Table 1 presents the descriptive statistics of women of reproductive ages (15-49 years) in Nigeria. As indicated in Table 1, majority were between ages 30-39 years (39.5%) and 40-49 years (37.8%) compared to only 0.7% of women that were between ages <18 years. Also, 91.8% of the women were married or cohabiting while only ≤ 5% were either widowed or separated. Islam was the most practiced religion and accounted for 59.5% of the religion practiced by women of reproductive ages while 39.6% were Christians and <1% practicing traditional or other religion. Majority of the study participants were located in the north where 31.3% were from the north-west, 20.6% and 17.0%from the north-east and north-central respectively. The south-east account for 11.0% of the population while <11% were found in the south-south and south-west. About 49.9% of the population were uneducated compared to only 6.1% of the population that had acquired a higher level of education. In addition, there were declining proportions of women from poorest to richest wealth index as majority of the population were either in the poorest (24.4%), poorer (23.1%) and middle (21.3%) while the richest accounted for only 13.0% of the population. Also majority were either grandparous (65.7%) or multiparous (23.2%) compared to only 11.1% that had low parity.

In this population, 63.4% of the women of reproductive ages had taken fansidar for malaria in pregnancy while only 6.1% had received healthcare for malaria from informal sources.

Table 2 represents the chi-squared analysis to assess the association between socio-demographic variables and initiation of IPT for malaria in pregnancy. As indicated in table 2, there was a statistically significant association between region of residence and intake of IPT for malaria in pregnancy among women of reproductive ages (X²=452.31, P:.000). Similarly, educational level (X²=1212.76, P:.000), wealth index (X²=1372.83, P:.000) and age group (X²=43.56, P:.000) of women were significantly associated with intake of IPT intake for malaria in pregnancy among women of reproductive ages. Also, religion (X2=269.76, P;.000) and parity (X²=84.20, P:.000) were significantly associated with IPT intake for malaria in pregnancy among women of reproductive ages. However, marital status was no significantly associated with intake of IPT for malaria in pregnancy (X²=5.72, P:.126).

As represented in (Table 3) below, there was a statistically significant association between region of residence and health seeking behaviour for malaria among women of reproductive ages (X²=63.21, P;.000). Similarly, educational level (X²=144.42, P;.000), wealth index (X²=188.28, P;.000) and age group (X²=17.61, P;.001) of women were significantly associated with health seeking behaviour for malaria in pregnancy among women of reproductive ages. Also, marital status (X²=14.01, P;.003) and religion (X²=501.04, P;.000) were associated with health seeking for malaria in pregnancy among women of reproductive ages. However, parity (X²=3.85, P; .146) was not significantly associated with health seeking for malaria in pregnancy among women of reproductive ages.

Table 4 represent the summary of statistics assessing the relationship between socio-demographic variables and intake of IPT for malaria in pregnancy among women of reproductive ages. The logistic regression model was statistically significant (P<.001). As represented in (Table 4), rural residents had 97% reduced likelihood of taking IPT for malaria in pregnancy compared to urban women ^{AOR = 0.97 (CI: 0.91}. Adjusted odds ratio revealed increased odds of taking IPT for malaria during pregnancy among women of reproductive ages that had primary ^{AOR = 2.43 (CI: 2.07}, secondary ^{AOR = 1.50 (CI: 1.30} and higher education ^{AOR = 1.22 (CI: 1.06}.

All wealth index categories were significant associated with increased likelihood of taking IPT for malaria in pregnancy including poorer [AOR = 2.72 (CI: 2.38-3.11), P<.05], middle [AOR = 2.18 (CI: 1.92-2.49), P<.05], richer [AOR = 1.50 (CI: 1.33-1.69), P<.05] and richest [AOR = 1.19 (CI: 1.06-1.35), P<.05]. On the other hand, the odds of taking fansidar for malaria in pregnancy were insignificant among the different age groups (P>.05). Married/cohabiting [AOR = 1.39 (CI: 1.07-1.81), P<.05] women were more likely than women that were never in a union to take IPT for malaria in pregnancy. Similarly, Muslim women [AOR = 0.45 (CI: 0.30-0.67), P<.05], traditional women [AOR = 0.39 (CI: 0.26-0.58), P<.05] and women that practice other religion [AOR = 0.26 (CI: 0.14-0.48), P<.05] had reduced likelihood of taking IPT for malaria in pregnancy compared to Christian women of reproductive ages. However, parity had no influence over intake of IPT for malaria in pregnancy among women of reproductive ages in Nigeria.

(Table 5) below represents the relationship between socio-demographic variables and health seeking behaviour for malaria in pregnancy. Women living in the rural region were 80% less likely to seek formal healthcare compared to women living in the urban region [AOR = 0.80 (CI: 0.67-0.97), P<.05]. Also, women that had primary [AOR = 2.17 (CI: 1.44-3.27), P<.05] and secondary [AOR = 1.52 (CI: 1.01-2.30), P<.05] education had higher likelihood of seeking formal healthcare for malaria during pregnancy compared to women that had no form of education. However, there was significant relationship between health seeking behaviour for malaria in pregnancy among women with tertiary education compared to women that had not form of education [AOR = 1.34 (CI: 0.92-1.94), P>.05].

Women categorized into the poorer wealth index were 2.22 times more likely than the poorest women to seek formal healthcare for malaria in pregnancy [AOR = 2.22(1.59-3.09), P<.05]. Similarly, the richest women were 1.36 times more likely than the poorest women to seek formal healthcare for malaria in pregnancy [AOR = 1.36 (1.01-1.83), P<.05]. Other socio-demographic variables were insignificantly related with health seeking for malaria in pregnancy among women of reproductive ages in Nigeria.

This study was conducted to assess how socio-demographic factors affect the occurrences and health seeking for malaria in pregnancy among Nigeria women of reproductive ages. The socio-demographic factors assessed in this study includes region of residence, highest educational level, wealth index, age group, marital status, religion and parity. After controlling for other variables, some socio-demographic variables were found to be significantly associated with intake of IPT and health seeking for malaria in pregnancy.

It is also important to note that recommendation has been made by the World Health Organization that countries should adopt intermittent preventive treatment (IPT) for malaria in pregnancy 14. In this study, region of residence was not associated with intake of IPT for malaria in pregnancy. However, health seeking for malaria in pregnancy was significantly influenced by region as women from rural region were less likely to access conventional source for malaria in pregnancy. Some of the challenges associated with healthcare seeking in rural regions compared to urban include lower socio-economic status as represented in this study and other studies that have been conducted 151617181920. Also, distance to health facility and poor perception of healthcare practitioners have been found to influence health seeking for women seeking healthcare 21222324.

Despite numerous programs and policies developed and implemented to prevent disease and improve access to healthcare services in African countries, socio-economic status significantly impacts the occurrence and health seeking behaviours for infectious disease 23. In this study, increasing wealth index was found to increase the likelihood of women utilizing preventive treatment for malaria in pregnancy. Health seeking behaviour for malaria in pregnancy was also significant in the poorer and richest group compared to the poorest. A previous study conducted in Nigeria provides an evidence of the prevailing challenges of socio-economic status of pregnant women and its negative impact on the likelihood to seek conventional source for treatment of malaria in pregnancy 17. Other findings have revealed increased likelihood of pregnant women with higher socio-economic status to seek IPT 2425.

Education plays a critical role on health awareness and literacy especially in populations where there are limitations in the health systems and health care service delivery 26. In turn, health literacy also influences actions and decisions to prevent disease occurrences. In this study increase in the level of education was associated with increased likelihood of taking IPT for malaria in pregnancy among women of reproductive ages while increasing education was significantly associated with increased likelihood to seek healthcare from formal sources.

Although there are limited studies assessing relationship between socio-demographic variables and intake of preventive treatment for malaria in pregnancy, finding from this study is consistent with a previous study that revealed the influence of educational level in increasing the likelihood to utilize preventive method for malaria in pregnancy 1617242728293031. As a result, less educated women in Nigeria may lack adequate information about the prevention of adverse effects of malaria in pregnancy and this in turn influence their decisions to take preventive measures. Also, women that are less educated may be less likely to seek conventional healthcare for malaria in pregnancy. While socio-economic status influencing health seeking behaviours of women, education also influences wealth index of women and therefore influence health seeking for malaria in pregnancy.

In this study, there was a significant increase in the likelihood of women to take IPT during pregnancy among married/cohabiting women compared to single women. On the other hand, there was a significantly increased likelihood of widowed women to seek formal healthcare for malaria in pregnancy compared to single women. It is expected that married women due to their experiences in pregnancies and increased knowledge of malaria in prevention, should seek formal healthcare for malaria in pregnancy However, another Nigerian study found the divorced/separated were less likely than single women to seek formal healthcare for malaria in pregnancy 24. Additionally, this study showed that Muslim, traditional and women of other religions were less likely to initiate IPT for malaria in pregnancy compared to their Christian counterpart. It could be suggested that as a result of certain religious beliefs among the other religions, choice to initiate IPT may be prevented due to women s dependence on their religious beliefs.

This study is however not without limitations. Due to the use of NDHS, there were many missing variables which may have affected the statistical strength of our findings. Also, due to incomplete data, it was impossible to assess the influence of other socio-demography on other key healthcare indices relevant to this study. Also, the use of survey data increases the risk of measurement errors, and information bias as some of the variables assessed were dependent on the participant s ability to recall previous experiences.

However, this research has provided evidence of the existing limitations in strategies adopted in the prevention of malaria in pregnant women in Nigeria. It also provides adequate data to compare findings from previous studies and track progress in the awareness of IPT and utilization for appropriate healthcare for maternal illnesses. By using NDHS data, this study provides a more representative finding that can be generalized on the Nigerian population. With findings from this study, strategies can be adopted to improve prevention of malaria in pregnancy while improving health seeking behaviour of women of reproductive ages in Nigeria. Also, using NDHS data, the potential of selection bias has been reduced.