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

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.