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Background: Malaria in pregnancy remains a public health problem in Nigeria. It causes maternal anaemia and adversely affects birth outcome leading to low birth weight, abortions and still births. Nigeria has made great strides in addressing the prevention and control of malaria in pregnancy. However, recent demographic survey shows wide disparities in malaria control activities across the geopolitical zones. This situation has been compounded by the political unrest and population displacement especially in the Northeastern zone leaving a significant proportion of pregnant women at risk of diseases, including malaria. The use of malaria preventive measures during pregnancy and the risk of malaria parasitaemia, anaemia and low birth weight babies were assessed among parturient women in an insurgent area. Methods: A cross-sectional survey was conducted among 184 parturient women at Federal Medical Centre, Nguru in Yobe state, between July and November 2014. Information on demographics, antenatal care and prevention practices was collected using an interviewer-administered questionnaire. Maternal peripheral and the cord blood samples were screened for malaria parasitaemia by microscopy of Giemsa-stained blood films. The presence of anaemia was also determined by microhaemocrit method using the peripheral blood samples. Data was analysed using descriptive and analytical statistics. Results: Prevalence of malaria parasitaemia, anaemia and low birth weight babies was 40.0, 41.0 and 37.0 %, respectively, and mothers aged younger than 25 years were mostly affected. Eighty (43.0 %) of the women received up to two doses of sulfadoxine-pyrimethamine for intermittent preventive treatment (IPTp-SP) during pregnancy and most, 63 (83.0 %) of those tested malaria positive received less than these. Presence of malaria infection at antenatal clinic enrollment (OR: 6.6; 95 % CI: 3.4-13.0), non-adherence to direct observation therapy for administration of IPTp-SP (OR: 4.6; 95 % CI: 2.2-9.5) and receiving <two doses of IPTp-SP (OR: 3.1; 95 % CI: 1.5-6.7) were significant risk factors for malaria parasitaemia at delivery. Conclusion: The high prevalence of malaria in pregnancy and the adverse outcome in this insurgence area reflects the poor access of pregnant women to preventive measures such as IPTp-SP. Effort to reach displaced pregnant women and supervision of delivery of malaria preventive measures by healthcare providers should be intensified.
This study was conducted from June to November 2014 at Federal Medical Center, a tertiary and referral health institution in Nguru, Yobe State, Nigeria. It is a 390-bed hospital and has an obstetrics and gynaecology department that provides antenatal care services. The antenatal clinic (ANC) runs 2 days per week (both for bookings and check-up), and the services rendered include health education, provision of IPTp-SP, distribution of ITNs, routine laboratory and radiological investigations. Nguru town is a malaria endemic area with transmission all the year round and peaks during the rainy season [3]. The town has the Nguru Lake that provides a breeding ground for the vector, mosquitoes. The total population of this area is 205,296 while the population of women of child-bearing age is 45,165 and that of pregnant women is 10,265. Majority of the women are housewives. Descriptive cross-sectional study design was used. The study population was parturient women delivering at FMC, Yobe. They must have been booked, had attended antenatal clinic in FMC, Nguru and presented in labour at term (between 36 and 40 weeks of gestation). Those with an eventful antenatal period, coexisting premorbid condition, preterm labour and who had no antenatal care and supporting records were excluded. The study minimum sample size of 168 was calculated using sample size formula for single proportion with 12.5 % prevalence of malaria parasitaemia at delivery from a study in Sokoto [4], precision of 5 % and standard normal deviate of 1.96 at 95 % confidence intervals. In consideration of non-response rate of 10 %, the minimum sample needed for the study was 184. Study participants were recruited consecutively as they presented during labour until the sample size was attained. Only those who had available supporting ANC record were included in the study. Written informed consent was obtained from each study participant or guardians for mothers less than 18 years of age before enrollment. Trained laboratory scientists collected 5 mls of peripheral blood from the mother using vacutainer cup and needle and cord blood from the newborn into separate EDTA bottles from each study participant. Each sample was given a number and paired (mother-newborn) and labeled with the patient’s information. Thick and thin blood films were made from both venous and cord blood, then stained with Giemsa. They were examined microscopically using oil immersion objective (×100) for the presence of malaria parasite. Parasites were identified and densities estimated by counting against 200 leucocytes [5]. Slides without parasites were indicated as; No Malaria Parasites Seen (NMPS) while parasitaemia were graded as either low (1–999/high power field), moderate (1000–9999/high power field (HPF), or high (≥10,000/high power field). The stained slides were first read by the laboratory technician and secondly by a blinded reader (a WHO certified microscopist (level 1) with over 5 years of working experience) from the same institution. A third reader, a WHO microscopist (level 1 with more than years of working experience) from Kano State, read slides that had discordant readings by the first two readers. The packed cell volume (PCV) of the mothers was determined using capillary blood sample collected in a heparinized capillary tube. The samples were spun at 5000 rpm for 5 min in Microhaematocrit machine (Hawskley England) and the haematocrit reader was used to estimate the PCV. Presence of anaemia was considered as a PCV or haematocrit value less than 30 % [6, 7]. Trained research assistants administered a structured pre-tested questionnaire to collect information on demographics, malaria preventive strategies used, doses and trimester of administration of IPTp-SP and haematocrit values during the ANC visits and at delivery. Data on previous use of IPT, malaria infection and treatment during pregnancy were extracted from the ANC records. Digital weighing scale for babies was used in the labour ward by skilled midwives to measure the baby’s weight and recorded in the labour ward delivery register. Baby’s birth weight was collected from labour ward record. Low birth weight (LBW) babies were categorized as those with birth weight <2500 g [3]. Data collected for the study were entered, cleaned and analysed using Epi-info version 3.7 and Microsoft excel. Means, standard deviation and proportions were computed as relevant to summarize the data. Bivariate analysis (Chi square test) was used to determine association between categorical. Multiple logistic regression was carried out to determine predictors of malaria parasitaemia. Level of significance was set at 5 %. The ethical approval for the conduct of the study was obtained from the Institutional Ethics Review Committee of Federal Medical Center, Nguru. Written informed consent was obtained from each study participant or from guardians for mothers less than 18 years of age whose assents were also sought. Results of those found to have anaemia and parasitaemia were provided to the obstetricians for appropriate management of the patients. Information collected from the participants was kept confidential and stored in both hard-locked in cabinets and password- protected electronic files. Non-personal identifiers were used during analysis and presentation.
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