Integrated malaria service delivery and its determinants among pregnant women in Ethiopia: Multi level analysis of 2021/22 National Service Provision Assessment Survey

BACKGROUND: Malaria in pregnancy poses significant health risks to mothers and their, fetuses, and newborns children in Tropical and subtropical countries including Ethiopia. The delivery of integrating essential malaria services into routine antenatal care is crucial for effective prevention and control. However, evidence on the extent and determinants of this integration in Ethiopia remains limited. OBJECTIVE: This study aimed to assess the delivery of integrated malaria services during ANC visit and its determinants among pregnant women in Ethiopia. METHODS: We conducted a secondary analysis of the Ethiopia Service Provision Assessment Survey 2021/22, a nationally representative cross‑sectional study. The final sample included 4273 pregnant women nested across 662 health facilities. Factors were identified based on the WHO Malaria in Pregnancy framework. Multilevel logistic regression models were applied to identify significant factors influencing integrated service uptake. RESULT: Only 7.9% of pregnant women attended ANC visits where all components of integrated malaria services were delivered concurrently, with substantial regional disparities. At the client level, women with two previous pregnancies (AOR = 1.67, 95% CI: 1.06-2.62), attending three or more ANC visits (AOR = 1.58, 95% CI: 1.04-2.40) and client who received an Insecticide-Treated Net during ANC (AOR = 2.81, 95% CI: 1.29-6.12) were more likely to attend ANC visits in which integrated malaria services were delivered. Furthermore, clients attending facilities with malaria-trained providers were more likely to receive integrated malaria services during ANC than those attending facilities without such training (AOR = 4.24, 95% CI: 1.80-10.00). Rural facility attendance was also positively associated with integrated malaria service delivery compared with urban facility attendance (AOR = 2.73, 95% CI: 1.04-7.19). CONCLUSION: Integrated malaria service delivery during ANC remains unacceptably low in Ethiopia, constrained by regional disparities and multilevel factors. Strengthen continuity of ANC follow up, updating policy on ITN distribution, strengthening providers' capacity, and addressing geographic disparities to accelerate progress toward WHO maternal health targets.