Abstract
BackgroundMalaria in pregnancy is a major public health challenge, but its risk factors remain poorly understood in some settings. This study assessed the association between household and maternal characteristics and malaria among pregnant women in a high transmission area of Uganda.MethodsA nested prospective study was conducted between 6th September 2016 and 5th December 2017 in Busia district. 782 HIV uninfected women were enrolled in the parent study with convenience sampling. Socioeconomic and house construction data were collected via a household survey after enrolment. Homes were classified as modern (plaster or cement walls, metal or wooden roof and closed eaves) or traditional (all other homes). Maternal and household risk factors were evaluated for three outcomes: (1) malaria parasitaemia at enrolment, measured by thick blood smear and qPCR, (2) malaria parasitaemia during pregnancy following initiation of IPTp, measured by thick blood smear and qPCR and (3) placental malaria measured by histopathology.ResultsA total of 753 of 782 women were included in the analysis. Most women had no or primary education (75%) and lived in traditional houses (77%). At enrolment, microscopic or sub-microscopic parasitaemia was associated with house type (traditional versus modern: adjusted risk ratio (aRR) 1.29, 95% confidence intervals 1.15–1.45, p < 0.001), level of education (primary or no education versus O-level or beyond: aRR 1.13, 95% confidence interval 1.02–1.24, p = 0.02), and gravidity (primigravida versus multigravida: aRR 1.10, 95% confidence interval 1.02–1.18, p = 0.009). After initiation of IPTp, microscopic or sub-microscopic parasitaemia was associated with wealth index (poorest versus least poor: aRR 1.24, 95% CI 1.10–1.39, p < 0.001), house type (aRR 1.14, 95% CI 1.01–1.28, p = 0.03), education level (aRR 1.19, 95% CI 1.06–1.34, p = 0.002) and gravidity (aRR 1.32, 95% CI 1.20–1.45, p < 0.001). Placental malaria was associated with gravidity (aRR 2.87, 95% CI 2.39–3.45, p < 0.001), but not with household characteristics.ConclusionsIn an area of high malaria transmission, primigravid women and those belonging to the poorest households, living in traditional homes and with the least education had the greatest risk of malaria during pregnancy.
Highlights
Malaria in pregnancy is a major public health challenge, but its risk factors remain poorly understood in some settings
In an area of high malaria transmission, primigravid women and those belonging to the poorest households, living in traditional homes and with the least education had the greatest risk of malaria during pregnancy
Factors associated with parasitaemia at enrolment At enrolment, 51.1% of women had malaria parasites detected by microscopy and 81.8% had malaria parasites detected by microscopy or quantitative PCR (qPCR)
Summary
Malaria in pregnancy is a major public health challenge, but its risk factors remain poorly understood in some settings. This study assessed the association between household and maternal characteristics and malaria among pregnant women in a high transmission area of Uganda. Malaria remains a major preventable cause of maternal morbidity and adverse birth outcomes in Africa, where an estimated 12.4 million pregnant women were exposed to malaria in 2010 [1]. In Uganda, it has been observed that younger and less educated women are at greater risk of malaria in pregnancy [21], while IRS and ≥ 2 doses of SP during pregnancy may offer some protection against adverse birth and maternal outcomes [5, 22].
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
