Asymptomatic Malaria Parasitaemia Research Articles

Is asymptomatic malaria really asymptomatic? Hematological, vascular and inflammatory effects of asymptomatic malaria parasitemia

Asymptomatic malaria infections are highly prevalent in malaria endemic regions and most of these infections remain undiagnosed and untreated. Whereas conventional malaria symptoms are by definition absent, little is known on the more subtle health consequences of these infections. The aim of our study was to analyze the hematologic, vascular and inflammatory effects of patent and subpatent asymptomatic malaria parasitemia in children and adults on the Indonesian island Sumba. Both children and adults with parasitemia had increased high-sensitive C-reactive protein levels compared to aparasitemic individuals. In addition, children, but not adults with parasitemia also had lower platelet counts and Hb levels and higher levels of von Willebrand factor and platelet factor-4, markers of endothelial and platelet activation, respectively. These findings suggest that asymptomatic malaria infections have subtle health consequences, especially in children, and should be regarded as potentially harmful.

Asymptomatic Malaria and Other Infections in Children Adopted from Ethiopia, United States, 2006-2011.

We screened 52 children adopted from Ethiopia for malaria because they had previously lived in a disease-endemic region or had past or current hepatomegaly or splenomegaly. Seven (13.5%) children had asymptomatic malaria parasitemia by microscopy (n = 2) or PCR (n = 5). Our findings suggest that adoptees at risk for asymptomatic malaria should be screened, preferably by PCR.

Prevalence and predictors of asymptomatic malaria parasitemia among pregnant women in the rural surroundings of Arbaminch Town, South Ethiopia.

BackgroundIn Sub-Saharan African countries, including Ethiopia, malaria in pregnancy is a major public health threat which results in significant morbidities and mortalities among pregnant women and their fetuses. In malaria endemic areas, Plasmodium infections tend to remain asymptomatic yet causing significant problems like maternal anemia, low birth weight, premature births, and still birth. This study was conducted to determine the prevalence and predictors of asymptomatic Plasmodium infection among pregnant women in the rural surroundings of Arba Minch Town, Southern Ethiopia.MethodsA community based cross-sectional study comprising multistage sampling was conducted between April and June, 2013. Socio-demographic data were collected by using a semi-structured questionnaire. Plasmodium infection was diagnosed by using Giemsa-stained blood smear microscopy and a rapid diagnostic test (SD BIOLINE Malaria Ag Pf/Pv POCT, standard diagnostics, inc., Korea).ResultsOf the total 341 pregnant women participated in this study, 9.1% (31/341) and 9.7% (33/341) were confirmed to be infected with Plasmodium species by microscopy and rapid diagnostic tests (RDTs), respectively. The geometric mean of parasite density was 2392 parasites per microliter (μl); 2275/ μl for P. falciparum and 2032/ μl for P. vivax. Parasitemia was more likely to occur in primigravidae (Adjusted odds ratio (AOR): 9.4, 95% confidence interval (CI): 4.3–60.5), secundigravidae (AOR: 6.3, 95% CI: 2.9–27.3), using insecticide treated bed net (ITN) sometimes (AOR: 3.2, 95% CI: 1.8- 57.9), not using ITN at all (AOR: 4.6, 95% CI: 1.4–14.4) compared to multigravidae and using ITN always, respectively.ConclusionAsymptomatic malaria in this study is low compared to other studies’ findings. Nevertheless, given the high risk of malaria during pregnancy, pregnant women essentially be screened for asymptomatic Plasmodium infection and be treated promptly via the antenatal care (ANC) services.

Anemia associated with asymptomatic malaria among pregnant women in the rural surroundings of Arba Minch Town, South Ethiopia.

BackgroundAnemia during pregnancy is a well known medical condition most of the time under-recognized as it is overshadowed by the normal physiological condition during pregnancy. This study aimed at determining the prevalence and predictors of anemia among pregnant women residing in the rural surroundings of Arbaminch Town, south Ethiopia.MethodsA cross-sectional community based study was conducted between April and June, 2013. A structured questionnaire was used to collect socio-economic and socio-demographic characteristics of the pregnant women. Hematocrit (HCT) level was determined to classify the pregnant women as anemic and non-anemic. Diagnosis of asymptomatic malaria parasitemia was done by Giemsa stained blood smear microscopy. HCT < 33%, (HCT ≥ 30% & < 33%), (HCT ≥ 21% & < 30%), and HCT < 21% was used to indicate anemia, mild anemia, moderate anemia, and severe anemia respectively.ResultsA total of 341 pregnant women participated in this study, out of which 118 (34.6%) were anemic. The median age of the pregnant women was 25 years (Inter-quartile range: 23–29). The mean HCT was 35.2% (95% CI: 34.6%–35.8%) with SD of ±5.5%. Of those 118 anemic women; 73(61.9%) were mildly anemic, 38(32.2%) were moderately anemic, and 7(5.9%) were found to be severely anemic. The prevalence of asymptomatic malaria parasitemia was 9.1% (31/341). The odds of being anemic were 15.72 times [AOR: 15.72, 95% CI (3.97, 62.22), P-value ≤ 0.001] more likely to occur in parasitemic individuals relative to the non parasitemic pregnant women. Not using insecticide treated bed net (ITN) was a significant predictor of anemia among the pregnant women [AOR: 3, 95% CI: (1.72, 5.22), P < 0.001].ConclusionThis study highlighted the significant association between anemia and asymptomatic malaria among pregnant women in the study area. Therefore, the practice of routine screening for malaria and anemia followed by prompt management should be encouraged to curb the effect of malaria and anemia on the pregnant women as well as her fetus. Further studies should also be in place to test the effectiveness of routine screening for malaria and anemia followed by prompt management.

Association between malaria exposure and Kaposi's sarcoma-associated herpes virus seropositivity in Uganda.

ObjectiveUnlike other herpes viruses, Kaposi's sarcoma-associated herpes virus (KSHV) is not ubiquitous worldwide and is most prevalent in sub-Saharan Africa. The reasons for this are unclear. As part of a wider investigation of factors that facilitate transmission in Uganda, a high prevalence country, we examined the association between antimalaria antibodies and seropositivity against KSHV.MethodsAntibodies against P. falciparum merozoite surface protein (PfMSP)-1, P. falciparum apical membrane antigen (PfAMA)-1 and KSHV antigens (ORF73 and K8.1) were measured in samples from 1164 mothers and 1227 children.ResultsKaposi's sarcoma-associated herpes virus seroprevalence was 69% among mothers and 15% children. Among mothers, KSHV seroprevalence increased with malaria antibody titres: from 60% to 82% and from 54% to 77%, comparing those with the lowest and highest titres for PfMSP-1 and PfAMA-1, respectively (P < 0.0001). Among children, only antibodies to PfAMA-1 were significantly associated with KSHV seropositivity, (P < 0.0001). In both mothers and children, anti-ORF73 antibodies were more strongly associated with malaria antibodies than anti-K8.1 antibodies.ConclusionThe association between malaria exposure and KSHV seropositivity suggests that malaria is a cofactor for KSHV infection or reactivation.

Plasmodium falciparum parasitaemia among booked parturients who received two doses of sulfadoxine-pyrimethamine (SP) for intermittent preventive treatment in pregnancy (IPTp) in a tertiary health facility Southeast Nigeria.

Background:Malaria is preventable but has contributed significantly to maternal morbidity and mortality in our environment. Malaria parasitaemia during pregnancy is mostly asymptomatic, untreated but with complications.Aim:A follow-up study aimed at determining plasmodium falciparum parasitaemia and associated complications among booked parturient who had intermittent preventive treatment with sulfadoxine-pyrimethamine (SP) compared with another study among unbooked parturients who did not take SP for intermittent preventive treatment in pregnancy (IPTp).Materials and Methods:This study was conducted in the labour ward complex of Federal Teaching Hospital, Abakaliki from March to May 2012. Five hundred booked parturients at term that received two doses of SP were consecutively recruited. A structured data collection sheet was administered to each parturient. Thick and thin blood films were prepared for quantification and speciation of parasitaemia, respectively. The haemoglobin concentration and birth weights were determined. Analysis was done with the Statistical Package for the Social Sciences (SPSS) software with level of significance at P value < 0.05.Results:The prevalence of malaria parasitaemia in the study was 59.6%. The mean age of parturients was 28.7 (5.5). The highest prevalence of malaria parasitaemia, 92% was found among the parturients aged ≤19 years. The association between age and parasitaemia was significant (x2 = 16.496, P = 0.000). The median parity was 1.0 (3.0). The highest prevalence of asymptomatic parasitaemia, 65.5% was noted among the nulliparous parturients. The association between parity and parasitaemia was significant (x2 = 11.551, P = 0.003). Majority of the parturients were of high social class. Those of the lowest social class (class 5) had the highest prevalence (80%) of parasitaemia. The association between social class and parasitaemia was significant (x2 = 9.131, P = 0.003). Prevalence of anaemia in the study was 14%. The non-parasitaemic and parasitaemic parturients had mean haemoglobin concentrations of 12.7 g/dl and 10.4 g/dl, respectively. There was significant association between haemoglobin concentration and parasitaemia (x2 = 39.143, P = 0.000). The prevalence of low birth weight was 3.0%. The relationship between birth weight and parasitaemia was significant (x2 = 2.535, P = 0.000).Conclusion:The was reduction in asymptomatic malaria parasitaemia compared to parturients who had no SP though the prevalence was still high showing possibly increasing resistance to SP but the treatment was still very effective in reducing anaemia and low birth weight associated with malaria in pregnancy.

Effect of HIV-1 Serostatus on the Prevalence of Asymptomatic Plasmodium falciparum Parasitemia Among Children Less Than 5 Years of Age in Benin City, Nigeria.

Human immunodeficiency virus (HIV) infection and Plasmodium falciparum malaria are 2 of the gravest health threats in sub-Saharan Africa. Multiple repeat infections with the malaria parasite as seen in endemic areas are necessary to develop specific malaria immunity. HIV is an immunosuppressive virus and in children aged <5 years, development of malaria-specific immunity may be impaired and malaria parasite clearance in theory will be delayed; hence the predisposition to increased incidence of asymptomatic malaria or severe malaria. This cross-sectional study was carried out to examine associations between immunosuppression and asymptomatic malaria parasitemia (ASMP) in HIV-infected children aged <5 years in Benin City. One hundred seventy-nine asymptomatic HIV-1-positive and 179 age- and sex-matched HIV-1-negative children aged <5 years were recruited. The malaria parasite was determined by Giemsa-stained blood film by certified microscopy while concomitant CD4(+) count was estimated in the HIV-infected children. The prevalence of ASMP in those who were HIV-infected of 34.1% was significantly higher than 17.3% in the HIV uninfected (P = .001). The prevalence of ASMP was highest (59.3%) among subjects who were severely immunosuppressed (CDC immunologic category 3). The prevalence of ASMP significantly increased with advanced immune disease in the subjects (P = .011). Severe (World Health Organization) clinical staging was also significantly associated with increased prevalence of ASMP (P = .031). The prevalence of ASMP is significantly higher among subjects not receiving cotrimoxazole, associated with threefold risk of having ASMP (P = .003: odds ratio = 3.5). ASMP is more common in HIV-positive children aged <5 years and is significantly associated with declining CD4(+) T-cell count and severe clinical disease. There is a need for integration of HIV- and malaria-control programs for stronger case management. Malaria-control programs may consider malaria prevention interventions and cotrimoxazole prophylaxis for preschool children who are HIV-infected and living in malaria-endemic regions.

Outcomes of asymptomatic malaria parasitaemia in neonates in a tertiary hospital, southeast Nigeria.

Background:Malaria infestation during pregnancy is mostly asymptomatic and untreated especially in unbooked pregnancies. It presents with almost all the fetal complications of overt malaria in pregnancy. The aim of this study was to determine the effect of asymptomatic malaria parasitaemia on the neonates of unbooked parturients delivered at term at the Federal Teaching Hospital, Abakaliki.Materials and Methods:This study was conducted in the labour ward complex of the Federal Teaching Hospital, Abakaliki from March to May 2012. Unbooked pregnant women who fulfilled the inclusion criteria and gave consent were consecutively recruited. Cord blood and placenta tissue were collected for haemoglobin concentration determination and histology, respectively. Birth weights were determined with an electronic weighing machine. Statistical Analysis was done with 2008 Epi Info™ software and level of significant was set at P-value <0.05.Results:A total of 250 unbooked parturients were recruited, of which 194 (77.6%) had asymptomatic malaria parasitaemia while 227 (90.8%) had placental parasitisation. The prevalence of low birth weight in the study was 16.4%. There was significant relationship between asymptomatic malaria parasitemia and birth weight (X2 = 43.70, P-value < 0.001). There were no low-birth-weight deliveries among paturients without placental parasitemia. No neonate, however, had anaemia in the study.Conclusion:Asymptomatic malaria parasitemia and placental parasitisation by malaria parasites contribute to the outcome of the foetal birth weight. Asymptomatic malaria parasitaemia and placental parasitaemia did not result in a corresponding foetal anaemia on babies delivered.

Prevalence and parasite density of asymptomatic malaria parasitemia among unbooked paturients at Abakaliki, Nigeria

Background: Malaria in pregnancy has contributed significantly to maternal morbidity and mortality in our environment. Aim: This study was aimed at determining the prevalence, and parasite density of asymptomatic malaria parasitemia among unbooked paturients at Federal Teaching Hospital Abakaliki. Subjects and Methods: This was a prospective cross‑sectional study conducted in the labor ward complex of the Federal Teaching Hospital Abakaliki over a period of three months from March to May 2012. Two hundred and fifty unbooked women presenting in labor at term and willing to participate were consecutively recruited. A structured data collection sheet was administered to each parturient. Thick and thin blood films were prepared for quantification and speciation of parasitemia respectively. Results: A total of 250 unbooked parturients participated in the study. The mean age of the parturients was 28.2 (7.2) years. One hundred and seven 107/250 (42.8%) were primigravid, 111/250 (44.4%) were between para 1‑4 while 32/250 (12.8%) were para 5 and above. Majority of the parturients 236/250 (95.2%) were of low socio‑economic class. The prevalence of asymptomatic malaria parasitemia was 77.6%. Asymptomatic malaria parasitemia was most prevalent among paturients of social class 5 (24/32 (75%) and primigravid paturients (93/107 (86.9%)) and the association of asymptomatic malaria parasitemia with parity (χ2 = 10.8, P = 0.01) and social class (χ2 = 10.88, P = 0.02) was statistically significant. Conclusion: There was high prevalence of asymptomatic malaria parasitemia in the study. Preconceptional care and early antenatal booking are advocated with emphasis on prevention of malaria infestation through health education and effective use of insecticide treated nets and intermittent prophylaxis therapy for malaria during pregnancy.

Anemia Among Unbooked Parturients With Asymptomatic Malaria Parasitemia At A Tertiary Institution Southeast Nigeria

Anemia Among Unbooked Parturients With Asymptomatic Malaria Parasitemia At A Tertiary Institution Southeast Nigeria

No asymptomatic malaria parasitaemia found among 108 young children at one health facility in Dar es Salaam, Tanzania

BackgroundAsymptomatic malaria parasitaemia has been reported in areas with high malaria transmission. It may serve as a reservoir for continued transmission, and furthermore complicates diagnostics, as not all individuals with a positive malaria test are necessarily ill due to malaria, although they may present with malaria-like symptoms. Asymptomatic malaria increases with age as immunity to malaria gradually develops. As mortality and morbidity of malaria is higher among younger children it is important to know the prevalence of asymptomatic malaria parasitaemia in this population in order to interpret laboratory results for malaria correctly.MethodsA total of 108 children that had neither been treated for malaria nor had a fever the previous four weeks were recruited consecutively at a maternal and child health clinic (MCHC) in Dar es Salaam, Tanzania. A rapid diagnostic test (RDT) for malaria and dried blood spot (DBS) on filter paper were taken from each child. Social and clinical data were recorded. DNA was extracted from the DBS of study participants by a method using InstaGene™ matrix. PCR targeting the Plasmodium mitochondrial genome was performed on all samples.ResultsMedian age was 4.6 months (range 0.5-38). All the RDTs were negative. PCR was negative for all study subjects.ConclusionThe study suggests that asymptomatic malaria may not be present in apparently healthy children up to the age of three years in Dar es Salaam, Tanzania. However, because of the small sample size and low median age of the study population, the findings cannot be generalized. Larger studies, including higher age groups, need to be done to clarify whether asymptomatic malaria parasitaemia is present in the general population in the Dar es Salaam area.

Asymptomatic malaria parasitaemia using rapid diagnostic test in unbooked pregnant women in rural Ondo-south district, Nigeria.

Malaria is a major contributor of maternal and peri-natal morbidity and mortality. The disease may be asymptomatic despite sequestration of parasitized red blood cells in the placental micro-circulation with antecedent complications. In such condition, it may also be difficult to identify the malaria parasite by the peripheral blood film microscopy, thus the need for use of simple but reliable tool for malaria parasite diagnosis. To determine the prevalence of asymptomatic malaria parasitaemia using the Rapid Diagnostic Test in pregnant unbooked women seen in a primary health centre during a malaria control campaign programme in rural Ondo-south, District Nigeria. Prevalence of asymptomatic malaria parasitaemia was 25.9%. Only 3 (3.5%) of the 85 women had the long lasting insecticide-treated nets. There was no significant association between malaria parasitaemia, and the age group, parity and gestation age. Given the high prevalence of asymptomatic malaria in pregnancy, routine screening for malaria at booking and scaling-up of other malaria control strategies such as the use of long lasting insecticidal-treated nets and intermittent preventive therapy for pregnant women are recommended.

The impact of intermittent preventive treatment with sulfadoxine-pyrimethamine on the prevalence of malaria parasitaemia in pregnancy

The Roll Back Malaria initiatives were introduced to ensure that 60% of pregnant women receive intermittent preventive anti-malarial treatment by the end of 2005 in an attempt to halve the mortality from malaria by 2010. Our aim was to determine the prevalence of asymptomatic malaria parasitaemia in pregnant women on intermittent preventive treatment (IPT) with sulfadoxine-pyrimethamine (SP) compared with a control group. This comparative study involved testing the peripheral blood of pregnant women on IPT with SP and a control group that did not receive SP for the malaria parasite upon registration and at 34 weeks gestational age. The levels of parasitaemia in the intervention group upon registration (4.9%) and at 34 weeks (63.9%) were not significantly different (P > 0.05) from that of the control group (10%) and at 34 weeks gestation (68.3%). IPT with SP during pregnancy did not significantly reduce the prevalence of the malaria parasitaemia among the pregnant women in our environment.

Asymptomatic malaria parasitemia does not induce additional oxidative stress in pregnant women of South East Nigeria

Objective To determine the relationship between asymptomatic malaria parasitemia and some oxidative stress parameters in pregnant Nigerian women. Methods This is a cross-sectional study involving 130 normal pregnant women at various trimesters, who were attending antenatal clinic at the University of Nigeria Teaching Hospital (UNTH) and Kenechukwu Specialist Hospital in Enugu. A comparable group (control), made of 30 non pregnant women was also recruited. After a 24 hour dietary recall, serum levels of vitamin A, C and malondialdehyde (MDA) were determined by colorimetric method, while vitamin E was determined by absorptiometric method. Results There were no statistically significant differences in age, parity, estimated calorie, vitamins A, C and E intake between the pregnant and non pregnant groups ( P> 0.05). The serum level of the vitamins (umol/L) and MDA (umol/L) in control, 1st, 2nd and 3rd trimesters respectively were: (1)Vitamin A: 1.6±0.36 vs 0.6±0.26 vs 0.62± 0.33 vs 0.46± 0.21 ( P < 0.0001); (2) Vitamin C: 75.65±14.15 vs 62.97±24.4 vs 37.85±15.19 vs 28.94±8.52 ( P<0.0001); (3) Vitamin E: 3.01± 1.32 vs 3.45±2.01 vs 9.36±2.75 vs 9.82±2.97 ( P<0.0001); (4) MDA: 1.42± 0.02 vs 1.61±0.02 vs 1.79±0.02 vs 2.03±0.05 ( P<0.0001). However, there were no significant changes in the serum level of the vitamins and MDA between the positive and the negative parasitemia subjects ( P>0.05). Conclusions Asymptomatic malaria parasitemia does not induce additional oxidative stress on pregnant women in Nigeria. The enormity of acute and complicated attack should be further investigated.

Prevalence of malaria parasitemia amongst asymptomatic pregnant women attending a Nigerian teaching hospital

Malaria parasitemia among pregnant women is associated with complications to mother and the unborn fetus. There is paucity of data on asymptomatic malaria parasitemia, particularly in the northwest region of Nigeria. The objectives of this study were to determine the prevalence of malaria parasitemia in asymptomatic pregnant women and to estimate the packed cell volume (PCV) of this group of pregnant women. This was a cross-sectional, descriptive study of only well pregnant women recruited consecutively at the time of booking for antenatal care. Thick film microscopy and qualitative immunoassay test for malaria parasite (MP) were performed for all the women. PCV estimation was also done using the micro-centrifuge method and comparison was made for women with parasitemia with those without MP. Some socio-demographic variables were also analyzed. Chi-square test was used to test for significance and a P-value less than 0.05 was considered statistically significant. Two hundred and twenty-five healthy pregnant women were studied. Seven women (3.1%) had MP by direct microscopy while 11 (4.8%) were MP positive with the qualitative immunoassay test. One hundred and eighty-five (82%) of the women were literate while 128 (57%) used insecticide treated mosquito nets in their homes. The mean PCV of the women with positive MP was 30.57 ± 2.26 as against 32.89 ± 2.45 for those without parasitemia (P < 0.05). The prevalence of asymptomatic malaria parasitemia in the study group was low but there was associated anemia in those with parasitemia. The use of intermittent preventive treatment is recommended for all pregnant women including those who are asymptomatic to forestall complications like maternal anemia.

The effect of free distribution of insecticide-treated nets on asymptomatic Plasmodium parasitemia in pregnant and nursing mothers in a rural Nigerian community

Malaria is a major public health problem in Nigeria, with adverse outcomes on the poor, pregnant women and children living in rural communities. A major component of current intervention in roll back malaria (RBM) initiative is vector control and insecticide-treated nets (ITNs). This research studied the impact of free distribution of ITNs on malaria parasitemia in a rural community in Nigeria. This is a longitudinal survey involving 990 pregnant and nursing mothers who received free ITNs between February 2007 and September 2008. Blood samples were collected at contact, then every 2 months to check for malaria parasites using standard methods. There was a sustained but insignificant rise in asymptomatic malaria parasitemia post-distribution of ITNs. We conclude that ITN intervention remains important in malaria prophylaxis but must be complemented with awareness campaigns and other vector control strategies.

Iron and Malaria: Absorption, Efficacy and Safety

Febrile malaria and asymptomatic malaria parasitemia substantially decrease iron absorption in single-meal, stable isotope studies in women and children, but to date there is no evidence of decreased efficacy of iron-fortified foods in malaria-endemic regions. Without inadequate malarial surveillance or health care, giving iron supplements to children in areas of high transmission could increase morbidity and mortality. The most likely explanation is the appearance of non-transferrin-bound iron (NTBI) in the plasma. NTBI forms when the rate of iron influx into the plasma exceeds the rate of iron binding to transferrin. Two studies in women have reported substantially increased NTBI with the ingestion of iron supplements. Our studies confirm this, but found no significant increase in NTBI on consumption of iron-fortified food. It seems likely that the malarial parasite in hepatocytes can utilize NTBI, but it cannot do so in infected erythrocytes. NTBI however may increase the sequestration of parasite-infected erythrocytes in capillaries. Bacteremia is common in children with severe malaria and sequestration in villi capillaries could lead to a breaching of the intestinal barrier, allowing the passage of pathogenic bacteria into the systemic circulation. This is especially important as frequent high iron doses increase the number of pathogens in the intestine at the expense of the barrier bacteria.

A study of anemia in women with asymptomatic malaria parasitaemia at their first antenatal care visit at the General Hospital, Ikot Ekpene, Akwa Ibom State, Nigeria

Objective To assess the prevalence of anemia and asymptomatia malaria parasitemia and the effect of prior antimalarials therapy on the parasite density in pregnant women at their first antenatal visit at the secondary level health care facility in Nigeria. Methods This cross sectional observational study was carried out in the antenatal clinic of General Hospital, Ikot Ekpene, Akwa Ibom State, Nigeria for 3 months period (1 st June to 31 st August, 2009). Five hundred and fourteen women attending their first antenatal registration visits in the hospital were recruited in the study. Socio-demographic information was obtained using pre-tested questionnaires. The malaria parasite was obtained by examining thick and thin blood films prepared on 2 glass slides while the hematocrit was obtained through 2 capillary tubes read by a Hawksleys microhematocrit reader. Results A total of 514 pregnant women participated in the study with a mean maternal age of 21.4 years and a mean gestational age at booking of 18.3 weeks. The primigravid women booked at significantly lower gestational age than multigravidae (16.2 weeks vs 21.6 weeks). Most of the women (59.3%) were anemic, out of which 60.4% were primigravida. More than half of the women had moderate to high parasite density and only 6.8% had no malaria parasitemia. All patients with severe anemia were parasitemic. Out of the 479 (93.2%) women with parasitemia, a third had taken antimalarial drugs. A majority (60.3%) of those without prior antimalarial drugs had moderate to high density parasitemia. Conclusions This study shows high prevalence of anemia in women with asymptomatic malarial parasitemia, particularly the primigravida. The severity of anemia is directly related to the density of malaria parasitemia. Those with effective antimalarial therapy appear to have low density parasitemia and therefore mild anemia. Routine screening for anemia and malaria parasites at booking, prompt parasite clearance and correction of anemia would reduce the associated maternal and perinatal complications.

Prevalence of anemia in women with asymptomatic malaria parasitemia at first antenatal care visit at the University of Calabar Teaching Hospital, Calabar, Nigeria

Anemia in pregnancy in malaria endemic areas is a public health challenge that has contributed either directly or indirectly to maternal morbidity and mortality in our environment. Anemia and malaria during pregnancy are highly preventable and treatable. The aim of this study is to assess the prevalence of anemia in asymptomatic malaria parasitemic women at first antenatal visit in a tertiary hospital facility. The study was conducted at the antenatal clinic of the University of Calabar Teaching Hospital, Calabar, Nigeria over a three-month period. Five hundred and forty-five pregnant women were recruited after obtaining an informed consent. A structured questionnaire was administered to each participant and two thin and thick blood films were used to identify the malaria parasites and estimate density. The average of two packed cell volumes at booking was determined using two capillary tubes and read from a Hawksleys microhematocrit reader. A total of 545 pregnant women participated in the study. The mean ages of primigravidas and multigravidas were 21.4 ± 3.1 and 24.3 ± 4.0 years. Two hundred and ninety (53.2%) were primigravidas while 255 (46.8%) were multigravidas. The parasite density in primigravidas was 1297 ± 1234 while that for multigravidas was 661 ± 497 (t = 7.7, P < 0.001). The prevalence of anemia in the study population was 59.6%. There was no statistically significant difference in the prevalence of anemia among the primigravidas (60.3%) and the multigravidas (58.8%) (χ(2) = 1.3, P = 0.08). There was a statistically significant association between severity of parasitemia and degree of anemia (χ(2) = 441.1, P < 0.001). There was a statistically significant association between antimalarials use before booking and severity of parasitemia (χ(2) = 36.52, P < 0.001). Anemia at first antenatal booking was significantly associated with malaria parasitemia. Routine screening for anemia and malaria parasites at booking, prompt parasite clearance, use of intermittent preventive treatment (IPT) during pregnancy and correction of anemia can reduce the prevalence of malaria related anemia and obstetric complications associated with it.

Malaria parasitaemia among pregnant women in a rural community of eastern Nigeria; need for combined measures

Malaria in pregnancy is a major contributor to adverse maternal and perinatal outcome. In hyper endemic areas like ours, it is a common cause of anaemia in pregnancy in both immune and non-immune individuals and is aggravated by poor socioeconomic circumstances. The aim of this study is to assess the prevalence of asymptomatic malaria parasitaemia among pregnant women in a rural setting. 272 pregnant women, aged between 18 and 40 years in some remote rural areas of Ebonyi State, Nigeria were recruited between January 2007 and March 2008.Their blood samples were collected and examined for malaria parasite, haemoglobin and packed cell volume using standard methods. Our results showed 59.9% prevalence of parasitaemia with the highest prevalence occurring in the first trimester [84.1%]. Among the positive cases, mild parasitaemia was recorded in 47.2% moderate parasitaemia in 37.4% while severe parasitaemia was recorded in 15.3% of cases. These differences were statistically significant [P<0.016]. Furthermore the distribution of malaria densities in different gravidity groups showed an inverse relationship, 45.4% in primigravidae, [31.9%] in secundigravidae and [10.4%] among people with more than five pregnancies. These findings were statistically significant [P<0.0001]. The prevalence of anaemia in pregnancy in this study was 62.4%. Apart from the use of nets, drugs and vector control, the prevention of malaria in pregnancy in very poor socioeconomic settings should make provision for nutritional support.