PREVALENCE AND RISK FACTORS FOR CONGENITAL MALARIA IN BABIES DELIVERED AT FEDERAL MEDICAL CENTRE OWERRI

Abstract

Aim: Prevalence and risk factors for congenital malaria in babies delivered at Federal Medical Centre Owerri.

This cross –sectional descriptive study was carried out between July and August 2011. Two hundred and thirty mother/baby pairs were recruited consecutively. The women were recruited once labour was established. Following their consent, a structured questionnaire was administered to each mother to capture her biodata, obstetric history, knowledge and use of malaria preventive measures during pregnancy as well as the presence of fever during pregnancy. Blood samples were collected from the mothers and later, upon delivery, from the placenta, cord and babies.
Thick blood smears were made for malaria parasites and their densities. Hematocrit was also determined using the cord blood. The smears were air dried, packaged and sent to the hospital laboratory where they were stained by the researcher and later on viewed by a WHO certified malaria microscopist while the samples for the hematocrit were spun in the departmental side laboratory using a microhematocrit centrifuge.

The babies were regarded as having congenital malaria if parasites were found in the cord and/or baby’s peripheral blood. The babies were subsequently weighed and examined up to 48 hours after delivery or until discharge from the hospital for features of congenital malaria or any other abnormalities.
A total of two hundred and thirty mother baby pairs were studied. The mean age of the mothers was 29.1 ± 5.4 years and 74.9% of them had tertiary education. Most of the mothers had their antenatal care at the tertiary health facility (the study centre). 68.8% of the babies were term and 95.7% had normal birth weight.
Out of the 66.7% of the women who took an antimalarial for malaria prevention during pregnancy, 94.8% took Intermittent Presumptive Treatment(IPT) with Sulfadoxine-Pyrimethamine ,though majority of them took it only once. The use of Insecticide Treated Nets(ITN) was low, 19.6%, despite the ample knowledge of that method of prevention (77.5%). This was mainly attributed to non availability of the nets. Only 22.1% of the mothers had fever and that was mostly in the 3rd trimester.
35.5% of the babies had congenital malaria while placental parasitemia was 57.6%. Parasite density was generally low in maternal, placental and baby’s blood (range 40-320 parasites /ul). Parasitemia in the maternal and placental blood and fever in the last trimester were significantly associated with congenital malaria P=0.000. Also, failure to use IPT and ITN increased the risk of having congenital malaria. Mothers of lower parities were more likely to have babies with congenital malaria (P=0.026). Babies with congenital malaria weighed less than those without it (P = 0.04).
In conclusion, all babies delivered by primigravidae and those with history of fever in the last trimester should be screened for congenital malaria. All pregnant women should be encouraged to take IPT at least twice in pregnancy and to sleep under ITN to reduce the risk of congenital malaria.

PREVALENCE AND RISK FACTORS FOR CONGENITAL MALARIA IN BABIES DELIVERED AT FEDERAL MEDICAL CENTRE OWERRI