Malaria in pregnancy control and pregnancy outcomes: a decade’s overview using Ghana’s DHIMS II data

Abstract

Background Malaria in pregnancy control interventions have been implemented through antenatal care services for more than 2 decades in Ghana. The uptake of these interventions has seen steady improvement over the years. This has occurred within the context of decreasing global trends of malaria infection confirmed by decreasing malaria in pregnancy prevalence in Ghana. However, not much is known about how these improvements in interventions uptake and reduction in malaria infection prevalence have impacted pregnancy outcomes in the country. This study aimed at describing trends of maternal anaemia and low birth weight prevalence and uptake of malaria in pregnancy control interventions over the last decade using data from Ghana’s District Health Information Management System (DHIMS II). Methods Data from Ghana’s DHIMS II on variables of interest covering the period 2012 to 2021 was analysed descriptively using Microsoft Excel 365. Results were computed as averages and percentages and presented in tables and graphs. Results The prevalence of maternal anaemia at booking and at term and low birth weight increased marginally from 31.0%, 25.5% and 8.5% in 2012 to 36.6%, 31.9% and 9.5% in 2021 respectively. Severe anaemia prevalence at booking and at term remained under 2% over the study period. Women making at least 4 ANC visits, receiving at least 3 doses of intermittent preventive treatment of malaria and an insecticide-treated net increased from 77.0%, 41.4% and 4.1% in 2012 to 82%, 55.0% and 93.3% in 2021, respectively. Malaria test positivity rate reduced from 54.0% to 34.3% between 2014 and 2021 while women receiving iron and folate supplementation for 3 and 6 months rose from 43.0% and 25.5% to 89.7% and 61.8%, respectively between 2017 and 2021. Conclusion Maternal anaemia and low birth weight prevalence showed marginal upward trends over the last decade despite reduced malaria infection rate and improved uptake of malaria in pregnancy control interventions. There is room for improvement in current intervention implementation levels but the complex and multi-factorial aetiologies of maternal anaemia and low birth weight need urgent investigation and quantification to inform policy and practice.

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 ].…”

Interventions for malaria prevention in pregnancy; factors influencing uptake and their effect on pregnancy outcomes among post-natal women in a tertiary facility in the Volta Region of Ghana

“…These findings contrast with those from a trend analysis of Ghana’s DHIMS 2 data that showed the prevalence of anaemia at term was persistently lower than at booking in the 10-year period from 2012 to 2021. 21 It is not immediately clear why the present study showed an increase in anaemia prevalence between booking ANC visit and 36–40 weeks but the findings provoke important questions on other contributors to maternal anaemia aside malaria infection, ITN use and uptake of IPTp-SP. The study did not take into consideration morbidities such as helminthiasis, sickle cell disease and other haemoglobinopathies, human immunodeficiency virus infection, schistosomiasis and others that could impact on maternal anaemia.…”

“…Approximately 84% of the study women received optimal IPTp-SP doses in their last pregnancy. This is higher than national level reports of 55.0% in 2021 from Ghana’s district health information management systems database (DHIMS 2) 21 and the 61% reported in the 2019 malaria indicator survey. 27 This may be due to differences in the denominator for computing these measures.…”

“…This is in spite of the fact that MiP remains a burden in the country with an average malaria test positivity rate of 37.3% among pregnant women over 2014-2021. 21 Understanding individual-level dynamics that facilitate uptake of these interventions in particular geographic areas are crucial for designing measures to improve uptake in that locality. 22 Several studies have reported 32%-80.7% uptake of ⩾3 doses of IPTp-SP.…”

Safety and immunogenicity of varied doses of R21/Matrix-M™ vaccine at three years follow-up: A phase 1b age de-escalation, dose-escalation trial in adults, children, and infants in Kilifi-Kenya

“…Vulnerable groups outside of early childhood include women with approximately one-third of the 40 million pregnancies in Africa affected. Malaria in pregnancy and early childhood is associated with anemia 2 – 4 , severe disease, poor birth outcomes (low birth weight, prematurity, and stillbirth), and has an adverse socio-economic impact. Until recently, public health measures targeting malaria control and elimination were primarily limited to long-lasting insecticide-treated bed nets, intermittent preventive treatment, and chemoprevention.…”