Structural and Behavioural Predictors of Malaria Prevention Compliance Among Pregnant Women in Southern Nigeria: A Multi-State Study

Malaria in pregnancy remains a leading driver of maternal and neonatal morbidity in Southern Nigeria, yet compliance with preventive regimens is inconsistently achieved across different ecological and social contexts. This study investigated structural and behavioural predictors of malaria prevention compliance among pregnant women in a multi-state study spanning Rivers, Edo, and Delta states in South South Nigeria. A cross-sectional analytical design was employed, with 360 pregnant women recruited from antenatal clinics in six local government areas. A validated structured questionnaire was used to collect data on compliance with intermittent preventive treatment, insecticide-treated net use, indoor residual spraying uptake, and perceived barriers. Data were analysed using hierarchical multiple regression and structural equation modelling. Results showed that health education exposure (beta 0.42, p less than 0.01), perceived susceptibility (beta 0.31, p less than 0.05), and facility-level structural support (beta 0.38, p less than 0.01) were the strongest predictors of comprehensive compliance. Spousal support and community norms also significantly moderated compliance behaviour. The study recommends integrating health behaviour theory into the design of antenatal malaria prevention education and addressing structural health system bottlenecks that limit access to preventive interventions. Keywords: malaria prevention compliance, pregnant women, South South Nigeria, predictors, health education