Abstract
BACKGROUND: Malaria in pregnancy contributes significantly to poor maternal health outcomes, accounting for 17.6% of outpatient visits in Ghana. The Ashanti Region, particularly Sekyere South District, bears a high burden despite interventions, such as ITN distribution and intensified IPTp education. Limited evidence exists on how pregnant women's knowledge, attitudes and practices (KAP) influence preventive behaviours and ANC use in this setting. METHODS: A cross-sectional survey was conducted among 422 pregnant women using structured questionnaires. Descriptive statistics and logistic regression were applied to assess predictors of malaria prevention behaviours and ANC attendance. RESULTS: Most respondents (78%) had adequate knowledge, though misconceptions persisted (56% believed malaria could spread person-to-person). Only 48% knew the recommended ≥ 3 IPTp doses, and ITN use was 63%, with non-use linked to heat discomfort and unavailability. Knowledge of IPTp dosage was significantly associated with uptake (p < 0.001), but socio-demographic factors were not predictors of ANC attendance. CONCLUSION: Gaps in malaria prevention stem from misconceptions, incomplete IPTp adherence, and inconsistent ITN use rather than supply shortages. Priorities include strengthening ANC counselling, correcting myths, introducing reminder prompts, and expanding outreach with ITN replacement. Enhancing implementation fidelity is critical to improving maternal health outcomes.