Impact of Plasmodium falciparum and hookworm infections on the frequency of anaemia in pregnant women of rural communities in Enugu, South East Nigeria

Abstract

IntroductionMalaria and hookworm infections are common in sub-Saharan Africa and they increase the prevalence of anaemia in pregnancy with resultant poor pregnancy outcomes. This study was carried out to assess the impact of Plasmodium falciparum and hookworm infections on the frequency of anaemia among pregnant women in two rural communities in Enugu, South East Nigeria.MethodsA cross sectional descriptive study was carried out in a total of 226 women attending antenatal clinics at two rural Primary Health Centres (PHC) from April 2011 to July 2011(each PHC with 113 subjects). Socio-demographic data were collected through a structured questionnaire. Blood and stool samples were evaluated for haemoglobin estimation and malaria parasites, and stool samples examined for parasitic infection in all the women. Data was analyzed using STATA 10 software statistical analysis package. Student t-test was used for comparing mean values and chi square test for comparing categorical variables and level of significance set at p<0.05 and logistic regression was used to identify the risk factors associated with malaria in pregnancy.ResultsThe mean age of the women was 27years with range 18 - 38years and SD of 5years. Most of the women were housewives and over 50% in their second trimester. 53% of them had malaria parasites while 27% had hookworm infection. About 40% of the women were anaemic (haemoglobin < 0.001). Similar association was found between hookworm infection and anaemia (p <0.001). Though both malaria and hookworm infections greatly increase the odds for anaemia (AOR 18.06, CI 18.15 -39.99, P<0.001) and (AOR 5.28, CI 2.26-12.38, P<0.001) respectively, the odds for having anaemia in pregnancy was higher for malaria than hookworm infections.ConclusionPlasmodium falciparum and hookworm infections have significant impact on the high frequency of anaemia in pregnancy in our rural communities. There is need to strengthen the control program that has been in place with an integrated intervention to combat these parasitic infections in our rural communities, with mass distribution of antihelminthics as one of the included relevant methods, among others.

Sociodemographic and Obstetric Characteristics of Anaemic Pregnant Women Attending Antenatal Clinic in Bolgatanga Regional Hospital

“…This study has also shown that participants with parasitic infections such as malaria and intestinal parasites (intestinal flagellate, S. mansoni , and S. haematobium ) were more anaemic ( Table 3 ), though the difference was not statistically significant. This is in contrast to a study by Agu et al [ 24 ] who observed a significant association between parasitic infection and anaemia among pregnant women. Majority of women with anaemia were from the rural settlement and the presence of intestinal parasite and malarial infection could have contributed to the anaemia.…”

Epidemiology of malaria in the Taabo health and demographic surveillance system, south-central Côte d’Ivoire

“…Not surprisingly, children were at highest risk, which is in line with previous studies conducted in Kenya [ 45 ], Nigeria [ 46 ] and Cameroon [ 47 ]. The association between Plasmodium infection and anaemia supports the finding that malaria plays a major role in the occurrence of anaemia in tropical areas [ 48 – 50 ]. Nevertheless, other causes cannot be excluded.…”

The Association of Parasitic Infections in Pregnancy and Maternal and Fetal Anemia: A Cohort Study in Coastal Kenya

“…Thus, even with relatively good antenatal care, treatment was not initiated until the second trimester at which time anemia was prevalent in this cohort. Furthermore, unlike the region where this study was conducted and despite the international recommendations, uptake of treatment for hookworm, malaria, and schistosomiasis in ANC is still low in many parts of Africa [40], [56]. In part, this may relate to perceptions that treatment has not been associated with improved pregnancy outcomes [38], or may be harmful [40].…”

“…Parasitic infections, including hookworm, may be evaluated by intensity of infection, as measured by the concentration of eggs in the stool [25] . While most morbidity has been seen with high intensity infections, in populations with low iron stores, even low-intensity hookworm infection has been associated with morbidities [25] – [30] . In addition to hookworm, P. falciparum malaria increases risk for moderate and severe maternal anemia [11] – [16] .…”

“…Many studies have focused on the effects of a single infectious agent on pregnancy outcome and maternal anemia, although a few studies have attempted to understand the relative effects of multiple agents with conflicting results [24] , [30] , [31] . Fetal anemia has been documented in association with maternal anemia, with rates of 10% to 23% reported in recent studies in Malawi [5] , [7] but its association with infection is less well understood.…”