Background: Malaria in pregnancy (MiP) is a major concern in Zambia. Here we aim to determine the burden and
risk factors of MiP.
Methods: Monthly reported district-level malaria cases among pregnant women (count data) from January 2009
to December 2014 were obtained from the Zambian District Health Information System. Negative binomial regression
model was used to investigate the associations between vector control tools, coverage of health care facilities,
transportation networks and population density. Data on MiP treatment were obtained from the 2012 Zambian
Malaria Indicator Survey. Yearly clusters of MiP were investigated using spatial statistics in ArcGIS v 10.1.
Results: The results indicated that MiP decreased in Zambia between 2010 and 2013. MiP was observed throughout
the year, but showed a strong seasonal pattern. Persistent hotspots of MiP were reported in the southeast and
northeast regions of Zambia, with districts that had better access to rail road and presence of water bodies associated
with decreased prevalence of MiP. Better indoor residual spraying and long-lasting insecticide-treated nets
coverage was demonstrated to be protective against MiP.
Conclusions: Mapping the distribution of MiP to track the future requirements for scaling up essential diseaseprevention
efforts in stable hotspots can help the Zambian National Malaria Control Center to further develop
strategies to reduce malaria prevalence in this vulnerable sub-population.