Abstract
BackgroundMalaria remains a major public health problem in sub Saharan Africa and the extent of utilisation of malaria preventive measures may impact on the burden of malaria in pregnancy. This study sought to determine the association between malaria preventive measures utilized during pregnancy and the birth outcomes of birth weight and preterm delivery.MethodsThis cross sectional survey involved 800 mothers who delivered at the University College Hospital, and Adeoyo Maternity Hospital, Ibadan. Data obtained included obstetric information, gestational age, birth weight and self reported use of malaria prevention strategies in index pregnancy.ResultsMost (95.6%) mothers used one or more malaria control measures. The most commonly used vector control measures were window net (84.0%), insecticide spray (71.5%) and insecticide treated bed nets (20.1%), while chemoprophylactic agents were pyrimethamine (23.5%), Intermittent Preventive Treatments with Sulphadoxine-Pyrimethamine (IPTsp) (18.5%) and intermittent chloroquine (9.5%) and 21.7% used herbal medications. The mean ± SD birthweight and gestational age of the babies were 3.02 kg ± 0.56 and 37.9 weeks ± 2.5 respectively. Preterm delivery rate was 19.4% and 9% had low birth weight.Comparing babies whose mothers had IPTsp with those who did not, mean birth weight was 3.13 kg ± 0.52 versus 3.0 kg ± 0.56 (p = 0.016) and mean gestational age was 38.5 weeks ± 2.1 versus 37.8 weeks ± 2.5 (p = 0.002).The non-use of IPTsp was associated with increased risk of having low birth weight babies (AOR: 2.27, 95% CI: 0.98; 5.28) and preterm birth (AOR: 1.93, 95% CI: 1.08, 3.44). The non use of herbal preparations (AOR: 0.55, 95% CI: 0.36, 0.85) was associated with reduced risk of preterm birth. The mean ± SD birth weight and gestational ages of babies born to mothers who slept under ITNs were not significantly different from those who did not (p = 0.07 and 0.09 respectively).ConclusionsThere is a need for improved utilisation of IPTsp as well as discouraging the use of herbal medications in pregnancy in order to reduce pregnancy outcome measures of low birth weight and preterm deliveries in this environment.
Highlights
Malaria remains a major public health problem in sub Saharan Africa and the extent of utilisation of malaria preventive measures may impact on the burden of malaria in pregnancy
The World Health Organisation recommends the use of intermittent presumptive treatment with sulphadoxine pyrimethamine (IPTsp), household use of insecticidetreated bednets (ITNs) and effective and prompt case management as malaria control strategies in pregnancy [4]
In Nigeria, traditional remedies against malaria have always been employed, though with unproven efficacy, while chemoprophylaxis with weekly pyrimethamine and chloroquine which were widely utilised in several African countries are no longer efficacious because of emergence of resistance [5,6,7]
Summary
Malaria remains a major public health problem in sub Saharan Africa and the extent of utilisation of malaria preventive measures may impact on the burden of malaria in pregnancy. This study sought to determine the association between malaria preventive measures utilized during pregnancy and the birth outcomes of birth weight and preterm delivery. The World Health Organisation recommends the use of intermittent presumptive treatment with sulphadoxine pyrimethamine (IPTsp), household use of insecticidetreated bednets (ITNs) and effective and prompt case management as malaria control strategies in pregnancy [4]. The study did not evaluate other malaria preventive measures such as personal protection. Nigeria adopted the use of IPTsp as national policy in 2000 This drug as well as ITN were made available by the government and expected to be provided free to pregnant mothers during antenatal care. This study seeks to evaluate the utilisation rates of these and other malaria preventive measures by pregnant Nigerian women as well as their impacts on outcomes of pregnancy in terms of low birth weight and preterm births
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