Adherence to malaria preventive measures during pregnancy and contextual determinants in community settings of Mbujimayi, Democratic Republic of the Congo

Background Malaria during pregnancy remains a major public health concern in the Democratic Republic of the Congo (DRC), where it causes serious risks to maternal and infant health. To mitigate these risks, preventive measures such as the use of long-lasting insecticide-treated nets (LLINs) and intermittent preventive treatment with sulfadoxine–pyrimethamine (IPTp-SP) are recommended. This study assessed adherence to these preventive strategies among women at community level in Mbujimayi, DRC. Methods A community-based cross-sectional survey was conducted among 330 women residing in Mbujimayi who had been pregnant within the previous five years. Data on LLIN and IPTp-SP use were collected through structured interviews, and factors associated with adherence were analyzed using logistic regression models. Results Of the women surveyed, 54.5% reported owning an LLIN, and 47.8% used one during their last pregnancy; among users, 66% reported consistent nightly use. In contrast, only 37.4% reported receiving IPTp-SP. LLIN use was positively associated with higher education (OR = 1.92, 95% CI [1.18–3.13]) and salaried employment (OR = 3.88, 95% CI [1.60–10.93]). IPTp-SP uptake was associated with higher education (OR = 2.31, 95% CI [1.38–3.96]) and being married (OR = 5.06, 95% CI [1.60–22.58]). Women living in Lukelenge and Muya health districts were less likely to receive IPTp-SP than those in Diulu. Conclusion Adherence to malaria prevention measures during pregnancy in Mbujimayi remains suboptimal. Educational level, employment, and marital status significantly influence preventive behaviors and should be considered in future interventions to improve adherence.