DETERMINANTS OF MALARIA RECURRENCE AMONG PREGNANT MOTHERS ATTENDING ANTENATAL CLINIC AT BELETWEYN REFERRAL HOSPITAL IN BELEDDWEYN DISTRICT, SOMALIA

Malaria recurrence among pregnant women remains a serious public health concern in Somalia, contributing significantly to maternal illness, death, and negative birth outcomes. Despite ongoing malaria control efforts, recurrent infections continue to hinder elimination goals, particularly in high-transmission areas such as Beledweyn District. This study examined the determinants of malaria recurrence among pregnant women attending antenatal clinics at Beledweyn Referral Hospital. Specifically, it assessed awareness of malaria prevention and treatment, explored socioeconomic risk factors influencing recurrence, and evaluated the coverage and utilization of Insecticide-Treated Nets (ITNs) among pregnant women. The research was guided by the Health Belief Model, Behavioral Change Model, and Trans-Theoretical Model, which collectively emphasize how individual perceptions, knowledge, and readiness to adopt preventive practices shape health behaviors. A cross-sectional descriptive design utilizing both quantitative and qualitative methods was employed. Structured questionnaires were administered to 369 pregnant women, while nine healthcare providers participated in key informant interviews. Data were analyzed using descriptive statistics, Pearson correlation, and multiple regression techniques. Results revealed strong positive associations between malaria outcomes and socioeconomic factors (r = 0.808, p < 0.001), awareness levels (r = 0.727, p < 0.001), and ITN coverage (r = 0.766, p < 0.001). Regression analysis showed that these variables jointly accounted for 86.4% of the variance in malaria recurrence (R² = 0.864, F = 367.552, p < 0.001), with ITN coverage being the most significant predictor (β = 0.414, p < 0.001). The study concluded that improving ITN accessibility, strengthening socioeconomic support, and promoting health education are crucial for reducing malaria recurrence. It recommends enhancing ITN distribution systems, implementing community-based education, and integrating malaria prevention with broader maternal health programs.