Prevalence Of Malaria Among Pregnant Women In PHC Nigeria
Malaria in pregnancy (MiP) is a major public health problem in endemic areas of sub-Saharan Africa and has important consequences on birth outcome. Because MiP is a complex phenomenon and malaria epidemiology is rapidly changing, additional evidence is still required to understand how best to control malaria. The study was conducted to find out the prevalence associated with malaria amongst pregnant women who presented from July 2020 to July 2021. The study design was a retrospective and descriptive survey carried out at Port Harcourt Hospital. Data was obtained from the hospital records from July 2020 to July 2021. The total number of admissions was 1861. A total of 213 cases had malaria in pregnancy out of 1861 admissions.
The prevalence of malaria in pregnancy was 11.4%. Most of the mothers diagnosed with malaria were between the ages of 15 to 24 years while those 35 years and above were list affected. Age bracket of 15 to 24 had 112 mothers with malaria; 25 to 34 had 68 mothers, the second highest; and 35 and above had 02 mothers.
Primigravidae had the majority of cases of malaria,68, with a percentage of 32% and the number of cases decreased with increase in gravidity. Malaria is one of the leading causes of hospital admissions in Port Harcourt Hospital and it is associated with many complications including anemia and threatening abortion.
Malaria, a parasitic infection transmitted by mosquitoes, is one of the most devastating infectious diseases, killing more than 1 million people annually, pregnant women, children and immunocompromised individuals have the highest morbidity and mortality, and Africa bears the heaviest burden(Malaria Facts, 2009),(The Global Fund, malaria, August 1,2009).
The World Health Organization defines malaria as a disease of poverty caused by poverty. Pregnant women infected with malaria usually have more severe symptoms and outcomes, with higher rates of miscarriages, intrauterine demise, premature delivery, low-birth-weight neonates, and neonatal death. They are also at a higher risk for severe anemia and maternal death (The Global Fund, malaria, August. 1. 2009)
Malaria is the second most common cause of infectious disease-related death in the World, after tuberculosis. It is estimated to affect between 350 to 500 million people annually and accounts for 1 to 3 million deaths per year, Sub-Saharan Africa has the largest burden of malarial disease, with over 90% of the worlds malaria related deaths occurring in this region. Twenty-five million pregnant women are currently at risk for malaria, and, according to the world Health Organization (WHO), malaria accounts for over 10,000 maternal and 200,000 neonatal deaths per year (Malaria Facts. August 1. 2009) (The Global Fund, malaria, August 1, 2009.)
As funding increases to combat both malaria and maternal mortality, understanding how malaria significantly affects pregnant women is crucial in our efforts to improve maternal and perinatal health and curb the spread of this preventable disease (Global Health perspective).
Pregnant women are 3 times more likely to suffer from disease as a result of malaria infection compared with their non pregnant counter parts, and have a mortality rate that approaches 50% (Guideline for treatment of malaria. WHO, 2006). In areas endemic for malaria, it is estimated that at least 25% of pregnant women are infected with malaria, with the highest risk for infection and morbidity in primigravidas, adolescents, and those co infected with HIV (Desai M, et al. Lancet Infect Dis. 2007). The second trimester appears to bring the highest rate of infection, supporting the need for ante partum care as part of malarial prevention and treatment efforts (Global Health Perspective).
Malaria infection during pregnancy is a significant health problem with substantial risks for the pregnant woman and her fetus, and the new born. Malaria- associated maternal illness and low birth weight is mostly the result of plasmodium falciparum infection and occurs predominantly in Africa. The symptoms and compilations of malaria in pregnancy vary according to malaria transmission intensity in the given geographical area, and the individual’s level of acquired immunity. In high- transmission settings, where levels of acquired immunity tend to be high, p.falciparum infection is usually asymptomatic in pregnancy. Yet, parasites may be present in the placenta and contribute to maternal anemia even in the absence of documented peripheral parasitaemia (Global Health perspective).
Although all pregnant women may be at risk of malaria, its complications are greatest in those with modified immunity such as primigravidae, secundigravidae, adolescents, immigrants from non-endemic areas and those infected with HIV.
The National malaria control program is committed to controlling malaria in pregnancy through minimum health care package outlined in the malaria in pregnancy control strategic plan. The three key components of the strategy are: Intermittent Preventive treatment (IPT), early diagnosis and prompt case management, and consistent insecticide treated net use for expectant mothers before, during and after pregnancy (Julianna schantz-Dunn, Malaria and Pregnancy: A Global Health Perspective).
In Nigeria, malaria accounts for 25%-40% of out patient’s attendances, 20% of all admissions and 14% of all in-patient deaths. Because of the impact malaria has on morbidity and mortality in Nigeria, effective malaria treatment is a top priority of the Ministry of Health. Early diagnosis and prompt treatment of malaria cases are important to effective malaria case management. The National Anti-Malaria policy stresses the importance of recognizing symptoms of malaria and treating within 24 hours after the onset of symptoms or a positive malaria test to prevent the development of severe and complicated malaria (Ministry of Health Nigeria).
The Ministry of Health emphasizes the importance of effective malaria case management for everyone and particularly for children under 5 and pregnant women who are more at risk of complications of malaria. Today, Nigeria faces new challenges for malaria treatment because of increasing resistance of malaria parasites to chloroquine (CQ) and sulfadoxine/pyrimethamine (SP). New and highly effective drugs have been introduced at both the public and private facilities. (Ministry of Health Nigeria). Hospital provides antenatal care services to pregnant women including malaria in pregnancy and carries out reaches to communities to carry out education about malaria in pregnancy.
1.2 Statement of the Research Problem
In Nigeria malaria is endemic in most regions, accounting for one-third or more of outpatient morbidity in the population. In 2002 and 2008, there were 3.7 and 7.1 million cases of malaria in Nigeria, resulting in 6,735 and 8,500 deaths respectively. Pregnant women are particularly vulnerable to malaria because pregnancy reduces the immunity to malaria, increases susceptibility to malaria infection, the risk of illness, severe anemia, acute pulmonary edema, renal failure, puerperal sepsis, postpartum hemorrhage and increase the risk of death; Malaria in pregnancy results in adverse pregnancy outcomes, such as spontaneous abortion, neonatal death and low birth weight, chronic anemia due to malaria may also affect a child’s growth and intellectual development(Africa summit on roll back malaria, 2007). Despite the devastating effects of malaria, there are no records of prevalence of malaria in pregnancy and associated factors in the population of study (Africa Summit on Roll Back Malaria, 2007).
Despite the abundant knowledge of people about malaria and the countless programmes, education, and funds and other resources available to combat malaria, malaria still remains a problem and a challenge among the communities served by Port Harcourt Hospital. It is also true that many of absenteeism in school and work place most of the time is due to malaria. Therefore, there was need and reason to assess the prevalence of and risk factors associated with malaria in the community and also to understand why malaria still remains a problem among diseases with high mortality in pregnant women, though people have enough knowledge about malaria and countless programmes put in place to fight it.
1.3 Research Questions
- What is the prevalence rate of malaria among pregnant mothers presenting to First Rivers Hospital Port Harcourt?
- What are the factors associated with malaria among pregnant women presenting to First Rivers Hospital Port Harcourt?
1.4 Study Objectives
To determine the prevalence associated with malaria among pregnant women inPort Harcourt.
- To determine the number of cases of malaria in pregnancy from July 2020 to July 2021 at First Rivers Hospital Port Harcourt.
- To determine the demographic and non-demographic factors associated with malaria among pregnant women who attended First Rivers Hospital Port Harcourt over the study period.
1.5 Significance of the Study
The study came up with the prevalence rate and factors associated with malaria in pregnancy at First Rivers Hospital Port Harcourt, which will be of importance in future proper planning for drugs and education of the community/masses and patients on ways of avoiding the risk factors.
The results already got from the study will be used to create public awareness on the current state of malaria in pregnancy as well as exposing the risk factors and measures to prevent and control malaria.
The study also looked in to how to prevent malaria among pregnant women hence consequently will lead to reducing the incidence and prevalence of malaria in pregnancy and eventually reducing the socio-economic burden of malaria.
1.6 Study Limitations
- Incomplete data from the records.
- Insufficient funds to carry out the research
- Time limitation
- Inaccessibility to all of the required patient’s information,
1.7 Purpose of the Study
The purpose of the study is to assess the prevalence of malaria among pregnant women in PHC Nigeria
1.8 Organization of the Study
The study is organized into six chapters.
- Chapter one covers; background to the study, statement of the problem, general objective of the study, specific objectives of the study, research hypotheses, significance of the study, limitation of the study, delimitations of the study, operational definition of terms and organization of the study.
- Chapter two covers review of related literature.
- Chapter Three covers research methodology which includes: introduction, research design, target population, sampling techniques and sample size, data collection instruments, validity and reliability of research instruments, data collecting procedures, data analysis techniques and ethical considerations.
- Chapter four covers research results of the study.
- Chapter five covers discussions and interpretations of research findings.
1.10 Definitions of Terms
The fact or condition of being prevalent; commonness.
A woman who is pregnant for the first time.
A woman (or female animal) that is or has been pregnant for at least a second time.
Discussion of Results
The study was carried out to determine the prevalence and factors associated with malaria in pregnant women who presented to Port Harcourt Hospital from July 2020 to July 2021. It was a retrospective and descriptive study where data for the study was collected using data collection sheets.
5.2 Prevalence of Malaria in Pregnancy at Port Harcourt Hospital
During July 2020 to July 2021, the total number of malaria cases was 213 out of 1861 patients who presented to ANC and were admitted in obstetric ward. This makes a prevalence of 11.4%. A ratio of 11 cases of malaria per 100 pregnant women.
According to gravidity the primigramidae had the majority of cases of malaria (68) with a percentage of 32%, which are 32 cases of malaria in every 100 pregnant mothers. This is in conformity with the various studies that primigravidae are more susceptible to malaria than the multigravidae. Also the majority of cases of malaria in pregnancy were in the age bracket of 15-24 years and there was a decrease in incidence with age.
The results also showed that HIV increased the susceptibility of a pregnant mother to malaria. Supported by the fact that, out of the total number of mothers who had malaria, HIV prevalence was at 12.2%. In comparison to 2.74% prevalence of HIV in all the pregnant mothers (total number of patients). This therefore implies that HIV has an effect on increasing the susceptibility of the pregnant mother to malaria infection.
Also urinary tract infection was associated with malaria in pregnancy at 8.9% (in every 100 pregnant women with malaria, approximately 9 had urinary tract infection).
Anemia was also associated with malaria in pregnant women (1.87%), (that is in every 100 pregnant women with malaria, approximately 2 had severe anemia).
In comparison a cross sectional study conducted at Mulago Hospital in Rivers, Nigeria, to assess the plasmodium falciparum burden came up with; malaria prevalence by each of three measures, peripheral smear, placental smear and placental histology of 9%(35/391), 11.3% (44/389), and 13.9% (53/389) respectively. Together, smear and histology data yielded an infection rate of 15.5% (59/380) of active infections and 4.5% (17/380) of past infections; hence 20% had been or were infected when giving birth. A crude parity dependence was observed with main burden being concentrated in gravidae 1 through gravudae 3, which agees with the result of this research also. Twenty two percent were afflicted by anaemia ( Fatuma et al, 26 Aug 2010)
Therefore, though these numbers of cases of malaria in pregnancy in this research result may be relatively high (percentage of 11.4% is high) compared to the result of peripheral smear ( 9%) comducted at Mulaga Hospital, the following could be some of the reasons; Some mothers do not utilize ANC services, they deliver at home and hence they are not captured hence the sample that was used may have not been the representative sample.
Because some mothers do not attend ANC services fully, they end up missing malaria prophylaxis hence increasing their chances of getting malaria (susceptibility).
Also may be a lot of campaigns have not been carried out towards educating the community about malaria, its causes, prevention and even its mortality level.
Also the climate may be another factor contributing to prevalence of malaria in area.
Based on the study results, the prevalence of malaria in pregnancy was somehow high, 11.4%.
Most of the mothers diagnosed with malaria were between the ages of 15 to 24 years while those 35 years and above were list affected.
Demographic factors associated with malaria in pregnancy
According to age distribution
- Pregnant mothers from 15 to 24 years had 112 cases of malaria.
- Mothers 25 to 34 years had 68 cases of malaria.
- Mothers 35 years and above had 02 cases of malaria.
Non demographic factors associated with malaria in pregnancy
Primigravidae had the majority of cases(68), making a percentage of 32% and the number of cases decreased with increase in gravidity; G1=68; G2=43; G3=28; G4=15; G5=14; G6=08; G7=02; G8=02; G9=03; G10=01.
Mothers who had malaria in pregnancy with HIV were 26, a percentage of 12.2% compared to overall percentage of 2.74% for all pregnant women.
Mothers who had malaria in pregnancy were 04, a percentage of 1.9%
From the study results, I would like to recommend the following;
The government should continue funding programmes and campaigns which educate people in the community about health matters, including malaria in pregnancy especially in rural areas where many people have no access to internet, news papers or available health services, so that the education about prevention of malaria and other diseases will be learnt and practiced.
Aggressive health education on safe mother hood, effects of malaria in pregnancy and how to prevent it.
Further studies should be carried out, so as to give better statistically accurate conclusion.
Close health monitoring systems should be given to pregnant mothers especially during their second and third trimesters because these are the most vulnerable periods of malaria attack in pregnancy.
Early diagnosis by blood slide for malaria parasites in pregnant women should be encouraged so as to prevent complications due to malaria.
Since the health services costs are unaffordable to most members in the community considering Nigeria is a developing country and many people live on far less than a dollar a day, where possible the government should provide health services for free or with little payment, as many people are dying because they can’t afford the health services charges.
Port Harcourt hospital should emphasize on the staff to participate effectively when they go in to the communities for outreaches, to benefit also the members of these communities by sharing the knowledge about malaria in pregnancy and other health problems.
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