Effectiveness of Family Empowerment Based on Arui Sai Cultural Values on Prophylactic DHP Adherence and Malaria Incidence among Pregnant Women in Papua, Indonesia

Abstract

Papua represents a disproportionate share of Indonesia's national malaria burden.More than 86% of all malaria cases in Indonesia in 2023 originated in Papua, with an annual parasite incidence (API) of 156.59 per thousand people, compared with the ABSTRACT Background: Malaria during pregnancy remains a major public health concern in Papua, Indonesia, with significant maternal and neonatal consequences.Although dihydroartemisinin-piperaquine (DHP) is effective as prophylaxis, adherence remains suboptimal.Culturally grounded, family-based approaches may improve adherence.Objective: To evaluate the effectiveness of a family empowerment intervention based on Arui Sai cultural values on DHP adherence and malaria incidence among pregnant women.Methods: A quasiexperimental study with a pretest-posttest control group design was conducted in Kepulauan Yapen Regency from March to December 2025.A total of 184 pregnant women (92 in the intervention group; 92 in the control group) were analyzed.The intervention involved family empowerment through educational modules, home visits, and family engagement, whereas the control group received standard antenatal care.The outcomes included DHP adherence (≥80%) and malaria incidence during a five-month follow-up period.Data were analyzed using chi-square tests and logistic regression.Results: DHP adherence was significantly greater in the intervention group (95.7% vs. 63.0%;OR=12.90;95%CI: 4.35-38.27;p<0.001).In the multivariable analysis, the intervention remained a significant predictor (adjusted OR=13.73;95%CI: 4.42-42.65;p<0.001).The incidence of malaria was lower in the intervention group according to the results of the bivariate analysis (7.6% vs. 20.7%;RR=0.37; 95%CI: 0.16-0.83;p=0.020) but was not significantly different after adjustment (adjusted OR=0.42; 95%CI: 0.15-1.17;p=0.098).Living near vector breeding sites was an independent predictor (adjusted OR=4.09; p=0.010). Conclusion: Family empowerment based on Arui Sai cultural values significantly improves DHP adherence.Integration with environmental risk control is necessary for malaria prevention in high-endemic settings.

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