Prevention Of Malaria In Pregnancy Research Articles

WHO antenatal care policy and prevention of malaria in pregnancy in sub-Saharan Africa

BackgroundThe WHO 2016 antenatal care (ANC) policy recommends at least eight antenatal contacts during pregnancy. This study assessed ANC8 uptake following policy implementation and explored the relationship between ANC attendance and intermittent preventive treatment in pregnancy (IPTp) coverage in sub-Saharan Africa following the rollout of the World Health Organization (WHO) 2016 ANC policy, specifically, to assess differences in IPTp uptake between women attending eight versus four ANC contacts.MethodsA secondary analysis of data from 20 sub-Saharan African countries with available Demographic Health and Malaria Indicator surveys from 2018 to 2023 was performed. The key variables were the number of ANC contacts and IPTp doses received during a participant's last completed pregnancy in the past two years. Pooled crude and multivariable logistic regression models were used to explore factors associated with attendance of at least four or eight ANC contacts as well as receipt of at least three doses of IPTp during pregnancy.ResultsOverall, only a small proportion of women (median = 3.9%) completed eight or more ANC contacts (ANC8 +). Factors significantly associated with increased odds of ANC8 + included early ANC attendance (AOR: 4.61: 95% CI 4.30—4.95), literacy (AOR: 1.20; 95% CI 1.11—1.29), and higher wealth quintile (AOR: 3.03; 95% CI 2.67—3.44). The pooled estimate across all countries showed a very slight increase in the odds of IPTp3 + among women with eight (AOR: 1.06; 95% CI 1.00—1.12) compared to those with four contacts. In all but two countries, having eight instead of four ANC contacts did not confer significantly greater odds of receiving three or more doses of IPTp (IPTp3 +), except in Ghana (AOR: 1.67; 95% CI 1.38—2.04) and Liberia (AOR: 1.43; 95% CI 1.18—1.72).ConclusionEight years after the WHO ANC policy recommendation, all countries still had sub-optimal ANC8 + coverage rates. This paper is a call to action to actualize the vision of the WHO and the global malaria community of a malaria free world. Policies to improve ANC and IPTp coverage should be operationalized with clear actionable guidance and local ownership. Study findings can be used to inform multi-level policy, programmatic, and research recommendations to optimize ANC attendance and malaria in pregnancy prevention, thus improving maternal and child health outcomes, including the reduction of malaria in pregnancy.

Prevalence and risk factors of malaria among pregnant women presenting at the antenatal clinic in Hoima Regional Referral Hospital

Malaria, according to the World Health Organization (WHO), is a life-threatening disease caused by parasites that are transmitted to people through the bites of infected female Anopheles mosquitoes. Malaria infection during pregnancy is a significant public health problem with substantial risks for the pregnant woman, her fetus, and the newborn child. In Uganda, the overall burden of malaria is high, and its adverse outcomes for the infected mother and the unborn child are widespread. This study was designed to assess the prevalence of malaria in pregnancy and its associated factors among pregnant women presenting at the antenatal clinic in Hoima Regional Referral Hospital. A hospital-based cross-sectional study was conducted. The study was conducted in the antenatal clinic of Hoima Regional Referral Hospital, in the Hoima district of Western Uganda from from February 2022 to April 2022. A sample size of 204 was used. Data was coded and entered into IBM SPSS version 25. Data was then analyzed and the Chi-square test and logistic regression were done to find the associated factors of malaria in pregnancy at a 95% confidence interval. Results shows that the prevalence of malaria in pregnant women attending Hoima Regional Referral Hospital was 17.6%. This study showed that pregnant women remain particularly vulnerable to malaria and that the prevalence of malaria in pregnant women attending Hoima Regional Referral Hospital is high. Therefore, seminars and media education programmes should be started or put in place to educate women on the risk of malaria during pregnancy. Girl child education should be promoted by the government, as educated women are associated with a lower of malaria during pregnancy. Keywords: Malaria, Anopheles mosquitoes, Plasmodium falciparum, Pregnant women

Prevalence, Associated Factors and Treatment Outcomes of Laboratory-confirmed Pregnancy Malaria at Antenatal Care in Three Healthcare Facilities of Douala, Cameroon

Pregnancy malaria is a life-threatening condition to the mother, the fetus and the newborn. Since the implementation of the World Health Organization’s recommendations of specific malaria control strategies to pregnant women in malaria endemic countries, evaluation studies are needed to assess the prevalence of malaria in pregnancy. This cross-sectional prospective study was therefore set to determine the prevalence and associated factors as well as the treatment outcomes of Plasmodium infection among pregnant women attending antenatal care in three hospitals of Douala in Cameroon.
 Each volunteered pregnant woman received for antenatal care was questioned according to the study questionnaire to collect sociodemographic data, use of malaria prevention tools and pregnancy history. Then a laboratory test was carried for Plasmodium detection in the peripheral blood using microscopy and a HRP2-based rapid diagnostic test. Plasmodium carrying pregnant women were treated according to the national malaria program scheme followed by post-treatment follow-up. Data were processed and analyzed using SPSS.20 software. Association of Plasmodium infection with risk factors was analyzed as univariate using Pearson Chi-square and Fisher Exact tests considering a P-value < 0.05 as statistically significant.
 A total of 487 pregnant women aged between 18 years and 42 years were included in the study. The prevalence of Plasmodium infection was 3.5% and 4.3% by malaria rapid diagnostic test and microscopy respectively. Only Plasmodium falciparum asexual stage was detected. Parasite loads were low. Factors associated with Plasmodium falciparum higher prevalence were being less than 21 years old (0.02), not sleeping under mosquitoe net daily (p=0.04) and having fever during the pregnancy (p=0.04). Parenteral treatment with either artesunate, artemether or quinine sulfate showed good efficacy.
 Conclusion: Pregnant women attending the antenatal cares harbored low Plasmodium infection prevalence and loads. Being of young age, not sleeping under mosquitoe bednet daily and having fever during the pregnancy were predictive Plasmodium falciparum. Plasmodium infected pregnant women were successfully treated with antimalarial medications recommended by the national Ministry of Public Health. The authors recommend increasing efforts by health authorities to strengthen malaria prevention in pregnant women through more adherence to sleeping under ITNs daily and taking IPT-sp as well as systematic detection of Plasmodium infection at each antenatal visit.

Predictors of placental malaria in HIV-positive and HIV- negative pregnant women in Enugu, South-Eastern Nigeria

Background: Placental malaria has long been recognized as a complication of malaria in pregnancy with serious adverse outcome. Recognition of possible predictors is an effort in the right direction. Aim of the study: The study determined and compared the Predictors of placental malaria in HIV-positive and HIV- negative pregnant women attending antenatal clinics in Poly General Hospital, South-Eastern Nigeria. Material and method: A cross-sectional descriptive study, carried out on 200 HIV positive and 200 HIV negative pregnant women attending antenatal clinics in Poly General Hospital, Enugu, selected using simple random sampling technique between May to December 2023. Placenta blood samples were collected and thick blood films were examined for malaria parasite using Giemsa expert microscopy. A structured self-administered questionnaire was used for data collection and the data analysed using SPSS version 23. Results: The prevalence of malaria in HIV positive and negative pregnant women were 83.5% (167/200) and 75.5%(151/200) respectively (P < 0.001). The HIV positive and HIV negative participants were between 16-45 years of age with majority in the age range of 31-35 years. Mean gestational age of HIV positive and HIV negative participants were 24.3±1.1 and 24.4±1.3 weeks respectively. Placental malaria was significantly associated with rural residence, hemoglobin genotype AA, not receiving intermittent preventive treatment in pregnancy (IPTp), and not sleeping under insecticide-treated bed nets (ITN) ((P<0.001)). Conclusion: The study showed that Placental malaria was significantly associated with rural residence, hemoglobin genotype AA, not receiving intermittent preventive treatment in pregnancy (IPTp), and not sleeping under insecticide-treated bed nets (ITN). Recognition of these significant predictors will enhance review and implementation of strategies for the prevention of malaria in pregnancy.

Evaluating the use of intermittent preventive malaria treatment among pregnant women in a health facility in Ghana

Background/Aims Malaria in pregnancy increases the risk of severe maternal anaemia, low birth weight and death. Sulphadoxine pyrimethamine is used to prevent malaria in pregnancy and improve maternal haemoglobin and infant birth weight. This study investigated the use of sulphadoxine pyrimethamine in the prevention of malaria in pregnancy using directly observed therapy in a sub-Metro hospital in Ghana. Methods This quantitative study involved 400 mothers who gave birth at the hospital between 1 August and 31 October 2019. Those who consented to participate were purposively and randomly sampled. A structured questionnaire, as well as a chart review of maternal records and babies' birth weights, were used to collect data. Data were analysed with descriptive paired sample t-tests, and cross-tabulations at 95% confidence intervals. Results Less than a third (31.0%) of participants knew what sulphadoxine pyrimethamine was, and only 51.5% used it. Only 13.1% took the recommended three doses. The number of doses was significantly associated with haemoglobin level (P=0.005). However, there was not a clear relationship between number of doses and infant birth weight (P=0.78). Conclusions The use of sulphadoxine pyrimethamine in preventing malaria in pregnancy using directly observed therapy is well-known in Ghana. However, actual use of this treatment should be enhanced through public education programmes.

Malaria Parasitaemia, Risk Perception, and Preventive Practices Among Women Attending Ante-Natal Clinics in Ogun State

Malaria contributes over 10% of all deaths among pregnant women. The prevalence of malaria in pregnancy in Nigeria particularly in Ogun State is high. The coverage and uptake of Intermittent Preventive Treatment with Sulphodoxine Pyrimethamine (IPT-SP) and Long-Lasting Insecticidal Nets (LLINs) in Southwest Nigeria is still very low despite their proven cost effectiveness in improving maternal and infant health. This study therefore determined the malaria parasitaemia, risk perception, preventive practices and associated factors among women attending Ante-natal Clinics (ANCs) in Ogun state. A cross-sectional study was carried out using mixed methods. An estimated sample size of 426 was computed and selected from ANCs across the state through multistage sampling technique. Pre-tested semi-structured interviewer administered questionnaire was used to collect information. Also, focused group discussions (FGDs) were conducted among women attending ANC and blood samples were taken from asymptomatic women for laboratory analysis to determine prevalence of malaria parasitaemia. Measures of association between the dependent and independent variables were tested using Chi-square. All tests of significance were done based on a ɑ-level of 0.05. Response rate was 100% for this study. The mean age of respondents was 27.9 ±5.5 years. Risk perception of malaria was observed to be good. Malaria parasitaemia was 2.7% and was 100% due to <i>Plasmodium falciparum</i>. Maternal age was significantly associated with malaria parasitaemia. Therefore, it is recommended that malaria elimination programmes should be sustained; access and affordability of ANC care should be ensured by the Government.

Can Outreach Training and Supportive Supervision Improve Competency in Malaria Service Delivery? An Evaluation in Cameroon, Ghana, Niger, and Zambia.

Outreach Training and Supportive Supervision (OTSS) of malaria services at health facilities has been adopted by numerous malaria-endemic countries. The OTSS model is characterized by a hands-on method to enhance national guidelines and supervision tools, train supervisors, and perform supervision visits. An independent evaluation was conducted to evaluate the effectiveness of OTSS on health worker competence in the clinical management of malaria, parasitological diagnosis, and prevention of malaria in pregnancy. From 2018 to 2021, health facilities in Cameroon, Ghana, Niger, and Zambia received OTSS visits during which health workers were observed directly during patient consultations, and supervisors completed standardized checklists to assess their performance. Mixed-effects logistic regression models were developed to assess the impact of increasing OTSS visit number on a set of eight program-generated outcome indicators, including overall competency and requesting a confirmatory malaria test appropriately. Seven of eight outcome indicators showed evidence of beneficial effects of increased OTSS visits. Odds of health workers reaching competency thresholds for the malaria-in-pregnancy checklist increased by more than four times for each additional OTSS visit (odds ratio [OR], 4.62; 95% CI, 3.62-5.88). Each additional OTSS visit was associated with almost four times the odds of the health worker foregoing antimalarial prescriptions for patients who tested negative for malaria (OR, 3.80; 95% CI, 2.35-6.16). This evaluation provides evidence that successive OTSS visits result in meaningful improvements in indicators linked to quality case management of patients attending facilities for malaria diagnosis and treatment, as well as quality malaria prevention services received by women attending antenatal services.

Factors Associated with Malaria in Pregnancy among Women Attending Fort Portal Regional Referral Hospital in Fort Portal City, Western Uganda

Globally, there was a significant decrease in the number of malaria-risk pregnancies between 2007 and 2020. The risk of Plasmodium falciparum or Plasmodium vivax malaria increased by 25% in Africa compared to 2007. Due to the fast-expanding population and associated rise in pregnancies in malaria-endemic areas, the number of people at risk in Africa has increased despite malaria rates declining in the region. This study determined the prevalence and factors associated with malaria in pregnancy among women attending Fort Portal Regional Referral Hospital. This was a single-center health facility-based cross-sectional study. Data was collected using a face-to-face interview through a structured questionnaire from willing participants. After collecting the data, the principal investigator checked the completed questionnaires for consistency and completeness. Data was coded, cleaned, and entered into the computer using Microsoft Excel, and then analyzed using SPSS version 20. Logistic regression analysis was done to ascertain the relationship between dependent and independent variables. Descriptive statistics were summarized in the form of frequency tables, pie charts, p-values, and odds ratios. A total of 253 pregnant mothers attending ANC were enrolled in this study. The majority (38.3%) of the study participants were aged 30-39 years, attained secondary education (52.2%), earned 100,000–200,000 per month (56.9%), and were housewives (51.0%). In this study, the prevalence of malaria in pregnancy was 10.3%. Age, level of education, income status, and residence, use of an ITN, gravidity, and ANC follow-up were significantly associated with malaria in pregnancy at multivariate logistic regression analysis. Malaria continues to be a major public health issue among pregnant mothers. Age, level of education, income status, and residence, use of an ITN, gravidity, and ANC follow-up were factors significantly associated with malaria in pregnancy. Keywords: Pregnancies, Malaria, Plasmodium, ITN, ANC.

Increased Uptake of Intermittent Preventive Treatment for Prevention of Malaria in Pregnancy and Scale-Up of Group Antenatal Care in Nasarawa State, Nigeria

Increased Uptake of Intermittent Preventive Treatment for Prevention of Malaria in Pregnancy and Scale-Up of Group Antenatal Care in Nasarawa State, Nigeria

Safety and efficacy of dihydroartemisinin–piperaquine for intermittent preventive treatment of malaria in pregnant women with HIV from Gabon and Mozambique: a randomised, double-blind, placebo-controlled trial

The cornerstone of malaria prevention in pregnancy, intermittent preventive treatment (IPTp) with sulfadoxine-pyrimethamine, is contraindicated in women with HIV who are receiving co-trimoxazole prophylaxis. We assessed whether IPTp with dihydroartemisinin-piperaquine is safe and effective in reducing the risk of malaria infection in women with HIV receiving co-trimoxazole prophylaxis and antiretroviral drugs. For this randomised, double-blind, placebo-controlled clinical trial, women with HIV attending the first antenatal care clinic visit, resident in the study area, and with a gestational age up to 28 weeks were enrolled at five sites in Gabon and Mozambique. Participants were randomly assigned (1:1) to receive either IPTp with dihydroartemisinin-piperaquine at each scheduled antenatal care visit plus daily co-trimoxazole (intervention group) or placebo at each scheduled antenatal care visit plus daily co-trimoxazole (control group). Randomisation was done centrally via block randomisation (block sizes of eight), stratified by country. IPTp was given over 3 days under direct observation by masked study personnel. The number of daily IPTp tablets was based on bodyweight and according to the treatment guidelines set by WHO (target dose of 4 mg/kg per day [range 2-10 mg/kg per day] of dihydroartemisinin and 18 mg/kg per day [range 16-27 mg/kg per day] of piperaquine given once a day for 3 days). At enrolment, all participants received co-trimoxazole (fixed combination drug containing 800 mg trimethoprim and 160 mg sulfamethoxazole) for daily intake. The primary study outcome was prevalence of peripheral parasitaemia detected by microscopy at delivery. The modified intention-to-treat population included all randomly assigned women who had data for the primary outcome. Secondary outcomes included frequency of adverse events, incidence of clinical malaria during pregnancy, and frequency of poor pregnancy outcomes. All study personnel, investigators, outcome assessors, data analysts, and participants were masked to treatment assignment. This study is registered with ClinicalTrials.gov, NCT03671109. From Sept 18, 2019, to Nov 26, 2021, 666 women (mean age 28·5 years [SD 6·4]) were enrolled and randomly assigned to the intervention (n=332) and control (n=334) groups. 294 women in the intervention group and 308 women in the control group had peripheral blood samples taken at delivery and were included in the primary analysis. Peripheral parasitaemia at delivery was detected in one (<1%) of 294 women in the intervention group and none of 308 women in the control group. The incidence of clinical malaria during pregnancy was lower in the intervention group than in the control group (one episode in the intervention group vs six in the control group; relative risk [RR] 0·12, 95% CI 0·03-0·52, p=0·045). In a post-hoc analysis, the composite outcome of overall malaria infection (detected by any diagnostic test during pregnancy or delivery) was lower in the intervention group than in the control group (14 [5%] of 311 women vs 31 [10%] of 320 women; RR 0·48, 95% CI 0·27-0·84, p=0·010). The frequency of serious adverse events and poor pregnancy outcomes (such as miscarriages, stillbirths, premature births, and congenital malformations) did not differ between groups. The most frequently reported drug-related adverse events were gastrointestinal disorder (reported in less than 4% of participants) and headache (reported in less than 2% of participants), with no differences between study groups. In the context of low malaria transmission, the addition of IPTp with dihydroartemisinin-piperaquine to co-trimoxazole prophylaxis in pregnant women with HIV did not reduce peripheral parasitaemia at delivery. However, the intervention was safe and associated with a decreased risk of clinical malaria and overall Plasmodium falciparum infection, so it should be considered as a strategy to protect pregnant women with HIV from malaria. European and Developing Countries Clinical Trials Partnership 2 (EDCTP2) and Medicines for Malaria Venture. For the Portuguese and French translations of the abstract see Supplementary Materials section.

Malaria in pregnancy: Meta-analyses of prevalence and associated complications.

This review aims to assess the prevalence of malaria in pregnancy during antenatal visits and delivery, species-specific burden together with regional variation in the burden of disease. It also aims to estimate the proportions of adverse pregnancy outcomes in malaria-positive women. Based on the PRISMA guidelines, a thorough and systematic search was conducted in July 2023 across two electronic databases (including PubMed and CENTRAL). Forest plots were constructed for each outcome of interest highlighting the effect measure, confidence interval, sample size, and its associated weightage. All the statistical meta-analysis were conducted using R-Studio version 2022.07. Sensitivity analyses, publication bias assessment, and meta-regression analyses were also performed to ensure robustness of the review. According to the pooled estimates of 253 studies, the overall prevalence of malaria was 18.95% (95% CI: 16.95-21.11), during antenatal visits was 20.09% (95% CI: 17.43-23.06), and at delivery was 17.32% (95% CI: 14.47-20.61). The highest proportion of malarial infection was observed in Africa approximating 21.50% (95% CI: 18.52-24.81) during ANC and 20.41% (95% CI: 17.04-24.24) at the time of delivery. Our analysis also revealed that the odds of having anaemia were 2.40 times (95% CI: 1.87-3.06), having low birthweight were 1.99 times (95% CI: 1.60-2.48), having preterm birth were 1.65 times (95% CI: 1.29-2.10), and having stillbirths were 1.40 times (95% CI: 1.15-1.71) in pregnant women with malaria.

Knowledge, attitude and practices on intermittent preventive treatment in pregnant women with malaria: a mixed method facility-based study in Western Kenya.

intermittent preventive treatment remains a core strategy for malaria prevention in pregnancy. Sulfadoxine-pyrimethamine is recommended for all pregnant women in malaria-prone zones. It is scheduled monthly at each antenatal care visit for up to 36 weeks. Here, we sought to assess the knowledge, attitude, and practices of intermittent preventive treatment among pregnant women with malaria in Webuye Hospital. a total of 140 participants aged between 18 and 49 years and at approximately 16 weeks of gestation were enrolled in this study, which utilized a mixed qualitative-quantitative method. Before enrollment, malaria testing was conducted using microscopy, and participants were divided into two cohorts: malaria-positive and malaria-negative. Close-ended and open-ended questionnaires were used. Qualitative-quantitative data analyses were performed. our analysis revealed a significant difference between the proportion of mothers in the negative and positive groups in terms of their knowledge about side effects (p ≤ 0.001) and different doses (p ≤ 0.012) of intermittent preventive treatment. The proportion of mothers who knew side effects and different doses was higher among the malaria-positive group as compared to malaria-negative group with 37(52.9%, n=70) versus 18(25.7%, n=70) and 14(20.0%, n=70) versus 4(5.7%, n=70) respectively. Additionally, there was also a significant difference in knowledge about intermittent preventive treatment before administration (p ≤ 0.003) between the two groups. good knowledge, attitude and practices on intermittent preventive treatment (IPT) benefits, side effects, safety, doses and other prior information should be leveraged to empower pregnant women in malaria-endemic zones.

Prevalence and determinants of malaria infection among pregnant women attending antenatal clinic in Ejisu government hospital in Ghana: A cross-sectional study.

Malaria in pregnancy is a global public health problem with the majority of its impact seen in sub-Saharan Africa. Pregnant women with malaria infection are at risk of adverse maternal outcomes. In Ghana, malaria in pregnancy accounts for about 17.6% of outpatient department attendance. Ashanti region is among the three regions with the highest malaria prevalence in pregnancy, particularly in the Ejisu Municipality. The study, therefore, assessed the prevalence and determinants of malaria infection among pregnant women seeking antenatal care at the Ejisu Government Hospital in Ghana. A cross-sectional study design with a convenience sampling technique was used to select 140 respondents for the study. Primary data such as age and residence of respondents were collected using a questionnaire and secondary data such as gestational age and Sulphadoxine Pyrimethamine (SP) administration were collected from clients' maternal health record booklet. Bivariate and multivariate logistic regression analysis were used to assess the association between the malaria infection and the independent variables, and a p-value of < 0.05 was considered statistically significant. The overall prevalence of malaria in pregnancy was 24 (17.1%). Most of the respondents had received counselling and health education 126 (90%), two or more doses of SP 95 (87.2%), Insecticide Treated Net (ITN) 99 (70.7%) and were sleeping under ITN 104 (74.3%). Multivariate logistic regression analysis showed a statistically significant association between malaria infection and sleeping under ITN (AOR = 0.05; 95% CI = 0.01-0.28, p< .001), the use of insecticide mosquito spray (AOR = 0.27; 95% CI = 0.09-0.84, p = .045) and reason for not using ITN due to the use of other preventive measures (AOR = 0.06; 95% CI = 0.01-0.61, p = .017). There was a high prevalence of malaria infection among study respondents despite the high usage of preventive measures for malaria in this study. It is therefore crucial that stakeholders in malaria control identify effective strategies to curb malaria transmission globally.

Malaria in pregnancy in India: a 50-year bird's eye.

In 2021, India contributed for ~79% of malaria cases and ~ 83% of deaths in the South East Asia region. Here, we systematically and critically analyzed data published on malaria in pregnancy (MiP) in India. Epidemiological, clinical, parasitological, preventive and therapeutic aspects of MiP and its consequences on both mother and child were reviewed and critically analyzed. Knowledge gaps and solution ways are also presented and discussed. Several electronic databases including Google scholar, Google, PubMed, Scopus, Wiley Online library, the Malaria in Pregnancy Consortium library, the World Malaria Report, The WHO regional websites, and ClinicalTrials.gov were used to identify articles dealing with MiP in India. The archives of local scientific associations/journals and website of national programs were also consulted. Malaria in pregnancy is mainly due to Plasmodium falciparum (Pf) and P. vivax (Pv), and on rare occasions to P. ovale spp. and P. malariae too. The overall prevalence of MiP is ~0.1-57.7% for peripheral malaria and ~ 0-29.3% for placental malaria. Peripheral Pf infection at antenatal care (ANC) visits decreased from ~13% in 1991 to ~7% in 1995-1996 in Madhya Pradesh, while placental Pf infection at delivery unit slightly decreased from ~1.5% in 2006-2007 to ~1% in 2012-2015 in Jharkhand. In contrast, the prevalence of peripheral Pv infection at ANC increased from ~1% in 2006-2007 to ~5% in 2015 in Jharkhand, and from ~0.5% in 1984-1985 to ~1.5% in 2007-2008 in Chhattisgarh. Clinical presentation of MiP is diverse ranging from asymptomatic carriage of parasites to severe malaria, and associated with comorbidities and concurrent infections such as malnutrition, COVID-19, dengue, and cardiovascular disorders. Severe anemia, cerebral malaria, severe thrombocytopenia, and hypoglycemia are commonly seen in severe MiP, and are strongly associated with tragic consequences such as abortion and stillbirth. Congenital malaria is seen at prevalence of ~0-12.9%. Infected babies are generally small-for-gestational age, premature with low birthweight, and suffer mainly from anemia, thrombocytopenia, leucopenia and clinical jaundice. Main challenges and knowledge gaps to MiP control included diagnosis, relapsing malaria, mixed Plasmodium infection treatment, self-medication, low density infections and utility of artemisinin-based combination therapies. All taken together, the findings could be immensely helpful to control MiP in malaria endemic areas.

Prevalence of molecular markers of resistance to sulfadoxine–pyrimethamine before and after community delivery of intermittent preventive treatment of malaria in pregnancy in sub-Saharan Africa: a multi-country evaluation

The effectiveness of community delivery of intermittent preventive treatment (C-IPT) of malaria in pregnancy (IPTp) with sulfadoxine-pyrimethamine has been evaluated in selected areas of the Democratic Republic of the Congo, Madagascar, Mozambique, and Nigeria. We aimed to assess the effect of C-IPTp on the potential development of Plasmodium falciparum resistance to sulfadoxine-pyrimethamine, since it could threaten the effectiveness of this strategy. Health facility-based cross-sectional surveys were conducted at baseline and 3 years after C-IPTp implementation in two neighbouring areas per country, one with C-IPTp intervention, and one without, in the four project countries. Dried blood spots from children under five years of age with clinical malaria were collected. Sulfadoxine-pyrimethamine resistance-associated mutations of the P falciparum dhfr (Asn51Ile/Cys59Arg/Ser108Asn/Ile164Leu) and dhps (Ile431Val/Ser436Ala/Ala437Gly/Lys540Glu/Ala581Gly/Ala613Ser) genes were analysed. 2536 children were recruited between June 19 and Oct 10, 2018, during baseline surveys. Endline surveys were conducted among 2447 children between July 26 and Nov 30, 2021. In the Democratic Republic of the Congo, the dhfr/dhps IRNI/ISGEAA inferred haplotype remained lower than 10%, from 2% (5 of 296) at baseline to 8% (24 of 292) at endline, and from 3% (9 of 300) at baseline to 6% (18 of 309) at endline surveys in intervention and non-intervention areas respectively with no significant difference in the change between the areas. In Mozambique, the prevalence of this haplotype remained stable at over 60% (194 [64%] of 302 at baseline to 194 [64%] of 303 at endline, and 187 [61%] of 306 at baseline to 183 [61%] of 301 in endline surveys, in non-intervention and intervention areas respectively). No isolates harbouring the dhps ISGEAA genotype were found in Nigeria. In Madagascar, only five isolates with this haplotype were found in the non-intervention area (2 [>1%] of 300 at baseline and 3 [1%] of 300 at endline surveys). No isolates were found carrying the dhps ISGEGA genotype. C-IPTp did not increase the prevalence of molecular markers associated with sulfadoxine-pyrimethamine resistance after three years of programme implementation. These findings reinforce C-IPTp as a strategy to optimise the control of malaria during pregnancy, and support the WHO guidelines for prevention of malaria in pregnancy. UNITAID [2017-13-TIPTOP].

Predictors of Daily Utilization of Long-Lasting Insecticidal Nets for Malaria Prevention in Pregnancy among Antenatal Care Recipients in Southern Nigeria

Malaria remains a significant public health concern, particularly among pregnant women in sub-Saharan Africa. Long Lasting Insecticidal Nets (LLINs) have been recognized as an effective preventive measure against malaria transmission. However, the utilization of LLINs among pregnant women remains suboptimal. This study aimed to assess the level of daily LLIN utilization and identify its predictors among pregnant women receiving antenatal care in a tertiary healthcare centre in Southern Nigeria. A cross-sectional study was conducted among antenatal recipients at the University of Uyo Teaching Hospital in Uyo, AkwaIbom State. A total of 323 respondents were recruited for the study. Data were collected using a pre-tested semi-structured questionnaire. Multivariable logistic regression analyses were performed to identify predictors of daily LLIN usage. One hundred and twenty seven (39.3%) of the respondents had ever slept inside a LLIN during the index pregnancy, while 22.6% reported daily usage. LLIN ownership was reported by 47.7% of the respondents, highlighting a discrepancy between ownership and consistent use. Predictors of daily LLIN usage included LLIN ownership (aOR 3.83, 95% CI 1.95-7.48), absence of discomfort during LLIN use (aOR 9.33,95%CI 4.32-20.17), non-use of other malaria preventive measures (aOR 3.7,95% CI 11.51-8.93) and presence of mosquitoes in home dwelling (aOR 3.56 95%CI 1.35-9.37). Health education campaigns should emphasize the benefits of daily LLIN usage during pregnancy. Policy interventions are warranted to increase LLIN distribution and availability to pregnant women through antenatal care clinics.

Superoxide dismutase activity levels in parturients on intermittent preventive treatment with sulphadoxine pyrimethamine and their controls at current confinements

Malaria prevention in pregnancy especially in endemic areas has been greatly emphasized. This is especially so during the antenatal periods. Malaria prevention is important for reducing the problems of malaria in pregnancy. Early trimester miscarriages, preterm labours, anaemia in pregnancy, small for date babies and increased admissions into special care baby units are some of the problems encountered that are traceable to malaria infection. It is also noteworthy that some favourable antioxidants have been noted to help pregnant women enjoy and cope with their pregnancies. In that same way, it has also been noted that optimal levels of superoxide dismutase is equally necessary to help pregnant women enjoy uneventful pregnancies as well as stay free from some problems associated with malaria in pregnancy. Objectives: We have comparatively and objectively assessed the plasma Levels of superoxide dismutase in Parturients on Intermittent Preventive Treatment with Sulphadoxine Pyrimethamine and their Controls at Current Confinements. Method: This comparative study was conducted at the Obstetrics and Gynaecology Department of the Federal Medical Centre (FMC) Owerri, South East Nigeria. Owerri is widely known for its heavy malaria endemicity. Prior to participant recruitment, appropriate ethical clearance was applied for and obtained from the ethics committee of FMC Owerri. This enabled the commencement of the longitudinal recruitment of participants after due counseling and adequate informed consent involving both study groups. This bench-based research and cross-sectional descriptive study involved two hundred and ninety-six (296) consented participants. The participants were made to understand clearly the study protocol as well as satisfy the inclusion criteria for either the study (case) or control groups. Upon recruitment, participants were then followed up all throughout their entire antenatal course culminating in the delivery. The follow up enabled the collection of blood samples for the estimation of Superoxide Dimutase (SOD) plasma levels at delivery. The SOD levels were estimated using the Misra and Fridovich method, 1972. The ability of superoxide dismutase to inhibit the auto oxidation of adrenaline at pH 10.2 makes this reaction a basis for the SOD assay. Superoxide anion (O2) generated by the xanthine oxidase reaction is known to cause the oxidation of adrenaline to adrenochrome. The yield of adrenochrome produced per superoxide anion introduced increased with increasing pH and also with increasing concentration of adrenaline. These led to the proposal that auto oxidation of adrenaline proceeds by at least two distinct pathways, one of which is a free radical chain reaction involving superoxide radical and hence could be inhibited by SOD. Data analysis: Data computation and analysis were done using the computer Software Package for Social Science (SPSS) version 20.0 (SPSS, Inc, 2007, Chicago). Important descriptive statistics (mean, standard deviation, range, percentages etc) were determined for continuous variables. P-value less than (&lt;0.05) at 95% confidence interval was considered statistically significant. Result: The mean serum level of superoxide dismutase (SOD) in the study group was 12.61 U/ml ± 3.105 while the minimum and maximum serum superoxide dismutase were 7 and 20 U/ml respectively. For their controls, the mean serum level of superoxide dismutase was 11.69 U/ml ± 2. 969. However, the minimum and maximum serum superoxide dismutase were 7 and 20 U/ml respectively. The difference was found to be statistically significant (p= 0.011) with odds ratio 1.12 (CI of 95% 1.024-1.193).

Prevention of Malaria in Pregnancy: Knowledge and Practical Attitudes of Pregnant Women at the Mother of the Health Reference of Kalaban Coro

The aim was to assess pregnant women's knowledge and practical attitudes towards malaria prevention. Materials and Methods: It was a prospective, cross-sectional, descriptive study over a period of 4 months from August 1, 2018 to November 30, 2018. The Results: The study was carried out in 324 pregnant women aged 15 to 40 years: 45.7% were illiterate; 98.5% were married, 28.3% were Bambara. The name "Sumaya" was the local name for malaria. The pregnant women had a good knowledge of modes of transmission, means of prevention and factors favoring mosquito reproduction. The insecticide-treated mosquito net was cited by the majority of pregnant women as a preventive measure against malaria, of which 83.3% used it and 68.2% impregnated at a rate of 6 months. Conclusion: At the end of our study we understood that our pregnant women have quite satisfactory knowledge about malaria. The distribution of ITNs and MS among pregnant women showed a benefit in terms of the occurrence of gestational malaria in our study.

High prevalence of malaria in pregnancy among women attending antenatal care at a large referral hospital in northwestern Uganda: A cross-sectional study.

Malaria in pregnancy contributes to substantial morbidity and mortality among women in Uganda. However, there is limited information on the prevalence and factors associated with malaria in pregnancy among women in Arua district, northwestern Uganda. We, therefore, assessed the prevalence and factors associated with malaria in pregnancy among women attending routine antenatal care (ANC) clinics at Arua regional referral hospital in north-western Uganda. We conducted an analytic cross-sectional study between October and December 2021. We used a paper-based structured questionnaire to collect data on maternal socio-demographic and obstetric factors and malaria preventive measures. Malaria in pregnancy was defined as a positive rapid malarial antigen test during ANC visits. We performed a modified Poisson regression analysis with robust standard errors to determine factors independently associated with malaria in pregnancy, reported as adjusted prevalence ratios (aPR) and 95% confidence intervals (CI). We studied 238 pregnant women with a mean age of 25.32±5.79 years that attended the ANC clinic, all without symptomatic malaria. Of the participants, 173 (72.7%) were in their second or third trimester, 117 (49.2%) were first or second-time pregnant women, and 212 (89.1%) reported sleeping under insecticide-treated bednets (ITNs) every day. The prevalence of malaria in pregnancy was 26.1% (62/238) by rapid diagnostic testing (RDT), with the independently associated factors being daily use of insecticide-treated bednets (aPR 0.41, 95% CI 0.28, 0.62), first ANC visit after 12 weeks of gestation (aPR1.78, 95% CI 1.05, 3.03), and being in the second or third trimester (aPR 0.45, 95% CI 0.26, 0.76). The prevalence of malaria in pregnancy among women attending ANC in this setting is high. We recommend the provision of insecticide-treated bednets to all pregnant women and early ANC attendance to enable access to malaria preventive therapy and related interventions.

Interventions for malaria prevention in pregnancy; factors influencing uptake and their effect on pregnancy outcomes among post-natal women in a tertiary facility in the Volta Region of Ghana.

Malaria in pregnancy is associated with adverse pregnancy outcomes including maternal anaemia and low birthweight. Uptake of preventive interventions is sub-optimal in sub-Saharan Africa including Ghana. Understanding local-level factors that influence uptake of these interventions can enhance control. The study assessed uptake of intermittent preventive treatment of malaria during pregnancy using sulphadoxine-pyrimethamine (IPTp-SP) and insecticide-treated net (ITN) use, their determinants and effects on pregnancy outcomes. A cross-sectional study involving 349 post-partum women was conducted from 25 August 2022 to 9 October 2022 at the Ho Teaching Hospital. A structured questionnaire was used to collect data on participant socio-demographics, ITN use, number of doses of sulphadoxine-pyrimethamine received, knowledge of malaria in pregnancy, haemoglobin levels and birth weight among others. Summary statistics were reported as frequencies, percentages and means. Associations between exposure and outcome variables were assessed using logistic regression methods and odds ratios reported with 95% confidence intervals. Statistical significance was concluded at p < 0.05. More than 80% (291) of respondents received ⩾3 doses of intermittent preventive treatment using sulphadoxine-pyrimethamine and 64.8% (226) slept under ITNs the night before the survey. Age >25 years, employment, good knowledge of malaria in pregnancy, parity ⩾2 and initiating antenatal care visits in the first trimester facilitated the uptake of these interventions. Receiving ⩾3 doses of sulphadoxine-pyrimethamine was associated with having normal-weight babies (adjusted odds ratio 2.80, 95% CI: 1.07, 7.34; p = 0.036) while ITN use was associated with having term babies (adjusted odds ratio 2.72, 95% CI: 1.24, 5.90; p = 0.013) and normal maternal haemoglobin concentration at term (adjusted odds ratio 1.57, 95% CI: 1.01, 2.47; p = 0.044). The interventions were beneficial against low birthweight and preterm births which predispose to neonatal deaths and poor cognitive function in children. Malaria in pregnancy health campaigns should be intensified, especially among younger-aged primigravidae, to increase their knowledge of the condition as a way to further improve uptake of these preventive interventions.