Background: Malaria remains a major health concern in Busia district, Eastern Uganda. Due to their low pregnancy-specific immunity, primigravidas are more vulnerable to malaria infection and prone to severe malaria-related maternal and fetal complications. This study aimed to assess the prevalence and associated factors of malaria among primigravidas attending Antenatal Care at Masafu General Hospital Busia district, Uganda.

Method: A cross-sectional study involving 126 participants was undertaken from December 2024 to April 2025. Malaria in pregnancy was defined as a positive rapid malaria antigen test or blood slide microscopy during Antenatal clinic visit. Capillary blood samples were collected from the participants and tested using malaria rapid diagnostic tests and microscopy to assess the malaria prevalence. A structured and pretested questionnaire was used to collect data on socio-demographics and other risk-factors. Bivariate analysis was done to identify variables significantly associated with malaria status (p<0.05). Multivariate logistic regression was further run to adjust for confounding factors and thus determine the independent predictors of malaria infection.

Results: Of the 126 primigravidas that were included in this study, 40 were malaria positive representing the overall prevalence of 31.8% (95% CI: 23.6%-39.9%). Of the positive cases, 20% were asymptomatic. This study revealed that single mothers and those residing in the villages exhibited the highest prevalence rates of 45.95% and 33.66% respectively. In the adjusted model, significant risk factors included occupation (p=0.042), sleeping under a treated mosquito net (p<0.001), living near mosquito breeding sites (p=0.013), and lack of health education on malaria prevention.

Conclusion: The study found that the prevalence of malaria among primigravidas was 31.8%, of which 20% were asymptomatic. The factors associated with malaria were inadequate use of mosquito nets, living near mosquito‑breeding sites, and poor access to health education in their communities.