Wealth-related inequalities and correlates of malaria message exposure among pregnant women in four malaria high-burden countries in sub-Saharan Africa: evidence from recent malaria indicator surveys

Malaria remains a critical public health challenge in sub-Saharan Africa (SSA). Social and behaviour change communication (SBCC) is one of the cornerstones of effective malaria control strategies. Pregnant women are vulnerable to malaria compared to other sub-populations, and exposure to malaria messages is not evenly distributed in this sub-population, but the potential determinants are unclear. This study determined the prevalence of exposure to malaria messages among pregnant women in Uganda, Tanzania, Ghana, and Burkina Faso, including its wealth-related inequalities and the associated factors. We utilised data from the Malaria Indicator Surveys in Burkina Faso, Ghana, Tanzania, and Uganda. Only women who were pregnant at the time of the survey were included in this study, resulting in a weighted sample of 2552 pregnant women. Equity plots and the concentration index were used to establish wealth-related inequalities. A multilevel mixed-effects logistic regression model was used to identify factors associated with exposure to malaria messages at the 5% significance level. Of 2,552 participants, 1,440 (56.4%) pregnant women reported exposure to malaria messages. By country, the highest rate was recorded in Ghana (88.4%), followed by Burkina Faso (63.9%), with Uganda and Tanzania showing similar levels of exposure to malaria messages (48.3% and 48.1%, respectively). Exposure to malaria messages was largely concentrated among rich women, with a significant unstandardized concentration index of 0.075 ( p < 0.001). Women aged 35–49 years [Adjusted odds ratio (aOR) = 1.42; 95% confidence interval (CI): 1.16, 1.74] and women with secondary or higher level of education [aOR = 2.70; 95% CI: 1.17, 6.25] were associated with exposure to malaria messages. Overall, less than three in five pregnant women are exposed to malaria messages in sub-Saharan Africa, with pregnant women aged 35–49 years, with secondary or higher levels of education, who are wealthier, and with a previous birth history mainly exposed to malaria messages. The study revealed considerable variation in factors at the community and country levels. Therefore, malaria communication strategies should be targeted for better reach and impact.