Prevention Of Malaria In Pregnancy Research Articles

Determinants of utilization of malaria preventive measures during pregnancy among women aged 15 to 49 years in Kenya: an analysis of the Malaria Indicator Survey 2020

BackgroundMalaria is a significant cause of morbidity and mortality. Malaria infection in pregnancy can have severe consequences for the fetus and the mother. To fight against malaria infection in pregnancy, Kenya integrated the issuance of an insecticide-treated net (ITN) and intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTpSP) with antenatal care (ANC) for pregnant women. However, the uptake of the ITN and IPTpSP is still low. Individual, social, or structural factors may influence the low uptake. It is, therefore, important to identify the determinants associated with the uptake of ITN and IPTpSP during pregnancy in Kenya.MethodsData were from the 2020 Kenya Malaria Indicator Survey (MIS). A total of 1779 women between the ages of 15 to 49 years who had a history of either being pregnant or having given birth within 5 years before the MIS survey were included. Survey-adjusted multinomial logistic regression was used in the analysis.ResultsDuring pregnancy, ITN use was more than half (54.9%). The use of at least one dose of IPTpSP was 43.5%, three or more doses of IPTpSP was 27.2%, and only 28.2% of the participants used both ITN and IPTpSP during pregnancy. The significant determinants of combined use of ITN and IPTpSP during pregnancy were maternal age (RR 3.57, CI 1.80–7.08; p=<0.001), maternal education (RRR 2.84, CI 1.33–6.06; p=0.007), wealth index (RR 2.14, CI 1.19–3.84; p=0.011) and living in the different malaria epidemiological zones: lake endemic (RRR 10.57 CI 5.65–19.76; p=<0.001), coastal endemic area (RRR 4.86 CI 1.86–12.67; p=0.001), seasonal (RRR 0.21 CI 0.10–0.39; p=<0.001) and low risk (RRR 0.07, CI 0.03–0.17; p=<0.001).ConclusionThe uptake of malaria preventive measures is still below 80% for both ITN and IPTpSP during pregnancy in Kenya. The significant results on determinants of the use of ITN and IPTpSP could be considered in implementing malaria prevention programmes during pregnancy. For example, sensitizing the community on the importance of antenatal care visits will provide a platform to teach the importance of malaria prevention in pregnancy. Moreover, the pregnant mothers receive an ITN and IPTpSP during the ANC visit.

Systematic Review of Mixed Studies on Malaria in Pregnancy: Individual, Cultural and Socioeconomic Determinants of Its Treatment and Prevention.

Malaria in pregnancy (MiP) is a global public health problem; its research is predominantly quantitative. The objective was to analyze the individual, cultural and socioeconomic determinants of the treatment and prevention of MiP with a systematic review of mixed studies (search had no date restriction). Reproducibility and evaluation of the methodological quality were guaranteed. 21 studies were included (20 from Africa). The quantitative component included 7816 pregnant women and 483 health workers. The qualitative component included 800 subjects (pregnant women, health workers, family members and community leaders). The main topics were the use and acceptability of WHO strategies to prevent MiP, individual determinants related with knowledge, perceptions, attitudes and behaviors on MiP, and cultural and socioeconomic barriers for its treatment and prevention. The main determinants of MiP were long distance to the clinic, lack of economic resources, low-coverage antenatal care, few health workers in the communities, drug shortages, cultural rules that prevent women's participation in health issues, and misconceptions about MiP. MiP has determinants related to economic conditions, the structure and functioning of the health system, symbolic and cultural aspects, as well as knowledge, beliefs, perceptions and behavior of pregnant women, which prevent optimal access and use of preventive strategies. This study evidences the importance of intersectional, intersectoral, and interdisciplinary work to prevent MiP.

First-trimester use of ACTs for malaria treatment in pregnancy

People who are pregnant are particularly susceptible to the consequences of malaria infection, including maternal anaemia, fetal loss, and low-birthweight neonates.1 Prevention of malaria in pregnancy is crucial, and pregnant people who develop malaria require effective case management.2 WHO currently recommends that pregnant people with malaria in the second and third trimester of pregnancy receive treatment with artemisinin-based combination therapies (ACTs), and available evidence about their safety is reassuring.

Prevention of Malaria in Pregnancy: What Do the Pregnant Women of Nigeria Know and Do about It?

We assessed knowledge, attitude, and practice regarding two malaria prevention measures (long-lasting impregnated mosquito nets, LLINs, and intermittent preventative therapy with sulphadoxine-pyrimethamine (IPTp-SP)) among pregnant women in Nigeria. Pregnant women selected from among the four communities of Nnewi were interviewed by using a semistructured, interviewer-administered questionnaire on the respondents' demography, knowledge of the cause, consequences, and malaria prevention methods. Also, a total of 48 focused group discussions, 24 key informant interviews, and 24 in-depth interviews were held among women leaders, village heads, pregnant women, community health workers, husbands of pregnant wives, and drug and insecticide-treated net sellers. A total of 384 women (88.0% third trimester, 90.0% literate, and 41.1% primigravidae) participated. About 80.0% suffered from malaria during their current pregnancy. The majority was aware of the cause of malaria, local name of malaria, mode of transmission, risk of malaria among pregnant women, etc. However, their knowledge and attitude were inadequate regarding the symptomatology and complications of malaria in pregnancy, benefits of sleeping under the net or taking chemoprophylactic doses, or the concurrent use of both. About 80.0% had LLINs, yet only 41.5% slept under it the previous night. Only 31.0% had IPTp-SP doses under direct observation. Only 35.9% had a good understanding of IPTp-SP during pregnancy. Our work presents important practice gaps associated with the prevention of malaria during pregnancy. The pregnant women seemed to be aware of the basic concepts related to malaria but that does not translate into adequate attitude and practice necessary for malaria reduction.

DETERMINATES OF UPTAKE OF INTERMITTENT ANTI-MALARIA DRUGS AMONG WOMEN ATTENDING ANTE-NATAL CLINIC AT CHUKWUEMEKA ODUMEGWU OJUKWU UNIVERSITY TEACHING HOSPITAL, AWKA, ANAMBRA STATE

Malaria is a major public health that passes a huge threat to the world at large. The general public is at risk of malaria infection; however, pregnant women are at greater risk than others. This is because malaria in pregnancy is a threat to both mother and child. Malaria in pregnancy accounts for high rate of mortality of both mothers and neonates. As such, there is need to curb, if possible, eliminate malaria in pregnancy. To this effect, intermittent preventive treatment was introduced in the healthcare system. This treatment regime involves pregnant women being treated for malaria with sulphadoxine-pyrimethamine, not minding if they have the ailment or not. The study’s participants involved expectant mothers using the antenatal clinic at Chukwuemeka Odumegwu Ojukwu University Teaching Hospital, Amaku, Awka, Anambra state. A standard questionnaire was used to obtain information from the participants, who were mostly between the ages 20 and above. The variables were reported using descriptive statistics namely Chi-square test, mean and standard deviation with a significance of p&gt;0.05 and 95% confidence range. From the result, it was shown that respondents who did not take ITP drugs for malaria had greater prevalence of malaria in pregnancy than their colleagues who did. Out of the 523 women, 127 (24.3%) reported to have taken at least one dose of IPTp-SP, 209 (38.0%) all three doses and 53 (10.1%) double doses. Of the 171 (32.7%) who did not receive IPTp, reasons were due to medical complications and allergic reactions. Uptake of ITPp is a means of achieving zero mortality in pregnancy from malaria. As such, expectant mothers are advised to take the doses, which can only be done during visits to the antenatal clinics. This can only be possible with increased number of visits to the antenatal clinics. Therefore, expectant mothers are advised to be faithful and regular in their visits to the antenatal clinics and also to make use of clinics with adequate facilities, so, they can have access to ITPp. Keywords: Intermittent Anti-Malaria Drugs; Ante-Natal Clinic; Chukwuemeka Odumegwu Ojukwu University Teaching Hospital DOI: 10.7176/JHMN/104-06 Publication date: November 30 th 2022

A comparison of peripheral blood smear microscopy and detection of histidine-rich protein 2 in blood in the diagnosis of malaria in pregnancy.

Detection of malaria in pregnancy poses a huge challenge in Sub-Saharan Africa. Accurate diagnosis enables timely and appropriate clinical management. This study aimed to compare the accuracy of peripheral venous blood smear microscopy (PVBSM) and a rapid diagnostic test detecting histidine-rich protein 2 in the blood (RDT-HRP2) with placental histology as the control in the diagnosis of malaria in pregnancy in Nigerian women. This was a comparative, cross-sectional study conducted between January and July 2017. Asymptomatic pregnant women who presented to the labor ward and who gave informed consent had peripheral venous blood samples as well as placental tissue obtained following delivery. The blood samples obtained were tested for malaria parasites using PVBSM and RDT-HRP2 in blood, while the placenta was subjected to histology. A total of 326 patients participated in the study. The prevalence of malaria in pregnancy was 13.8%, 17.8%, and 32.8% using PVBSM, RDT-HRP2, and placental histology. The sensitivity, specificity, and accuracy of PVBSM were 40.2%, 99.1%, and 79.8% and the corresponding values for RDT-HRP2 were 49.5%, 97.7%, and 81.9%. The positive predictive value was 95.6% for PVBSM and 91.4% for RDT-HRP2 and the negative predictive value was 77.2% for PVBSM and 79.9% for RDT- HRP2. The diagnostic performances of both tests were comparable; however, RDT-HRP2 had a higher sensitivity and accuracy than PVBSM for the diagnosis of malaria in pregnancy.

Prevention of malaria in pregnancy: The threat of sulfadoxine-pyrimethamine resistance.

Malaria infection in pregnancy can lead to adverse outcomes for both the pregnant person and fetus. The administration of intermittent preventative therapy (IPTp) with sulfadoxine-pyrimethamine (SP) during pregnancy (IPTp-SP) improves outcomes, including severe maternal anemia, placental malaria infection, and low infant birth weight. The WHO recommends IPTp-SP for pregnant individuals living in areas of moderate or high malaria transmission in Africa. The current regimen consists of two or more doses of SP starting as early as possible in the second trimester, at least 1 month apart. Unfortunately, rising Plasmodium falciparum SP resistance throughout Africa threatens to erode the benefits of SP. Recent studies have shown a decrease in IPTp-SP efficacy in areas with high SP resistance. Thus, there is an urgent need to identify new drug regimens that can be used for intermittent preventative therapy in pregnancy. In this review, we discuss recent data on P. falciparum SP resistance in Africa, the effect of resistance on IPTp-SP, and studies of alternative IPTp regimens. Finally, we present a framework for the ideal pharmacokinetic and pharmacodynamic properties for future IPTp regimens.

Prevalence and risk factors of malaria and anaemia and the impact of preventive methods among pregnant women: A case study at the Akatsi South District in Ghana.

AimThis study aimed to ascertain the prevalence and risk factors of malaria and anaemia as well as the impact of preventive methods among pregnant women at the Akatsi South District Hospital of Ghana.Subjects and methodsA hospital based cross-sectional study using simple random sampling technique was conducted among 200 pregnant women receiving antenatal care and laboratory services at the Akatsi District Hospital from May 2016 to July 2016. A semi-structured questionnaire was administered to obtain participants’ malaria preventive methods in addition to demographic and gestational details. Participants’ hemoglobin and malaria status were assessed using one milliliter (1 ml) whole blood collected from each participant following standard procedures. Factors that produced a p-value of ≤0.2 from the univariate model were included in the final model. Association between potential covariates and the outcomes was assessed using multivariate logistic regression. The Clopper-Pearson test statistic was used to determine the 95% confidence intervals of the outcome variables of interest. We also estimated the population attributable fraction (PAF) of anaemia due to malaria by substituting the adjusted relative risk estimates (RRi) (using the adjrr command in STATA) of anaemia due to malaria into the category-specific attributable formula. P-values of <0.05 were considered statistically significant.ResultsPrevalence of anaemia in pregnancy (AiP), malaria in pregnancy (MiP) and AiP/MiP comorbidity was 63.5% (95% CI:56.4–70.2), 11.0% (96% CI:7.0–16.2) and 10.5% (95% CI:6.6–15.6) respectively. Prevalence rates of AiP (66.7%) and MiP (18.5%) predominated among pregnant women aged < 20 years. PAF of AiP due to MiP was 34.5% (95% CI:23.8–43.6). High use of IPTp-SP, 64.0% (95% CI:56.9–70.6) and LLIN, 90.0% (95% CI:85.0–93.8) was observed in this study. Only 42.0% (95% CI:35.1–49.2) used repellent. Not being on the IPTp-SP program posed a 11.70 times risk of MiP (95% CI:2.32–58.96; p = 0.003) compared to pregnant women on the IPTp-SP program. Similarly, not sleeping under LLIN posed an 8.07 times risk of MiP (95% CI:1.98–32.2; p = 0.004) compared to pregnant women who slept under LLIN. Meanwhile, being positive for MiP posed a 12.10 times risk (95% CI:1.35–85.06; p = 0.025) of AiP compared to those negative for malaria whereas failure to attend ANC as scheduled posed 6.34 times risk (95% CI:1.81–22.19; p = 0.004) of AiP among the pregnant women studied.ConclusionThe prevalence of MiP and AiP among pregnant women in the Akatsi South District remains a great concern. High utilization of IPTp-SP and LLIN was observed with a resultant positive effect on malaria prevalence among pregnant women. Improved access to IPTp-SP and LLIN is hence encouraged to help further diminish the risk of malaria infection amongst pregnant women in the District.

Impact of Intermittent Presumptive Treatment for Malaria in Pregnancy on Hospital Birth Outcomes on the Kenyan Coast.

Intermittent preventive treatment (IPTp) for pregnant women with sulfadoxine-pyrimethamine (SP) is widely implemented for the prevention of malaria in pregnancy and adverse birth outcomes. The efficacy of SP is declining, and there are concerns that IPTp may have reduced impact in areas of high resistance. We sought to determine the protection afforded by SP as part of IPTp against adverse birth outcomes in an area with high levels of SP resistance on the Kenyan coast. A secondary analysis of surveillance data on deliveries at the Kilifi County Hospital between 2015 and 2021 was undertaken in an area of low malaria transmission and high parasite mutations associated with SP resistance. A multivariable logistic regression model was developed to estimate the effect of SP doses on the risk of low birthweight (LBW) deliveries and stillbirths. Among 27 786 deliveries, 3 or more doses of IPTp-SP were associated with a 27% reduction in the risk of LBW (adjusted odds ratio [aOR], 0.73; 95% confidence interval [CI], .64-.83; P < .001) compared with no dose. A dose-response association was observed with increasing doses of SP from the second trimester linked to increasing protection against LBW deliveries. Three or more doses of IPTp-SP were also associated with a 21% reduction in stillbirth deliveries (aOR, 0.79; 95% CI, .65-.97; P = .044) compared with women who did not take any dose of IPTp-SP. The continued significant association of SP on LBW deliveries suggests that the intervention may have a non-malaria impact on pregnancy outcomes.

A qualitative assessment of the health systems factors influencing the prevention of malaria in pregnancy using intermittent preventive treatment and insecticide-treated nets in Ghana

BackgroundGhana has adopted and implemented intermittent preventive treatment using sulfadoxine-pyrimethamine (IPTp-SP) and insecticide-treated nets (ITNs) in an antenatal care (ANC) context to prevent malaria among pregnant women. However, the increased ANC attendance and its frequency facilitated by a free maternal health care policy in Ghana does not correspond with the uptake of IPTp-SP and ITN use among pregnant women. This study sought to elucidate the contextual health system factors influencing the delivery of IPTp-SP and ITN from a related quantitative study conducted in Ghana.MethodsThis is the qualitative section of a mixed-methods study design, where audio recorded key informant interviews (KIIs) were conducted with health workers from across health facilities, districts, regional and national health directorates. The KIIs elicited information on health worker knowledge, perceptions, and rationale for the delivery practices of IPTp-SP and ITN revealed in the quantitative findings. The interviews were transcribed and imported into NVivo for analysis. Using the World Health Organization (WHO) Health Systems Framework as the theoretical basis, thematic analysis was conducted under broad themes of the building blocks. Findings are presented in narrative quotes, with a mindmap used to summarize the various health system factors and their interrelated relationship influencing the delivery of IPTp-SP and ITN.ResultsHealth system factors identified included health staff untrained on malaria delivery directives due to an ineffective trainer of trainer (ToT) system. Additionally, health worker confusion on when to commence SP (at quickening or ≥ 16 weeks) was found to result in delayed start of SP. Stock-outs in facilities due to procurement delays at the national level resulted in missed opportunities to deliver SP to eligible pregnant women at the ANC. Similarly, ITN stock outs led to eligible pregnant women not receiving one at ANC clinics.ConclusionPoor health worker knowledge on policy directives, a consequence of ineffective training strategy led to delayed delivery of IPTp-SP to eligible pregnant women. Supply chain management challenges related to stock of SP and ITN resulted in missed opportunities to deliver the interventions to pregnant women attending ANC.

Impact of malaria prophylaxis on Plasmodium Parasitemia among pregnant women receiving care at Federal Medical Centre, Owerri

Background: Malaria during pregnancy harms the baby's health. As personal protection and chemoprevention therapy, insecticide-treated nets (ITN) and intermittent preventive treatment (IPTps) of malaria during pregnancy are recommended. According to the World Health Organization, the introduction of IPTp and ITN constituted a defining moment in malaria prevention in endemic areas during pregnancy. The purpose of this research was to see if there was an association between the usage of IPTp and ITNs and maternal malaria prophylaxis. Methods: A cross-sectional study was conducted on 327 pregnant women who presented at the federal medical center in Owerri. Participants' blood samples were taken for microscopic inspection to detect malaria parasites using established procedures. Pregnant women provided information on their use of IPTp and ITN. Descriptive statistics were used to characterize the independent variables, and chi-square was used for categorical variables as needed using Microsoft Excel 2016. Results: There was a significant association between IPTp use in the prevention of malaria in pregnancy (P-Value = &lt;0.001) and ITN use in the prevention of malaria in pregnancy respectively (P-Value = &lt;0.001). Conclusions: Maternal Malaria is a major public health issue that poses severe danger to pregnant women and their fetuses. IPTp and ITN use are beneficial in malaria prevention among this population.

Community Malaria Knowledge, Experiences, Perceived Roles, and Acceptability of Community-Directed Distribution of Intermittent Preventive Therapy for Pregnancy in Rural Southeast Nigeria.

Background The community plays key roles in protecting pregnant women in rural areas from malaria. This study assessed malaria experiences, knowledge, perceived roles in malaria prevention in pregnancy, and acceptability of community-directed distribution of intermittent preventive therapy (IPTp) for malaria in pregnancy in rural Southeast Nigeria. Methods This study presents part of the baseline findings of a before-and-after study. Data was collected from 817 community members in Ebonyi State using interviewer-administered questionnaires and focus group discussions (FGDs). Data were analyzed using SPSS version 20 and thematic analysis. Results The majority of the respondents were females (73.8%) with a mean age of 36.08 ± 15.4. Most respondents (65.2%) had Insecticide-Treated Net (ITN) and fever in the past year (67.1%). Malaria (88.6%) was identified as the major health condition in the community. Majority (74.1%) knew infected mosquito bites as the cause of malaria while 61.1% and 71.5% were definitely sure that pregnant women and children were at risk for malaria. Sleeping under ITN (54.3%), clean environment (39.7%), and herbal medications (26.8%) were the main ways of malaria prevention cited. Only 18.4% of the participants rated their knowledge of IPTp as adequate, and only 9.3% knew the common drug names used for IPTp. The major perceived roles in malaria prevention in pregnancy were referral of pregnant women to the health facility, encouragement of household ITN use, and sustaining malaria-related projects. The majority of the participants (60.6%) strongly agreed that community-directed distribution of IPTp-SP will improve the prevention of malaria in pregnancy. Most (77.2%) considered community-directed distribution of IPTp acceptable, and 74.4% of the pregnant respondents preferred community to facility administration of IPTp. Conclusions Malaria was recognized as a prevalent disease, but there was inadequate knowledge of malaria prevention in pregnancy notably intermittent preventive therapy. There was positive perception of roles in malaria prevention in pregnancy and high acceptability of community-directed distribution of IPTp. Community-level malaria control programs should utilize a whole-of–community approach to optimally engage and educate the community on malaria prevention in pregnancy as well as explore community distribution approach for IPTp.

Effect of In-Service Training Program on the Practice of Healthcare Workers toward Malaria Prevention and Treatment Guidelines during Pregnancy in Health Facilities in Jowhar District, Somalia

Malaria is generally considered a major public health problem in Somalia. Providing early diagnosis and effective treatment is the key element of malaria control strategies in malaria-endemic countries, including Somalia. This required to advocate and ensure health worker’s adherence to the national malaria guidelines at all levels of health care service. A well-designed in-service training program may improve the level of health worker’s adherence to national malaria treatment guidelines, although results have been inconsistent. This is an interventional health facility-based pre and post comparative study aimed to assess the effect of an in-service training program on the practice of healthcare workers toward malaria prevention and treatment guidelines, during in pregnancy in health facilities in Jowhar district, Middle Shabelle region of Somalia. The study was implemented in three phases: pre-intervention phase, intervention phase and post-intervention phase. The sample size consisted of (n = 150) health workers who were selected from ten public health facilities using proportionate stratified sampling; the data collection adopted in this research is composed of a structured interview questionnaire and observational checklist. Data was analyzed through the application of descriptive statistical analysis that includes frequency and percentage and the Chi-square (x2) test was used to test the associations among variables using SPSS software version 25. The study showed that the level of health workers’ awareness of the national malaria guidelines in the treatment and prevention of malaria in pregnancy was found to be good before the intervention 89 (59.3%) and this proportion increased to 150 (100%) post-intervention of the training program. A significance difference has been observed between health workers’ awareness and their adherence to the malarial guidelines at pre-test and post-test with a p-value = 0.000. The proportion of health workers who attended previous training on national malaria guidelines in the treatment and prevention of malaria in pregnancy increased from 46 (30.7%) at the pre-test to 150 (100%) after the post-test. A significant difference was observed in the training status among different categories of health worker and their adherence to the guidelines during the pre- and post-intervention of the training program, with a p-value of 0.000. The result showed that health workers were adhering to the guidelines at the pre-test 33 (22%), this increased after the post-test to 87 (58%). The knowledge of the need to adhere led to an increase in the adherence rate after the training program intervention. The study reveals that inadequate awareness was most reason for the non-adherence in the majority of the health workers as indicated by 89 (59.3%) at the pre-test and 56 (37.3%) in the post-test. However, difference was not significant between the availability of anti-malaria drugs in the facilities and the health workers’ adherence to the guidelines p-value = 0.355 at the pretest and p-value = 0.258 at post-test. The study concluded that the in-service training program significantly improved health workers’ knowledge and practice to the national malaria guidelines in the treatment, and prevention of malaria in pregnancy. The researcher recommends that the national malaria control programme (NMCP) of the Federal Ministry of Health should provide continuous regular in-service training to frontline healthcare workers at (facility and Community-based) to upgrade their skills and knowledge towards the malaria guidelines, disseminate job aids to the health facilities and undertake regular monitoring to ensure effective implementation of the national malaria treatment guidelines in the treatment and prevention of malaria in pregnancy in achieving desired proper case-management practices of malaria in pregnancy at all levels of health care service.

Factors Affecting Adherence to National Malaria Treatment Guidelines in the Diagnosis, Treatment and Prevention of Malaria in Pregnancy among Healthcare Workers in Public Health Facilities in Jowhar District, Somalia

Introduction: Early diagnosis and effective treatment remain critical elements of a malaria control strategy in preventing mortality and reducing the incidence of severe malaria illness in Somalia. In Sub-Saharan African countries showed different levels of adherence to their national malaria guidelines for malaria treatment and prevention in pregnancy, while experiences from many countries indicated several challenges and constraints that may make the implementation of the guidelines difficult. Objective: The study aimed to assess factors affecting adherence to revised national malaria treatment guidelines in the diagnosis, treatment and prevention of malaria in pregnancy among health care workers in public health facilities in Jowhar District, Somalia. Methodology: A cross-sectional health facility-based study conducted in Jowhar district. A structured interview questionnaire was used for data collection from (n = 150). Healthcare workers selected from ten health facilities using proportionate stratified sampling technique and an observational checklist was used to assess patient’s medical prescriptions to review their conformity to the guideline and the availability of antimalarial, malaria diagnostic tests (mRDTs and microscopy) and job aids, such as the national malaria treatment guideline, clinical algorithm (flow chart), malaria rapid diagnosis tests mRDTs’ use of wall charts, and drug dose wall charts at the facilities. Data was analyzed through the application of descriptive statistical analysis that includes frequency, and percentages by using Statistical Package for Social Sciences (SPSS) Version 25. Results: Healthcare workers interviewed were 89 (59.3%) aware of the existence of the revised malaria treatment guidelines. However, 61 (40.7%) were not aware of the guidelines and only 46 (30.7%) had been trained for the guidelines. Overall, 33 (22%) of the workers reported to adhere to guidelines, with 117 (78.0%) reported non-adherence. A statistically significance was observed between training and health worker’s adherence to national malaria guideline with (p-value of 0.022). Conclusion and Recommendation: In conclusion, the study showed that adherence to the national malaria guidelines for Malaria diagnosis, treatment and prevention in pregnancy among health care workers are associated with inadequate awareness of the revised national malaria guideline, inadequate supply of diagnostic tests (mRDTs and microscopy) and lack of access to revised national guidelines for malaria diagnosis and treatment 2016, a lack of regular supervision and monitoring and lack of in-service training respectively. The national malaria control program should intensify efforts to strengthen the readiness of the public health facilities in the district to handle malaria in pregnancy cases, diagnosis, treatment and prevention, improve the availability of antimalarial drugs and malaria diagnostic tests (mRDTs and microscopy), job aids and undertake regular monitoring and on job training to ensure the proper use of the guideline at all levels of health care service delivery points across the country.

Prevalence of Malaria among Pregnant Women in Nigeria: A Scope Review of Literature

Background: Malaria in pregnancy remains a major contributor to maternal and infant morbidity and mortality despite scale up in interventions. Its prevention is one of the major interventions in reducing maternal and infant morbidity and mortality. It is known to cause higher rates of miscarriage, intrauterine death, premature delivery, low birth-weight babies, and neonatal deaths. Since pregnant women are most vulnerable to malaria, implementation of the appropriate prevention and control measures among this group is very important. Therefore, the current review was designed to assess the prevalence of malaria among pregnant women in Nigeria. Method: A systematic analysis of recent literature on the prevalence of malaria in pregnancy was carried out and the evidence synthesized. The databases used were Google Scholar, MEDLINE and PubMed. Search terms used were “prevalence”, “malaria”, “pregnant women”, and “Nigeria”. Studies included were cross sectional studies published in different journals on the prevalence of malaria among pregnant women. The total population from the various studies analyzed was two thousand, eight hundred and sixty-six pregnant women between 15 and 45 years. All the women reside in rural and semi-urban areas in Nigeria. Findings: Among the six studies included in this analysis, the estimated pooled prevalence of malaria among pregnant women in Nigeria was 22% in North-Central, 41% in South-East, 26% in South-South, 4.3% in South-West, 41.6% in North-West and 36.74% in North-East. Conclusion: The current review showed that the pooled prevalence of malaria among pregnant women was relatively higher when compared with the prevalence of malaria in the general population. Therefore, the existing prevention and control measures should be strengthened; interventions on malaria prevention and control should focus on behavior change communication

Safety and efficacy of intermittent presumptive treatment with sulfadoxine-pyrimethamine using rapid diagnostic test screening and treatment with dihydroartemisinin-piperaquine at the first antenatal care visit (IPTp-SP+): study protocol for a randomized controlled trial

BackgroundIntermittent preventive treatment in pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) is recommended by the World Health Organization for the prevention of malaria in pregnancy (MIP)-associated adverse outcomes in high burden areas. However, the efficacy of IPTp-SP has decreased in step with increasing parasite drug resistance. Suitable alternative strategies are needed.MethodsThis is a protocol for a phase IIIb open-label, two-armed randomized controlled superiority trial to assess the safety and efficacy of a hybrid approach to IPTp combining screening and treatment with dihydroartemisinin-piperaquine (DP) to the current IPTp-SP regimen at the first antenatal care clinic visit. Pregnant women without HIV infection and without signs or symptoms of malaria will be randomized to either standard IPTp-SP or hybrid IPTp-SP plus screening and treatment (IPTp-SP+). In the IPTp-SP+ arm, participants who screen positive by rapid diagnostic test for P. falciparum will be treated with DP at the first antenatal visit while those who screen negative will receive SP per current guidelines. All participants will be administered SP on days 35 and 63 and will be actively followed biweekly up to day 63 and then monthly until delivery. Infants will be followed until 1 year after delivery. The primary endpoint is incident PCR-confirmed MIP at day 42. Secondary endpoints include incident MIP at other time points, placental malaria, congenital malaria, hemoglobin trends, birth outcomes, and incidence of adverse events in infants up to the first birthday.DiscussionA hybrid approach to IPTp that combines screening and treatment with an artemisinin-based combination therapy at the first visit with standard IPTp-SP is hypothesized to confer added benefit over IPTp-SP alone in a high malaria transmission area with prevalent SP resistant parasites.Trial registrationPan African Clinical Trials Registry 201905721140808. Registered retrospectively on 11 May 2019

INTRIGUING PREDICTORS ASSOCIATED WITH MALARIA INFECTION AMONG PREGNANT WOMEN IN MT. ELGON SUB COUNTY, KENYA

Introduction: Universally, malaria continues to ravage the lives of innocent expectant women. In Kenya malaria prevalence among adult females is 28% while in Mt. Elgon Sub County, which is categorised under highland epidemic prone malaria area, prevalence of malaria in pregnancy (MiP) is uncertain. Therefore, this study sought to determine intriguing predictors associated with malaria infection among pregnant women in Mt. Elgon Sub-County.&#x0D; Methods: Cross-sectional analytical design was employed and mixed methods used for data collection. For quantitative data collection, semi-structured questionnaire was used to collect primary data from pregnant women who attended ANC in selected health facilities in the study area. Further, qualitative approach adopted interview guides that targeted key informants in the health facilities. Systematic random sampling method was used to select 392 participants for the study. Data was analysed by SPSS version 25.0. Bivariate logistic regression analysis was used to test the association between independent variable and dependent variable.&#x0D; Findings: Study results revealed that, the prevalence of MiP was 16.2%. Prevalence was higher among women aged less than 25 (67.3%, n=262) compared to those aged &gt; 25 years (33.7%, n=137). The following five factors were statistically significantly associated with malaria prevalence in pregnancy: place of residence (OR: 5.7; 95%CI: 2.6 – 12.4; p &lt; 0.0001); those who tested positive in the last 2 years (OR: 1.7; 95%CI: 1.0 – 2.9; p = 0.05); preferred shape of ITN’s (OR: 3.8; 95%CI: 1.5 – 9.7; p = 0.008);earth floor (OR: 1.8; 95%CI: 1.0 – 3.1; p = 0.03); mud wall (OR: 1.8; 95%CI: 1.0 – 3.1; p = 0.03). In conclusion, age group, place of residence, testing positive in the last 2 years, preferred shape of ITN, earth floor and mud wall were significant factors associated with MiP.&#x0D; Recommendations: To curb MiP, the study recommends Bungoma County government to promote use of ITNs and preferable rectangular ITN’s by ensuring they are translated to appropriate use; support regular indoor residual spraying with insecticides and educate the residents on the role of improved housing on malaria protection and empowerment of the community to adopt improved housing.

An ethnographic study of how health system, socio-cultural and individual factors influence uptake of intermittent preventive treatment of malaria in pregnancy with sulfadoxine-pyrimethamine in a Ghanaian context.

Intermittent preventive treatment of malaria among pregnant women with sulfadoxine-pyrimethamine (IPTp-SP), is one of the three recommended interventions for the prevention of malaria in pregnancy (MiP) in sub-Sahara Africa. The World Health Organisation recommended in 2012 that SP be given at each scheduled ANC visit except during the first trimester and can be given a dose every month until the time of delivery, to ensure that a high proportion of women receive at least three doses of SP during pregnancy. Despite implementation of this policy, Ghana did not attain the target of 100% access to IPTp-SP by 2015. Additionally, negative outcomes of malaria infection in pregnancy are still recurring. This ethnographic study explored how health system, individual and socio-cultural factors influence IPTp-SP uptake in two Ghanaian regions. The study design was ethnographic, employing non-participant observation, case studies and in depth interviews in 8 health facilities and 8 communities, from April 2018 to March 2019, in two Ghanaian regions. Recommended ethical procedures were observed. Health system factors such as organization of antenatal care (ANC) services and strategies employed by health workers to administer SP contributed to initial uptake. Women's trust in the health care system contributed to continued uptake. Inadequate information provided to women accessing ANC, stock-outs and fees charged for ANC services reduced access to IPTp-SP. Socio-cultural factor such as encouragement from social networks influenced utilization of ANC services and IPTp-SP uptake. Individual factors such as refusing to take SP, skipping ANC appointments and initiating ANC attendance late affected uptake. Health system, socio-cultural and individual factors influence uptake of optimum doses of IPTp-SP. Consequently, interventions that aim at addressing IPTp-SP uptake should focus on regular and sufficient supply of SP to health facilities, effective implementation of free ANC, provision of appropriate and adequate information to women and community outreach programmes to encourage early and regular ANC visits.

Prevalence of pregnant women with malaria in Aceh, symptoms and fetomaternal outcome

WHO estimates that as many as 300 to 500 million people are infected with malaria each year. There are around 3 million severe malaria cases (complicated malaria) and deaths due to malaria. Other sources revealed that as many as 1.5 million to 2.7 million people die every year, especially children and pregnant women. Malaria is a disease that is emerging and continues to affect the people of Aceh. Malaria in pregnancy is a serious problem considering its effects on the mother and fetus, which can increase maternal and neonatal mortality rates if not treated quickly and accurately. Prevention of malaria in pregnancy can be started early through ANC visits by providing health education about malaria prevention and prophylactic treatment for those living in endemic areas. The purpose of this review is to discuss the classification of the Aceh Province according to the level of susceptibility to malaria was based on the API value criteria, to discuss prompt treatment of malaria will improve maternal and fetal outcomes.

Patterns OF Prevention OF Malaria in Pregnancy Among Pregnant Women at Selected Antenatal Care Facilities, Ilishan-Remo, Ogun State, Nigeria

Malaria in pregnancy is a preventable infectious disease, yet it remains the cause of maternal, in-utero morbidity and mortality. Pregnant women adopt different patterns of prevention against malaria occurrences and complications. This study aims to identify patterns of malaria prevention among pregnant women inIlishan Remo, Ogun State. In a descriptive cross-sectional study, a purposive sampling technique was used to proportionately select 271 pregnant women attending Ante-natal care (ANC) facilities. A self-administered questionnaire was used to obtained information on 56 items. Data were collected on clinic days for eight weeks duration and analyzed with SPSS 23 (for descriptive frequencies and percentages) and hypotheses tested with chi-square at p ≤ 0.005. One-third (35.4%) of the pregnant women aged 31-35years. Predominantly, 80.8% of the women were Christians, almost half (49.1%) had tertiary education. The mean of preventive measures used by pregnant women was 27.16±0.25. Slightly half (52.4%) always net windows and doors, 38.4% always and 53.4% often cleared bushes around house respectively. About 30.3% of pregnant women often used IPT-SP and 19.9% used direct observation therapy (DOT). On the categorized prevention patterns, half (54.2%) used conventional and 6.64% non-conventional. There was a significant relationship between the patterns of prevention and ANC facilities (χ2 =20.291), beliefs (χ2 = 16.540) at p&lt; 0.005. The patterns of conventional and non-conventional prevention were used by pregnant women. However, pregnant women should be advised to use the recommended FMOH/WHO standard malaria prevention for safety.