Epidemiology of malaria among pregnant women during their first antenatal clinic visit in the middle belt of Ghana: a cross sectional study

Abstract

Background Malaria during pregnancy may result in unfavourable outcomes in both mothers and their foetuses. This study sought to document the current burden and factors associated with malaria and anaemia among pregnant women attending their first antenatal clinic visit in an area of Ghana with perennial malaria transmission. Methods A total of 1655 pregnant women aged 18 years and above with a gestational age of 13–22 weeks, who attended an antenatal care (ANC) clinic for the first time, were consented and enrolled into the study. A structured questionnaire was used to collect socio-demographic and obstetric data and information on use of malaria preventive measures. Venous blood (2 mL) was collected before sulfadoxine-pyrimethamine administration. Malaria parasitaemia and haemoglobin concentration were determined using microscopy and an automated haematology analyser, respectively. Data analysis was carried out using Stata 14. Results Mean age (SD) and gestational age (SD) of women at enrolment were 27.4 (6.2) years and 16.7 (4.3) weeks, respectively. Overall malaria parasite prevalence was 20.4% (95% CI 18.5–22.4%). Geometric mean parasite density was 442 parasites/µL (95% CI 380–515). Among women with parasitaemia, the proportion of very low (1–199 parasites/µL), low (200–999 parasites/µL), medium (1000–9999 parasites/µL) and high (≥ 10,000 parasites/µL) parasite density were 31.1, 47.0, 18.9, and 3.0%, respectively. Age ≥ 25 years (OR 0.57, 95% CI 0.41–0.79), multigravid (OR 0.50, 95% CI 0.33–0.74), educated to high school level or above (OR 0.53, 95% CI 0.33–0.83) and in household with higher socio-economic status (OR 0.34, 95% CI 0.21–0.54) were associated with a lower risk of malaria parasitaemia. The prevalence of anaemia (< 11.0 g/dL) was 56.0%, and the mean haemoglobin concentration in women with or without parasitaemia was 9.9 g/dL or 10.9 g/dL, respectively. Conclusion One out of five pregnant women attending their first ANC clinic visit in an area of perennial malaria transmission in the middle belt of Ghana had Plasmodium falciparum infection. Majority of the infections were below 1000 parasites/µL and with associated anaemia. There is a need to strengthen existing malaria prevention strategies to prevent unfavourable maternal and fetal birth outcomes in this population.

Hepatitis B and Asymptomatic Malaria Infection among Pregnant Women in a Semiurban Community of North-Central Nigeria

“…In the current study, the prevalence of malaria, hepatitis B, and coinfections was 22.0%, 2.5%, and 0.5%, respectively. The malaria prevalence in our study is comparable with the national prevalence rate of 25% [ 1 ], 22.4% in Cameroon [ 17 ], 20.4% in Ghana [ 18 ], and 28.8% earlier reported among pregnant women from other parts of the state [ 13 ]. Lower prevalence rates of 10.2%, 11.6, and 7.7% in Ethiopia, Ghana, and Nigeria, respectively, have been reported [ 19 – 21 ].…”

Effectiveness of intermittent preventive treatment in pregnancy with sulphadoxine-pyrimethamine (IPTp-SP) in Ghana

“…A baseline study on the prevalence of malaria parasitaemia among pregnant women at first ANC visit in our study area in the middle belt of Ghana showed one-fifth of the women carried malaria parasites. 15 The low malaria parasite prevalence reported in this study can further be reduced if IPTp-SP uptake continues to increase over time.…”

“…Informed consent was obtained from all eligible pregnant women and a structured questionnaire was completed as previously described. 15 Gestational age was determined by midwives at the first ANC visit using the symphysis-fundal height measurement method 16 and subsequently using the ultrasound technique. IPTp-SP was administered by nurses at ANC clinics, following the WHO-revised policy guidelines and SP administration was recorded in the participant's antenatal book at each visit.…”

Predictors of knowledge and use of long-lasting insecticidal nets for the prevention of malaria among the pregnant women in Pakistan

“…Low birth weight, abortion, and miscarriage are serious health problems due to gestational anaemia resulting from malaria [ 7 , 8 ]. These and other adverse outcomes during pregnancy can be worse in areas where P. falciparum or Plasmodium vivax are endemic [ 9 , 10 ]. Pregnant women are, therefore, three times more at risk of dying due to malaria compared to non-pregnant women [ 11 ].…”