PREVALENCE OF MALARIA IN NEONATES ADMITTED INTO THE SPECIAL CARE BABY UNIT OF THE UNIVERSITY OF PORT HARCOURT TEACHING HOSPITAL, (UPTH), NIGERIA

Abstract

Malaria is a parasitic infection of the blood caused by a parasite that belongs to the plasmodium
species. Newborns were initially thought to be immune to malaria because of certain maternal
and foetal factors. Malaria in the newborn may be missed because it usually presents with non
specific symptoms and signs that may mimic neonatal septicaemia. If malaria is not suspected
and treated adequately, it may contribute significantly to morbidity and mortality in these
neonates. The aim of this study was to determine the prevalence of malaria in neonates admitted
into Special Care Baby Unit of University of Port-Harcourt Teaching Hospital. This was a
prospective study done in neonates admitted into the SCBU between 1st July 2012 and 31st
October 2012.
All babies with symptoms and signs suggestive of septicaemia and those whose mothers had
risk factors that predisposed them to septicaemia were recruited. All the neonates that had
received antimalarial and antibiotics prior to admission were excluded. The mother’s bio data,
social history, obstetric history, the baby’s bio data, anthropometry, clinical features and results
of investigations were entered into a questionnaire and analyzed. Malaria parasite identification
was by blood film using peripheral blood. Of the 353 neonates studied, 199(56.4%) were males
while 154(43.6%) were females. The mean gestational age of the babies was 38.10±3.15 weeks
with a mean birth weight of 3.02± 0.89kg.
One hundred and thirty-six (38.5%) had malaria parasite in peripheral blood film, made up of
71(52.2%) males and 65(47.8%) females. Of the 329 newborns admitted within the first seven
days of life, 93(28.3%) had malaria parasite on their peripheral blood film. Sixty seven neonates
received blood transfusion while on admission out of which 36(53.7%) had malaria parasite on
blood film after the blood transfusion (transfusional malaria).The parasite density count was
significantly higher in babies with transfusional malaria (p=0.000).The only specie of malaria

parasite identified in 100% of the positive peripheral blood films was Plasmodium falciparum.
The commonest presenting features in the neonates with malaria parasitaemia were respiratory
distress, in 86(63.2%), fever, in 50(36.8%) and jaundice, in 20(14.7%). Babies with malaria
parasite in their peripheral blood film had significantly lower birth weight (p=0.000), significantl
y lower lengths (p=0.004) and significantly smaller OFC (p=0.012). Although the
mean PCV of parasitized babies was lower, the difference was not statistically significant
(p=0.305). Ten (31.3%) neonates had malaria parasitaemia as well as positive blood culture,
though there was no difference between parasitaemic, aparasitaemic babies and positive
blood culture (p=0.375). The most statistically signifcant obstetric risk factor in the babies with
malaria parasitaemia was HIV in their mothers (p=0.001). Of the 24(6.8%) neonates that died
7(29.2%) had malaria parasite in peripheral blood film.
Malaria parasitaemia in the neonates is common and is associated with adverse effects on
neonatal growth. The clinical manifestations of babies with neonatal malaria were similar to those
of babies with neonatal sepsis and as such, screening for malaria should be incorporated into the
baseline investigations for all sick neonates admitted into neonatal units in malaria endemic
areas. On account of the high prevalence of transfusional malaria (53.7% of those transfused),
administration of prophylactic antimalarial to all babies that received blood transfusion should be
considered. There is also a need to review the protocol for blood donation and transfusion in order
to reduce the prevalence of transfusional malaria. Decision should be taken at which parasite
density count an individual should not be eligible to donate blood.

PREVALENCE OF MALARIA IN NEONATES ADMITTED INTO THE SPECIAL CARE BABY UNIT OF THE UNIVERSITY OF PORT HARCOURT TEACHING HOSPITAL, (UPTH), NIGERIA