RISK FACTORS FOR PLACENTAL MALARIA AND ITS ASSOCIATIONS IN PARTURIENT WOMEN AT NAUTH, NNEWI

Abstract

BACKGROUND
Placental malaria is one of the complications of malaria in pregnancy and is associated with poor pregnancy outcome. Demonstration of its prevalence, risk factors and its associations with pregnancy outcome will help us modify the measures in the prevention of malaria in pregnancy and strengthen the effective pre-existing preventive measures in our community. It will also make us understand the burden of this malaria in pregnancy. More so, there is paucity of studies of placental malaria in our environment using histology which is the gold standard.
AIM:
To identify the risk factors for placental malaria and its associations with pregnancy outcome.
STUDY DESIGN AND SETTING:
This is a cross sectional study carried out at Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, South East, Nigeria between 1ST August, 2012 and 31st January, 2013.
MATERIALS AND METHODS:
A cross section of pregnant women with singleton fetus of at least 28 weeks of gestation who presented to the labour ward for delivery was recruited for the study. The following data were obtained from those who met the inclusion criteria: phone number, age, parity, gestational age, the booking status, educational level and husband’s occupation. The history of intermittent preventive therapy (IPT), HIV status, Blood group and Haemoglobin genotype were also obtained.
Before delivery, blood sample was collected for packed cell volume (PCV) estimation, then after delivery a sample of placenta was collected for histology and the baby weighed within 12hours of delivery. At seventh day of delivery, the mothers were contacted through phone calls and the state of the baby noted. All these data were recorded in proforma.
Descriptive analysis of the results was done using the statistical package for social sciences (SPSS) version 16. Student-t- test and Odd ratio were used for univariate analysis while logistic regression was used for multivariate analysis and the results expressed in adjusted Odd ratio and confidence interval (C.I) ;and Pvalue <0.05 was taken as significant level.
RESULT:
Out of 200 placentae analyzed, 141 were positive for malaria, giving a prevalence of 67.8%. The commonest form of parasitisation was chronic infection (68.09%) followed by past infection (19.14%) and acute infection (12.77%). Using univariate analysis, the potential risk factors were young age, primigrividity, unbooked status, non use of IPT, non use of ITN, low social class, HIV positivity and haemoglobin genotype AA. However when these were subjected to logistic regression, the independent risk factors identified were young age, primigrividity, unbooked status, non use of IPT, and non use of ITN. Placental malaria was associated with lower maternal PCV (30.67±1.60 vs 32.51±2.82, pvalue < 0.001), preterm delivery (OR=4.99, C.I=1.15 – 45.08, p- value=0.020), and low birth weight ( OR = 4.71, C.I=1.08 – 42.71, p-value=0.027) but not associated with maternal anaemia (OR=2.27, C.I= 0.90-6.47, p-value=0.063) and perinatal deaths ( OR=Infinity, C.I =0.38 – infinity, p-value = 0.143).

CONCLUSION:
This study has highlighted high prevalence of placental malaria in our environment. The independent risk factors noted were young age, primigrividity, unbooked status, non use of IPT, and non use of ITN. Placental malaria was associated with low birth weight and preterm delivery but not associated with maternal anaemia and perinatal deaths.
Women empowerment through education, early booking, use of IPT and ITN are the way forward. Researches and global partnership should be encouraged in order to stem down placental malaria prevalence and its associated poor pregnancy outcome.

RISK FACTORS FOR PLACENTAL MALARIA AND ITS ASSOCIATIONS IN PARTURIENT WOMEN AT NAUTH, NNEWI