Assessment of malaria infection among pregnant women and children below five years of age attending rural health facilities of Kenya: A cross-sectional survey in two counties of Kenya

Abstract

In Kenya, health service delivery and access to health care remains a challenge for vulnerable populations, particularly pregnant women and children below five years. The aim of this study, therefore, was to determine the positivity rate of Plasmodium falciparum parasites in pregnant women and children below five years of age seeking healthcare services at the rural health facilities of Kwale and Siaya counties as well as their access and uptake of malaria control integrated services, like antenatal care (ANC), offered in those facilities. Cluster random sampling method was used to select pregnant women and children below five years receiving maternal and child health services using two cross-sectional surveys conducted in eleven rural health facilities in two malaria endemic counties in western and coastal regions of Kenya. Each consenting participant provided single blood sample for determining malaria parasitaemia using microscopy and polymerase chain reaction (PCR) techniques. Using PCR technique, the overall malaria positivity rate was 27.9% (95%CI: 20.9-37.2), and was 34.1% (95%CI: 27.1-42.9) and 22.0% (95%CI: 13.3-36.3) in children below five years and pregnant women respectively. Additionally, using microscopy, the overall positivity rate was 39.0% (95%CI: 29.5-51.6), and was 50.4% (95%CI: 39.4-64.5) and 30.6% (95%CI: 22.4-41.7) in children below five years and pregnant women respectively. Siaya County in western Kenya showed higher malaria positivity rates for both children (36.4% and 54.9%) and pregnant women (27.8% and 38.5%) using both PCR and microscopy diagnosis techniques respectively, compared to Kwale County that showed positivity rates of 27.2% and 37.9% for children and 5.2% and 8.6% for pregnant women similarly using both PCR and microscopy techniques respectively. Pregnant women presenting themselves for their first ANC visit were up to five times at risk of malaria infection, (adjusted odds ratio = 5.40, 95%CI: 0.96-30.50, p = 0.046). Despite evidence of ANC attendance and administration of intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP) dosage during these visits, malaria positivity rate was still high among pregnant women and children below five years in these two rural counties. These findings are important to the Kenyan National Malaria Control Programme and will help contribute to improvement of policies on integration of malaria control approaches in rural health facilities.