PREVALENCE AND FETOMATERNAL OUTCOME OF PLACENTAL MALARIA IN ASYMPTOMATIC PATIENTS AT DELIVERY IN UNIVERSITY OF PORT HARCOURT TEACHING HOSPITAL

Abstract

Background: Malaria is an important public health problem in sub-Saharan Africa especially
in pregnancy due to its association with poor fetomaternal outcome. Pregnant women are
particularly prone to malaria due to the depressed immunity that occurs physiologically in
pregnancy. This is worsened by the high level of poverty, illiteracy and poor health care delivery
system. Adequate preventive measures as well as effective case management are imperative in
curbing the menace of malaria in pregnancy. Even women who received malaria
chemoprophylaxis in pregnancy are still prone to placental malaria due to sequestration of the
malaria parasite in the placenta. Placental malaria affects the efficacy of the placenta resulting
in premature delivery, low birth weight and increased perinatal mortality.
OBJECTIVES: The main objective of this study was to determine the prevalence of placental
malaria in asymptomatic patients and also to compare the fetomaternal outcome between
affected and unaffected women.
Methodology: This study was a prospective cross-sectional study of 210 booked antenatal
women who delivered at the University of Port Harcourt Teaching Hospital (UPTH). Participants
were recruited during labour. All consecutive women at labour who met the eligibility criteria
and consented for the study were selected. A well designed proforma was used to obtain socio
demographic information from the participants. Each participant blood sample was collected
and examined for the presence of malaria parasite and also her baby’s umbilical cord and
placenta blood samples were also examined for malaria parasite. In addition, maternal and cord
blood haemoglobin concentration were also determined. Statistical analysis of generated data
was carried out using SPSS version 16 software package. Chi square test was used to compare
categorical variables while Student ‘t’ test was used to compare continuous variables between
affected and unaffected women and values of P < 0.05 was considered significant.
RESULTS: The prevalence of placental malaria was 65.2%. The mean age of women that took
part in the study was 30.38±4.8 years while the mean parity was 1.49±1.36. Nulliparity was
significantly associated with placental malaria(x2=21.32, p=0.0000039). The mean gestational
age at delivery was 38.57±1.7 weeks and 12.85% of women had preterm delivery. Placental
malaria was not significantly associated with preterm delivery (x2=0.03,p=0.86). Forty nine
(87.5%) of the 56 women who were not compliant with malaria chemoprophylaxis had
placental malaria and the difference was significant (x2=16.69,p=0.000044). Only 22.4% of
women used insecticide treated net in the index pregnancy. Sixty seven (31.9%) women had
anaemia at delivery and malaria parasitaemia was significantly associated with anaemia
(x2=8.34,p=0.0039). The mean haemoglobin concentration in the cord blood was 16.1±1.2g/dl
and only seven (3.5%) babies had haemoglobin concentration less than 15g/dl. None of the
babies had clinical manifestation of malaria at birth. The mean birthweight in affected and
unaffected mothers was 3.34±0.5kg and 3.48±0.54kg respectively but the difference was not
statistically significant (t=-1.756, p=0.081). Fourteen (6.67%) babies had low birthweight.
Placental malaria was not significantly associated with low birthweight (x2=0.03,p=0.87). Twelve
(5.71%) babies had birth asphyxia out of which 10 were successfully resuscitated. There were
two cases of perinatal death from severe birth asphyxia giving a perinatal mortality rate of
9.52/1000 total birth.
CONCLUSION: There is a high prevalence of placental malaria in the study population.
Nulliparity, poor drug compliance and maternal anaemia were significantly associated with
placental malaria.

PREVALENCE AND FETOMATERNAL OUTCOME OF PLACENTAL MALARIA IN ASYMPTOMATIC PATIENTS AT DELIVERY IN UNIVERSITY OF PORT HARCOURT TEACHING HOSPITAL