Assessing the relationship between gravidity and placental malaria among pregnant women in a high transmission area in Ghana

Abstract

Background Malaria infection during pregnancy can cause significant morbidity and mortality to a pregnant woman, her fetus and newborn. In areas of high endemic transmission, gravidity is an important risk factor for infection, but there is a complex relationship with other exposure-related factors, and use of protective measures. This study investigated the association between gravidity and placental malaria (PM), among pregnant women aged 14–49 in Kintampo, a high transmission area of Ghana. Methods Between 2008 and 2011, as part of a study investigating the association between PM and malaria in infancy, pregnant women attending antenatal care (ANC) clinics in the study area were enrolled and followed up until delivery. The outcome of PM was assessed at delivery by placental histopathology. Multivariable logistic regression analyses were used to investigate the association between gravidity and PM, identify other key risk factors, and control for potential confounders. Pre-specified effect modifiers including area of residence, socio-economic score (SES), ITN use and IPTp-SP use were explored. Results The prevalence of PM was 65.9% in primigravidae, and 26.5% in multigravidae. After adjusting for age, SES and relationship status, primigravidae were shown to have over three times the odds of PM compared to multigravidae, defined as women with 2 or more previous pregnancies [adjusted OR = 3.36 (95% CI 2.39–4.71), N = 1808, P < 0.001]. The association appeared stronger in rural areas [OR for PG vs. MG was 3.79 (95% CI 3.61–5.51) in rural areas; 2.09 (95% CI 1.17–3.71) in urban areas; P for interaction = 0.07], and among women with lower socio-economic scores [OR for PG vs. MG was 4.73 (95% CI 3.08–7.25) amongst women with lower SES; OR = 2.14 (95% CI 1.38–3.35) among women with higher SES; P for interaction = 0.008]. There was also evidence of lower risk among primigravidae with better use of the current preventive measures IPTp and LLIN. Conclusions The burden of PM is most heavily focused on primigravidae of low SES living in rural areas of high transmission. Programmes should prioritize primigravidae and young women of child-bearing age for interventions such as LLIN distribution, educational initiatives and treatment to reduce the burden of malaria in first pregnancy.

Screening for Resistant Bacteria, Antimicrobial Resistance Genes, Sexually Transmitted Infections and Schistosoma spp. in Tissue Samples from Predominantly Vaginally Delivered Placentae in Ivory Coast and Ghana

“…Fetal deaths in Ghana, in contrast, were found to be associated with fetal infections in 9.7% to 13.0% of cases [ 3 , 4 ] and placental inflammation in up to 24.8% of cases [ 4 ]. As repeatedly demonstrated, viral, bacterial, mycobacterial and parasitological infections threaten the health of mother and fetus [ 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 ]. For Ivory Coast, fewer respective studies have been published, but available data nevertheless indicate relevant pregnancy-associated infection risks [ 17 ].…”

Prevalence of and factors associated with placental malaria in the White Nile State: a cross-sectional study

“…Moreover, in Kenya, asymptomatic placental malaria infection was associated with younger mothers [7]. In Ghana, it has been shown that primigravidas are more than three times as likely to contract placental malaria as multigravidas [8]. A recent meta-analysis of 35 studies showed that primigravidas have a 1.54 times higher risk of asymptomatic malaria infection than multigravidas in sub-Saharan Africa [9].…”

“…It has been estimated that in 2020, globally there were 120.4 million pregnant women at risk of Plasmodium falciparum malaria [3]. Several recent studies have shown a high burden of malaria infection among pregnant women in sub-Saharan African countries [4][5][6][7][8][9], including Sudan [1,10]. Recently, Mangusho et al have shown that 26.1% of pregnant women in Uganda had P. falciparum malaria [11].…”

“…Moreover, recent reports in sub-Saharan Africa have shown that malaria infection during pregnancy is associated with poor maternal and perinatal effects including maternal anemia and low birth weight [2]. Malaria infection during pregnancy has also been associated with primiparity and younger age in several locations in sub-Saharan Africa [4][5][6][7][8][9].…”