Abstract
BackgroundMalaria continues to be a major health problem in low-income countries. Consequently, malaria control remains a public health priority in endemic countries such as Zambia. Pregnant women and children under 5 years of age are among groups at high risk of malaria infection. Malaria infection is associated with adverse birth outcomes that affect the mother, foetus, and infant. Infection with HIV has been shown to increase the risk of malaria infection in pregnancy. The prevalence and the predictors of malaria infection among pregnant women resident in the Nchelenge District of northern Zambia were investigated.MethodsBetween November 2013 and April 2014, pregnant women in the catchment areas of two health centres were recruited during their first antenatal care visit. HIV testing was conducted as part of routine care. In addition, blood samples were collected from 1086 participants and tested for malaria infection using standard microscopy and polymerase chain reaction (PCR) techniques specific for Plasmodium falciparum. Multivariate logistic regression were conducted to examine the predictors of malaria infection.ResultsThe prevalence of malaria identified by microscopy was 31.8 % (95 % confidence intervals [CI], 29.0–34.5; N = 1079) and by PCR was 57.8 % (95 % CI, 54.9–60.8; N = 1074). HIV infection was 13.2 % among women on their first antenatal visit; the prevalence of malaria detected by PCR among HIV-uninfected and HIV-infected women was 56.7 % (531/936) and 65.2 % (90/138), respectively. In the final model, the risk of malaria infection was 81 % higher among pregnant women recruited from Nchelenge health centre compared to those attending the Kashikishi health centre (adjusted odds ratio = 1.81; 95 % CI, 1.38–2.37, P < 0.001), and HIV-infected women across health centres had a 46 % greater risk of malaria infection compared to HIV-uninfected women (adjusted odds ratio = 1.46; 95 %, 1.00–2.13, P = 0.045).ConclusionHigh burden of malaria detected by PCR in these pregnant women suggests that past prevention efforts have had limited effect. To reduce this burden of malaria sustainably, there is clear need to strengthen existing interventions and, possibly, to change approaches so as to improve targeting of groups most affected by malaria.Electronic supplementary materialThe online version of this article (doi:10.1186/s12936-015-0866-1) contains supplementary material, which is available to authorized users.
Highlights
Malaria continues to be a major health problem in low-income countries
Approximately 35 million pregnant women are at risk of malaria infection each year in sub-Saharan Africa [1]
Meta-analysis of malaria in pregnancy (MiP) studies conducted in Eastern and Southern Africa between 1990 and 2011 showed that 32.0 %
Summary
Malaria continues to be a major health problem in low-income countries. malaria control remains a public health priority in endemic countries such as Zambia. Pregnant women and children under 5 years of age are among groups at high risk of malaria infection. 35 million pregnant women are at risk of malaria infection each year in sub-Saharan Africa [1]. Adverse consequences of malaria infection during pregnancy include maternal anaemia, intra-uterine growth retardation [2], preterm delivery [3], stillbirth [4, 5] and low birth weight [6]. When the time period was restricted to studies conducted between 2000 and 2011, parasitaemia was 29.5 % (95 % CI, 22.4–36.5; n = 18,375) [11] These estimates were calculated using a standard method for correcting errors of magnitude based on the known specificity and sensitivity of individual diagnostic methods [12]
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have