Abstract
Pregnancy-associated malaria (PAM) is a major public health concern constituting a serious risk to the pregnant woman, her foetus, and newborn. Management of cases and prevention rely partly on effective and efficient antenatal services. This study examined the effectiveness of antenatal service provision in a major district hospital in sub-Saharan Africa at preventing PAM. A cross-sectional hospital based study design aided by questionnaire was used. Malaria diagnosis was by microscopy. Overall prevalence of PAM was 50.7% (38/75). Mean Plasmodium falciparum density was (112.89 ± standard error of mean, 22.90) × 103/µL red blood cell (RBC). P. falciparum prevalence was not significantly dependent on gravidity, parity, trimester, age, and BMI status of the women (p > 0.05). Difference in P. falciparum density per µL RBC in primigravidae (268.13 ± 58.23) × 103 vs. secundi- (92.14 ± 4.72) × 103 vs. multigravidae (65.22 ± 20.17) × 103; and in nulliparous (225.00 ± 48.25) × 103 vs. primiparous (26.25 ± 8.26) × 103 vs. multiparous (67.50 ± 20.97) × 103 was significant (p < 0.05). Majority of attendees were at 3rd trimester at time of first antenatal visit. Prevalence of malaria parasitaemia in the first-time (48.6%), and multiple-time (52.6%) antenatal attendees was not significantly different (χ2 = 0.119, p = 0.730). The higher prevalence of malaria among bed net owners (69.6% vs. 42.9%, χ2 = 2.575, p = 0.109, OR = 3.048 (95% CI 0.765–12.135)) and users (66.7% vs. 33.3%, χ2 = 2.517, p = 0.113, OR = 4.000 (95% CI 0.693–23.089)) at multiple antenatal visits vs. first timers was not significant. None of the pregnant women examined used malaria preventive chemotherapy. Antenatal services at the hospital were not effective at preventing PAM. Holistic reviews reflecting recommendations made here can be adopted for effective service delivery.
Highlights
This study examined the effectiveness of antenatal service provision in a major district hospital in sub-Saharan Africa at preventing Pregnancy-associated malaria (PAM)
Pregnancy-associated malaria (PAM) is a major public health concern constituting a serious risk in sub-Saharan Africa to pregnant women, her foetus, and the newborn [1]
Thirty-eight (50.7%) of the women were positive for P. falciparum malaria parasitaemia
Summary
Pregnancy-associated malaria (PAM) is a major public health concern constituting a serious risk in sub-Saharan Africa to pregnant women, her foetus, and the newborn [1]. Especially Plasmodium falciparum, further subjects the woman to physiological and pathological stress, in addition to that arising from pregnancy This combination of stresses which, on one hand, is directed at ensuring the survival of the foetus and, on the other, at combating the parasite, may overwhelm the pregnant woman leading to her death, abortion of the foetus [2], or stillbirth [3]. Low birth weight is another effect attributable to PAM [4,5,6] as indirect consequences on the foetus from placenta sequestration of P. falciparum-infected red blood cells (RBC). This effect on the foetus results from interference with placento-foetal exchange, with shortage of glucose and oxygen supplies to foetus [5,7]. The risk for neonatal mortality increases steadily as the birth weight decreases to below the low birth weight threshold [7]
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