PREVALENCE OF MALARIA PARASITAEMIA AMONG PREGNANT WOMEN AT THE U.M.T.H, MAIDUGURI

Abstract

Background
Malaria in pregnancy constitutes a risk for both the mother and her unborn
child but there is paucity of data regarding the magnitude of the problem in
our region. This study was conducted with the main objective of determining
the prevalence of malaria parasitaemia among our pregnant women and its
consequences.
Subjects and Methods
Four hundred pregnant women who attended antenatal care and delivered at
the UMTH, Maiduguri were studied from 24th July 2007 to 12th January
2008. They were followed from booking to delivery. Blood samples were
collected at booking and delivery in to an EDTA bottle and a thick blood
smear were prepared on a glass slide and read under microscope for malaria
parasite while capillary tube, centrifuge machine and micro-haematocrit
reader were employed for packed cell volume. Malaria parasite was also
looked for in the cord blood of the babies and placental tissue using blood
film and histology respectively.
Results
The prevalence of malaria parasitaemia at booking was 60.3% (241/400) and
the mean parasite density was 701.04±382.22 parasite/µl. However atdelivery both the malaria parasitaemia and mean parasite density were
lowered to 28.8%(115/400) and 405.17±310.43 parasite/µl respectively. The
prevalence of malaria parasitaemia was highest among primigravidas and
secondigravidas at 77%(97/126) and 72.4%(42/58) respectively while the
grandmultiparous women had the lowest prevalence of 26.7%(16/60) at
booking(χ2=53.29, p=0.000) and a similar trend was also noticed at
delivery(χ2=28.81, p=0.000). There was a direct relationship between the
malaria parasitemia and anaemia. The prevalence of anaemia was highest,
81.8%(9/11) among those with parasite density of 1501-2000 parasite/µl and
lowest at 7.1%(9/126) among those with parasite density of ≤500
parasite/µl(ᵡ2=65.62,p=0.000) at booking. Also at delivery there was
increased prevalence of anaemia with increasing malaria parasite density,
50%(2/4) among those with parasite density of 1001-1500 parasite/µl
compared to 6%(6/101) when the parasite density was <500parasite/ µl
(χ2=24.37, p=0.000). Malaria parasitaemia at delivery was associated with
preterm delivery (OR=2.47,CI=1.12-5.23), low birth weight (OR=10.47 ,
CI=4.37-25.12) and cord parasitaemia (OR=16.89,CI=8.50-33.55).
The prevalence of placental parasitaemia was 32.3%(129/400). The
use of intermittent preventive therapy with sulphadoxine-pyramethamine
significantly decreased placental parasitaemia, as the prevalence was 58.8%(20/34) when no prophylaxis was used against 27.1%(69/255) when
two doses of the prophylaxis were used(χ2=14.86, p=0.001).
Conclusion
There is a high prevalence of malaria parasitaemia with a high parasite
density among pregnant women at booking, both of which decline
remarkably at delivery most probably as a result of intermittent preventive
therapy during antenatal care. Malaria parasitaemia in pregnancy is
associated with development of anaemia in pregnancy and the anaemia is
density dependant.
The prevalence of placental parasitaemia among parturients at UMTH
is high(32.3%). The use of antimalaria prophylaxis significantly protects
against placental parasitaemia.
Recommendation
There is need to educate the populace about malaria preventive measures so
as to reduce the exposure of the pregnant women to the malaria infection.
Insecticide treated nets should be made available at a subsidized rate to all
pregnant women. The use of intermittent preventive treatment should be
intensified and the drug should be given as directly observed treatment.

PREVALENCE OF MALARIA PARASITAEMIA AMONG PREGNANT WOMEN AT THE U.M.T.H, MAIDUGURI