Malaria Proliferation Among Pregnant Women And Its Health Consequences (A Case Study Of Select Patients In General Hospital)

Medical and Health Science Project and Seminar Material

Malaria Proliferation Among Pregnant Women And Its Health Consequences (A Case Study Of Select Patients In General Hospital)


Abstract


Malaria in pregnancy increases the risk of anemia, stillbirths, spontaneous abortion, premature delivery and low birth weight. Despite preventive measures put in place, rates of malaria in pregnancy and poor birth outcomes remain persistently high in many parts of Africa. This study was aimed at determining the prevalence of malaria and identifying health consequences in pregnant women attending ANC in Wuse general Hospital. A total of 185 pregnant women who had attended ANC within 1 year prior to the study who were tested for malaria were enrolled using simple random sampling. Demographic information, obstetric characteristics and malaria prevention practices were obtained using a structured questionnaire.

Chi square test and logistic regression analysis using IBM SPSS version 25 were used to compare factors associated with malaria in the pregnant women. The prevalence of malaria from the 185 pregnant women in this study was 5.4%. Participants who did not take IPT were 4 times more likely to have malaria than those who had taken IPT (OR=3.69; 95%CI= 1.062-12.872) and this was significantly associated with malaria infection (p=0.040). Participants who were living in rural areas were five times at risk of having malaria than those in urban areas (OR=4.62; 95%CI=0.577-37.007).

Similarly, women who were house wives were 5 times more likely to have malaria (OR=5.18; 95%CI=0.630-42.541) compared to those were employed. Primigravida women had a 2-fold risk of having malaria compared to multigravida women (OR=2.01; 95%CI= 0.587-6.882).

Malaria prevalence was low among the pregnant women studied.. The use of intermittent preventive treatment and ITNs should be strengthened among all pregnant women. Future research should be conducted in different transmission settings to provide current data on the national prevalence of malaria and risk factors in the context of scaled-up malaria control efforts.


Chapter One


Introduction

1.1 Background of the Study

Malaria according to world health organization (WHO) is a life-threatening disease caused by parasites that are transmitted to people through the bites of infected female Anopheles mosquitoes (WHO, 2015). In 2016, there were an estimated 216 million cases of malaria in 91 countries, an increase of 5 million cases over 2015(WHO, 2017). The same report shows that; WHO African Region carries a disproportionately high share of the global malaria burden. For instance, in 2016, the region was home to 90% of malaria cases and 91% of malaria deaths (WHO, 2017).
Malaria infection during pregnancy is a significant public health problem with substantial risks for the pregnant woman, her fetus, and the newborn child. Malaria-associated maternal illness and low birth weight is mostly the result of Plasmodium falciparum infection and occurs predominantly in Africa(WHO, 2016).Most cases of malaria in pregnancy in areas of stable malaria transmission are asymptomatic (Pehrson et al., 2016). Depending on the endemicity of malaria in an area, it can be expected that 1–50% of pregnant women may carry malaria parasitemia, especially in the placenta, without noticing it (Ashley, PyaePhyo, & Woodrow, 2018). This is attributed to immunity acquired during previous exposure that protects against clinical malaria (Srinivasan et al., 2014). Pregnant women are three times more likely to suffer from severe diseases as a result of malarial infection compared with their non-pregnant counterparts, and have a mortality rate that approaches 50% (Nigeria Clinical Guidelines, 2016, P. 659). The principal impact of malaria infection is due to the presence of parasites in the placenta, which causes maternal anaemia and low birth weight (Lalloo et al., 2016). Beyond the post-partum period, the long- term consequences of malaria during pregnancy on the infant include poor development, behavioral problems, short stature and neurological deficits (Nkumama, O’Meara, & Osier, 2017).

Protection of pregnant women living in malaria endemic countries has been of particular interest to many malaria control programs because of this group’s higher susceptibility and reduced immunity. WHO recommends the following package of interventions for the prevention and treatment of malaria during pregnancy: use of long-lasting insecticidal nets (LLINs);in all areas with moderate to high malaria transmission in Africa, intermittent preventive treatment in pregnancy (Intermittent preventive treatment during pregnancy) with sulfadoxine-pyrimethamine (SP), as part of antenatal care services; and lastly, prompt diagnosis and effective treatment of malaria infections(WHO, 2018).

In Nigeria, the overall burden of malaria is high and its adverse outcomes to the infected mother and the unborn child are widespread. The malaria day report 2018 show that Nigeria contributes 4% of the global malaria burden and currently, the national malaria prevalence is 19% (Ministry of Health, 2018). Although Nigeria is regarded as being a malaria-endemic region, the transmission level varies considerably across the country (NDHS, 2017). Therefore, this study was conducted to assess the prevalence of malaria infection and its health consequences among pregnant women attending antenatal clinic at Wuse general Hospital (WUSE GENERAL HOSPITAL).


1.2 Statement of the Problem

According to the latest World Malaria Report, released in November 2017, there were 216 million cases of malaria in 2016, up from 211 million cases in 2015. The estimated number of malaria deaths stood at 446 000 in 2016(WHO, 2018).The African region continues to carry a disproportionately high share of the global malaria burden. In 2016, the region was home to 90% of malaria cases and 91% of malaria deaths. Some 15 countries – all in sub-Saharan Africa, except India – accounted for 80% of the global malaria burden(WHO, 2017).

In sub-Saharan Africa, over 30 million pregnancies occurred annually in areas where malaria is endemic, and each year malaria in pregnancy is estimated to cause nearly one million low birth weight (LBW) deliveries and up to 100,000 infant deaths (WHO, 2016). Given this high burden of disease, the World Health Organization (WHO) recommends the implementation of malaria preventive measures in all African countries where Plasmodium falciparum remains endemic, including the use of long lasting, insecticide-treated nets (LLINs) and intermittent preventive treatment during pregnancy (Intermittent preventive treatment during pregnancy) with sulfadoxine-pyrimethamine (SP) (Centre for Disease Control and Prevention, 2016).

Despite these measures, rates of placental malaria and poor birth outcomes remain persistently high in many parts of Africa. Although no study has been done in WuseGeneral Hospital concerning malaria in pregnancy, a surveillance report from Wuse district showed that among febrile women who reported to hospital, 60.3% were found to have malaria (Agwu, 2015).To understand the burden of malaria in pregnancy in WuseGeneral Hospital, this study was done.


1.3 Purpose of the Study

The purpose of the study is to investigate malaria proliferation among pregnant women and its health consequences: a case study of select patients in general hospital


1.4 Objectives of the Study

To assess malaria proliferation among pregnant women and its health consequences: a case study of select patients in general hospital.

  1. To find out the prevalence among pregnant women attending antenatal clinic at Wuse General Hospital.
  2. To determine factors associated with malaria among pregnant women attending antenatal clinic at Wuse General Hospital.

1.5 Research Questions

  1. What is the prevalence of malaria among pregnant women attending antenatal clinic at Wuse General Hospital?
  2. What are the factors associated with malaria among pregnant women attending antenatal clinic at Wuse General Hospital?

1.6 Justification of the Study

Malaria in pregnancy is a serious health risk for the pregnant woman, the foetus and ultimately the newborn and infant(Ashley et al., 2018).

Even in highly endemic areas where adults have some level of acquired immunity, pregnant women (especially primigravidae) are at risk because placental tissue has never been exposed to the malaria parasites. In fact, a pregnant woman may be an asymptomatic carrier of placental malaria parasites which are none-the-less harming the fetus resulting in inter-uterine growth retardation, low birth weight, miscarriage, still birth, greater susceptibility to malaria during infancy and higher neonatal and infant mortality. Pregnant mothers themselves are also at risk for malaria associated anemia. Anemia, in turn, can adversely affect a mother’s ability to survive complications related to postpartum hemorrhage and is therefore a serious concern.

However, no study has been done in Wuse to assess the prevalence of malaria infection and health consequences among pregnant women. The study findings will help to establish prevalence of malaria and its associated morbidity and mortality, inform of policy makers and redirect resources for malaria case management and prevention.


1.7 Study Scope

The study took place in Wuse General Hospital, Wuse district Abuja. Nigeria. This study assessed the prevalence of malaria in pregnancy among pregnant mothers attending antenatal clinic.

The study took place between August 2018 and February 2019.


1.8 Organization of the Study

This research report dividing into five chapters: Chapter One deals with the Introduction of the study which includes Background of the study, Statement of problems, Objective of the study, Limitation, and scope of the study, and the Significance of the study. Chapter Two presented the related literature review regarding the research area on Audit practice in Non-financial firms and therefore sets out the theoretical and empirical grounds for the research. Chapter Three showed the Research Methodology of the study. Chapter Four reports the Analysis and Interpretation of the data. Chapter Five discussed with Summary of the study Conclusions of the study and also presented Suggestions for further research were given.


Chapter Five


Summary, Conclusion And Recommendation

5.1 Summary

This study examined malaria proliferation among pregnant women and its health consequences: a case study of select patients in general hospital. This chapter therefore discusses the findings of the study.


5.2 Prevalence of Malaria Among Pregnant Women

In this study the prevalence of malaria was 5.4%. The prevalence of 5.4% is higher than that reported by findings of a survey conducted in Kabale municipality south-western Nigeria from April-June, 2015 which found a prevalence of 25% (Mbonye et al., 2016). The difference in prevalence could have resulted from different methods of malaria diagnosis adapted. In this study, both RDT and microscopy methods were used together which have less sensitivity compared to PCR while the former study considered results from both microscopy and PCR which could have led to the higher prevalence in that study. The prevalence in this study is comparable to findings by a study in countries of Malawi, Senegal and Zambia by Roman et al., (2014)which reported a prevalence of 2.3% and that of a study in Wuse hospital by Namusoke et al., (2010) which reported a prevalence of 9%.

There is, therefore, a wide variation in reported prevalence of malaria. The low prevalence of malaria in this study could be explained by the improved education on malaria during pregnancy in Nigeria ministry of health and WUSE GENERAL HOSPITAL ANC staff. Indeed, in 2017, Wuse district health department report 2017 shows that malaria prevalence in the district was 2% (District Health Report, 217). The large differences in the reported prevalence rates of malaria may also be attributed to skill and experience of laboratory personnel involved in blood film preparation, staining and reading of the slides. WUSE GENERAL HOSPITAL laboratory has been accredited in accordance with the recognized international standards ISO 15189:2012 and one of their test is malaria test especially Microscopy which can be accepted anywhere in the world.


5.3 Risk Factors Associated with Malaria Among Pregnant Women

Studies have shown that age, gravidity, gestation, use of ITN, education level and the use of IPT are associated with malaria in pregnancy(WHO, 2017;Agwu, 2015;WHO, 2018). These studies have shown that pregnant women of young maternal age are at the greatest risk of malaria infection. Multigravidas have been noted to have lower effects of malaria in pregnancy than in other gravidities. This is as a result of acquisition of specific immunity to placental malaria due to previous exposure(Muhindo et al., 2016). Acquired specific immunity accumulates with subsequent infection and subsequent pregnancies (Eijk et al., 2015). In this study, older women (≥31 years) had least cases of malaria (2.2%) and multigravidas had reduced chance of getting malaria 3.9% compared to younger (7.4%) and primigravida(8.9%) women. However, this reduced chance was not significant. This could be because in a malaria endemic area such as Nigeria, it is possible that the women could have had a number of encounters with malaria infection prior to visiting the antenatal clinic used in this study. There could also have been no difference in the level of specific immunity of the study participants based on gravidity.

Education of the women was not significantly associated with malaria infection. This lack of significant association could be explained by the fact that majority of the study participants could have had very good knowledge of malaria preventive methods from campaigns on radio stations or ANC its self and availability of good malaria prevention strategies and appropriate treatment options available in Nigeria. Moreover, pregnant women attending antenatal clinic at Wuse General Hospitalare usually given a health talk on malaria and other conditions affecting them before being attended to. These campaigns have bridged the gap between those who have formal education and those who do not have.

In terms of residence, women residing in rural area had a higher malaria prevalence (7.0%) compared to those residing in urban setting (1.8%). However, this finding was not significant (X2=2.058; P= 0.151). A study in malaria-endemic areas of Al Hudaydah in the Tihama region, west of Yemen by Aderibigbe et al., (2015) reported that area of residence was significantly associated with malaria prevalence and respondents in urban areas had a reduced risk of malaria. Although residence was not significant in this study, participants who were living in rural areas had almost five times risk of getting malaria than those in urban areas (OR=4.62;95%CI=0.577-37.007). Similar findings were reported by Kibret et al., (2014) in Ethiopia.

In this study, Women who did not use ITN had similar chance of getting malaria (OR=0.38;95%CI=0.0483.093) like those who were using ITN and this was not significant (p=0.368). Lindblade et al., (2015) also reported a non-significant impact of ITN on malaria in pregnancy in Malawi.

The use of IPT has been shown to reduce malaria prevalence in pregnancy significantly (CDC, 2013).In this study, the use of IPT was significantly associated with malaria infection in pregnancy (p=0.040).Participants who had not taken IPT were 4 times more likely to have malaria than those who had taken IPT (OR=3.69; 95%CI= 1.062-12.872).


5.2 Conclusion

The prevalence of malaria among pregnant women attending ANC in WUSE GENERAL HOSPITAL was low. This is as a result Wuse General Hospital Laboratory was accredited by ISO group with ISO 15189:2012 and malaria test done here meet the world standards of laboratory diagnosis.


5.3 Recommendations

Based on the findings, there is need to:

  1. Upgrading laboratory to meet ISO standard as already done by Wuse General Hospital Laboratory, would improve the diagnosis with no false results.
  2. Future research should be conducted in different transmission settings to provide current data on the national prevalence of malaria and risk factors in the context of scaled-up malaria control efforts.

Get Complete Project Material

5,000 5000

The Complete Material Will Be Sent to You in Just 2 Steps

Quick & Simple…


Step One Purchase

Make Payment (Through Transfer) of ₦5,000 to the Account Below

Zenith BankAcc No: 1225513212
Samphina Academy
Current Account

Or CLICK HERE To Pay With Debit Card


FOR STUDENTS OUTSIDE NIGERIA
CLICK HERE To Purchase Material ($15)

Step Two Purchase

Send the Following Details on WhatsApp ( 08143831497) After Payment

  1. Payment Details

  2. TOPIC: Malaria Proliferation Among Pregnant Women And Its Health Consequences (A Case Study Of Select Patients In General Hospital)

The Complete Material Will Be Sent To You On WhatsApp After Receiving Your Details
T & C Apply


  Contact Our Help Desk


Need a Different Topic? Perform a Quick Search



List of Related Works

Click on Any Topic to Preview the Content

samphina.academy

Samphina Academy

Samphina Academy is an Online Educational Resource Center that is aimed at providing students with quality information and materials to aid them in succeeding in their academic pursuit.