Facilitators and barriers of malaria prevention and treatment services to pregnant women in Ethiopia: a multi-level health system analysis, 2025
Kassawmar Angaw Bogale, Muluken Azage Yenesew, Kassahun Alemu Gelaye, Kindie Fentahun Muchie, Mulusew Andualem Asemahagn, Wendemagegn Enbiale
Abstract
BACKGROUND: Malaria continues to pose a significant public health challenge for pregnant women in Ethiopia. This study explores the facilitators and barriers influencing malaria prevention and treatment services to this vulnerable group, emphasizing systemic, policy, and community-level factors within Ethiopia's healthcare framework. METHODS: A qualitative study engaged 49 multi-level stakeholders in the prevention and treatment services, including policymakers, programme managers, advocacy groups, and healthcare service providers from diverse geographic, socio-economic, and epidemiological contexts. Data from interviews and field notes were analysed using Open Code 4.03, with inductive thematic analysis. RESULTS: The study identified key to facilitators and barriers, reflecting multi-level influences on malaria service delivery for pregnant women. The facilitators included prioritization of pregnant women in bed net distribution, active partnerships with non-governmental organizations, increased antenatal care contact time, expanded diagnostic infrastructure, community engagement, and local leadership participation, However, barriers were multifaceted: chloroquine shortages, fragmented service delivery, staff shortages, and bed net misuse hindered prevention and care. Policy gaps, such as the absence of targeted interventions and delayed adoption of WHO-recommended intermittent preventive treatment (IPTp), further impeded progress. Critical systemic gaps included inadequate data surveillance and underreporting of asymptomatic cases, which hindered targeted resource allocation and programme evaluation. CONCLUSION: While Ethiopia demonstrates progress towards maternal services through decentralization of diagnostic services, increased antenatal care contact time, and community engagement. Persistent challenges in resource allocation, staffing, disintegrated service delivery and data surveillance hinder malaria care for pregnant women. Strengthening supply chains, adopting "one-stop-shop" ANC models, and piloting IPTp are essential. Improving digital surveillance with pregnancy-specific indicators and routine screening can guide equitable, evidence-based responses.