The following null hypothesis will be tested at the 0.05 level of significance:

H₀: There is no significant relationship between pregnant women’s knowledge and attitudes regarding malaria prevention and their malaria-prevention practices at Lagos State University Teaching Hospital.

1.7 Significance of the Study

The study will be significant to pregnant women because it will identify gaps in their knowledge and understanding of malaria prevention. The findings may encourage women to adopt appropriate preventive measures, including consistent use of insecticide-treated nets, compliance with recommended IPTp and prompt utilisation of appropriate healthcare services.

The study will be particularly useful to healthcare professionals at LASUTH, including doctors, nurses, midwives and public-health practitioners. The findings may enable healthcare providers to identify specific misconceptions and behavioural gaps among ANC attendees and tailor health education accordingly.

The study will also be useful to antenatal clinic administrators. Information on the KAP profile of women attending the clinic may help administrators strengthen health-education programmes, improve counselling approaches and ensure that malaria-prevention messages are consistently incorporated into ANC services.

The findings will be relevant to public-health practitioners and malaria-control programme managers. Evidence from a tertiary healthcare setting in Lagos may contribute to the design of targeted behavioural-change communication and malaria-prevention interventions for pregnant women.

The study will also be useful to Lagos State health authorities because it may provide evidence that can inform maternal-health and malaria-control policies. Identifying specific gaps in knowledge, attitudes and practices can help direct resources toward interventions with the greatest potential benefit.

The study will be significant to policymakers because malaria prevention during pregnancy is an important component of maternal and child health. The WHO recommends a package including ITN use, IPTp and prompt case management, making effective uptake of these measures an important policy concern.

The study will also benefit researchers and students in public health, nursing, medicine, epidemiology, community health and related disciplines. It will contribute to the existing Nigerian literature on malaria in pregnancy and provide a basis for comparative studies in other healthcare facilities and geographical areas.

Finally, the study will contribute to the broader goal of reducing malaria-related maternal and fetal complications by providing evidence on behavioural factors that may influence the use of established malaria-prevention interventions.

1.8 Scope of the Study

The study focuses on the knowledge, attitudes and practices regarding malaria prevention among pregnant women attending antenatal clinics at Lagos State University Teaching Hospital (LASUTH), Lagos State.

The study will examine pregnant women’s knowledge of malaria, including its cause, mode of transmission, symptoms, risk factors, maternal complications, fetal complications and preventive measures.

The study will assess attitudes concerning the perceived seriousness of malaria in pregnancy, perceived susceptibility, confidence in malaria-prevention measures, willingness to use insecticide-treated nets and acceptance of IPTp.

The study will examine preventive practices such as sleeping under insecticide-treated nets, participation in IPTp-SP, attendance at antenatal care, environmental control practices, prompt treatment-seeking and adherence to healthcare advice.

The study is geographically restricted to pregnant women attending antenatal clinics at LASUTH. It does not cover pregnant women receiving ANC exclusively from private hospitals, primary healthcare centres or other tertiary institutions in Lagos State.

The study is also concerned with malaria prevention rather than laboratory diagnosis or clinical treatment outcomes. Consequently, it will not primarily measure malaria parasitaemia, maternal haemoglobin levels or pregnancy outcomes.

1.9 Operational Definition of Terms

Antenatal Care (ANC): Healthcare services provided to a woman during pregnancy to monitor maternal and fetal health, prevent complications and promote a healthy pregnancy and childbirth.

Attitude: A pregnant woman’s beliefs, perceptions, feelings and disposition toward malaria and recommended malaria-prevention measures.

Insecticide-Treated Net (ITN): A mosquito net treated with insecticide and designed to protect people sleeping under it from malaria-transmitting mosquitoes.

Knowledge: The information and understanding possessed by pregnant women concerning malaria, its transmission, symptoms, complications and prevention.

Malaria: A potentially life-threatening infectious disease caused by Plasmodium parasites and transmitted primarily through infected female Anopheles mosquitoes.

Malaria Prevention: Measures undertaken to reduce the risk of malaria infection, including mosquito-net use, IPTp, environmental measures, health education and appropriate preventive behaviour.

Malaria in Pregnancy (MiP): Malaria infection occurring during pregnancy, with potential consequences for the pregnant woman, fetus and newborn.

Pregnant Woman: A woman carrying a developing fetus and attending antenatal care during the period of pregnancy.

Practice: The actual malaria-prevention behaviours undertaken by pregnant women, including ITN use, IPTp uptake, ANC attendance and prompt healthcare-seeking.

Intermittent Preventive Treatment in Pregnancy (IPTp): Administration of recommended antimalarial medicine at predetermined intervals during pregnancy, regardless of whether the woman has detectable malaria infection at the time.

Sulfadoxine-Pyrimethamine (SP): An antimalarial medicine used for intermittent preventive treatment of malaria during pregnancy in accordance with applicable national and WHO recommendations.

Long-Lasting Insecticidal Net (LLIN): An insecticide-treated mosquito net designed to retain insecticidal activity over an extended period without requiring frequent retreatment.

Health Education: The provision of relevant health information and communication intended to improve individuals’ knowledge, attitudes and behaviours concerning health.

Antenatal Clinic: A healthcare service unit where pregnant women receive routine assessment, counselling, preventive interventions and monitoring during pregnancy.

LASUTH: Lagos State University Teaching Hospital, a major tertiary healthcare institution in Lagos State, Nigeria.

Knowledge–Attitude–Practice (KAP): A research framework used to assess what individuals know about a health issue, how they perceive it and what they actually do concerning it.

Preventive Practice: Any deliberate behaviour undertaken by a pregnant woman to reduce her risk of malaria infection or its complications.

Project – Assessment of Knowledge, Attitudes and Practices Regarding Malaria Prevention among Pregnant Women: A Study of Women Attending Antenatal Clinics at Lagos State University Teaching Hospital (LASUTH), Lagos State