Despite the fact, that malaria is a controllable disease, in sub-Saharan Africa, including Rwanda, it is still killing pregnant mothers and their children aged less than five years. Due to their low immunity, those two groups are most vulnerable to malaria disease, in areas with high to moderate malaria transmission. With 11 years left to the Global Technical Strategy for malaria target of reducing 90% of malaria case incidence and mortality rates, and elimination in 35 countries by 2030, there is limited evidence and a paucity of studies done on malaria knowledge, access, awareness, and use of malaria control interventions among a high-risk group to reduce the maternal and child death caused by malaria disease in Huye district, Rwanda. The main objective of the study was to explore malaria knowledge, preventive practices, and current ownership and utilization levels of LLINs, as well as factors that are associated with the use of these among pregnant women in the Huye district in the southern province of Rwanda. This study used a cross-sectional observation design on knowledge, ownership, and utilization of malaria control interventions. The sample included pregnant women who were interviewed using a semi-structured questionnaire. The study participants were those living in the Tumba sector, Huye district. A questionnaire developed by the research staff of the Rwanda Biomedical Center research team was adapted to collect data on demographic characteristics; knowledge and awareness, guideline compliance, and utilization of malaria intervention strategies. The study was done within the period of three months from May to July 2019. This study used descriptive and logistic regression analysis. Of the 384 respondents, 340 (88.5%) were married and the mean age was 29.5±6.8 years with 172 (44.8%) aged between 25 and 29 years. The majority 224 (58.4%) had a primary level of education and 147(27.9%) were farmers. Of the 384 respondents who had low knowledge 96 (25%) whereas 42 (14.9%) had high knowledge and 246 (64.1%) had moderate knowledge. 298 (77.6%) were aware and knew that malaria is transmitted by female anopheles and the majority of respondents 323 (84.1%) were using LLINs. Education level, marital status, and occupation were associated with malaria knowledge on preventive practices and LLIN utilization (p=0.001). All study participants demonstrated high knowledge and mentioned that using and sleeping under LLINs helps to avoid mosquito bites however 381 (99.2%) knew that LLIN use, helps to fight against the malaria burden. LLIN ownership was 323 (84.1%) while LLIN utilization was 283 (87.6%) among LLIN owners. Level of education (p=0.001) and LLIN utilization (p=0.001) were significantly associated with LLIN ownership. Even though LLINs coverage was high, its utilization was still low across the country. Sixty-one respondents (15.9 %) did not have LLINs and 84 (22%) of respondents had low knowledge of LLINs utilization and its manipulation. This study reported the factors for not using LLINs among 384 study participants, 61 (15.9%) reported not using LLINs. Observed frequent factors that affect LLIN use among the respondents included: high temperature/heat 56 (94.9%), no access to LLIN 52 (88.1%), and used mosquito coil/spray 8 (13.6 %). Generally, formal education is strongly associated with LLIN utilization. Pregnant women who had high education levels were more expected to be LLIN users than those without formal education (OR 3.4 (95% CI 2.3–4.9). Also, pregnant women aged less than 29 years were less likely to utilize LLINs compared to older pregnant women (OR 0.7; 95% CI 0.5–0.9, p = 0.001). Finally, the overall mean score ±SD for the compliance index was 13.71 (5.4). Compliance index level of malaria control strategies, the model was, R2 = .131, F (5,486) = 13.18, p < .001. Two predictors, both age and education variables have significantly predicted the compliance towards malaria control measures with p < .03. Regression results on the impact of the maternal status on compliance index showed that pregnant women with under-five children were more likely to comply with policy guidelines on the malaria intervention strategies compared to those without under-five children. The study results have shown that the education level variable has an impact on the compliance index of malaria control interventions indicating that as the education level rises, the compliance index also raises. Therefore, this study revealed satisfactory knowledge of malaria control and prevention among pregnant women in southern Rwanda despite the poor implementation of current malaria control strategies. Malaria control policies were reported to be poorly implemented in the study area regardless of efforts made in malaria control and prevention. Yet there is a long journey in behavioral changes and communication among community members, lack of transportation means for referring malaria patients, and lack of feedback and decentralized supervision of health professionals were identified as possible challenges in malaria control policies execution in the study area. Forthcoming efforts need to emphasize behavioral changes and communication built on further research findings and regular national malaria control surveillance.

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