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Introduction. Malaria is the leading cause of consultation in Guinea health facilities. During pregnancy, it remains a major health concern causing considerable risks for mother, fetus, and newborn. However, little is known about the epidemiology of malaria among pregnant women in Guinea. We aimed to provide information on malaria-associated factors in parturients. Methods. It was a cross-sectional survey in two regional hospitals and two district hospitals. 1000 parturients and their newborns were surveyed. All patients were interviewed, and thick and thin blood smears were examined. To determine the predictive factors of malaria in parturients, the Classification and Regression Tree (CART) was first performed by using peripheral and placental malaria as dependent variables and sociodemographic and antenatal characteristics as independent variables; then, explanatory profile variables or clusters from these trees were included in the logistic regression models. Results. We found 157 (15.8%) and 148 (14.8%) cases of peripheral and placental malaria, respectively. The regular use of long-lasting insecticide-treated nets (LLINs) before delivery was 53.8%, and only 35.5% used sulfadoxine-pyrimethamine doses ≥3. Factors significantly associated with malaria were as follows: women from Forécariah and Guéckédou who did not regularly use LLINs and accomplished less than four antenatal care visits (ANC <4) and primigravid and paucigravid women who did not regularly use LLINs. Similarly, the odds of having malaria infection were significantly higher among women who had not regularly used LLINs and among primigravid and paucigravid women who had regularly used LLINs compared to multigravida women who had regularly used LLINs. Conclusion. This study showed that pregnant women remain particularly vulnerable to malaria; therefore, strengthening antenatal care visit strategies by emphasizing on promoting the use of LLINs and sulfadoxine-pyrimethamine, sexual education about early pregnancies, and family or community support during first pregnancies might be helpful.
This study was carried out in four hospitals, two of which were considered as district hospitals (first-level reference for health centers) and the other two as regional hospitals (second-level reference for health centers). Forécariah district hospital is located about 100 km from the capital Conakry; the district has 242,942 inhabitants, with rainfall for 6 months in a year and vegetation consisting of mangrove forests. Guéckédou district hospital is located about 600 km from the capital; the district has about 290,611 inhabitants, with rainfall for 10 months and vegetation consisting of dense forest. Kankan regional hospital is located about 700 km from the capital, with an estimated population of 2,097,257 inhabitants, with an estimated rainfall for 6 months but lower than that of Forécariah and vegetation made of grassy savannah. N'Zérékoré regional hospital is located about 950 km from the capital; the district has about 1,686,799 inhabitants with a rainfall for 10 months in a year and vegetation consisting of dense forest. These data were obtained from unpublished studies. This study was a cross-sectional survey of 1,000 parturients and their newborns. The sample was obtained based on the prevalence of malaria among pregnant women in Burkina Faso given the lack of information in Guinea [13], with n=Z 2∗ (P ∗ Q)/i 2, where n is the desired sample size; therefore, prevalence (P) = 18%; q = 1 − p (expected prevalence in the population); p = 88%. Z level of confidence according to the reduced normal centered law (for a 95% confidence level, α = 0.05, one has the z value of 1.96). By fixing i = 5% as the desired precision on the sample size. The minimum sample size was 226 parturients, taking into account the loss of biological material at 10%, this size was increased by 227/0.90 = 252 parturients and was finally 250 by district hospital. The study ran from May to September 2017, corresponding to the rainy season in Guinea. Four medical school students working on their dissertations were trained at all stages of the investigation. A pretest was organized prior to the start of the survey to ensure consistency of investigational tools. After stinging the fingertip in parturient and the heel in newborn, about 5 μl of blood (3–5 drops for the thick blood and 2 drops for the thin smears) was collected to make thick and thin blood smears which was dried and stained with a solution of Giemsa 10%. Peripheral malaria was diagnosed only by taking into consideration maternal test results. After delivery, a piece of placental cotyledon was cut on the maternal side of the placenta and placed on the slide. With another slide, the piece of cotyledon was triturated to make thick and thin blood smears. Thick and thin blood smears were examined by two certified microscopic biologists. A third microscopist intervened in cases of unconformity for more than 30% between the first 2 microscopists. For the smooth running of this study, it required the approval (0018/DM/CPM/17) of the Faculty of Medicine, and authorizations were obtained from heads of the different health facilities where the study has been conducted. Written inform consent was obtained before the study from all participants after explaining them the purpose of the study. The data were first entered in Access 2013 and then exported to Excel in comma-separated value (CSV) format. Data were summarized by frequencies and percentages for the categorical variables; continuous variables were analyzed by the average with the standard deviation. In univariate logistic analysis, associations were determined between the dependent variables (peripheral malaria and placental malaria) and sociodemographic variables. To identify factors associated with malaria among parturients, we used two complementary approaches: The following variables were recoded before analysis: age (14–18, 19–35, and 36–45), ANC (<4 low and ≥4 normal), SP dose (3 = multigravida) and parity (1 = primiparous, 2–3 = pauciparous, and >3 = multiparous). The use of CART allows us to overcome the issues of multicollinearity; the overall significance of the model was tested by the likelihood ratio; the Pearson residual test was performed for the relevance of the model and the ROC curve was used to assess the quality of our model. All analyses were done using the R software (version 3.5.1). The statistical tests were performed at the risk threshold α = 5%. All the values of p < 0.05 were considered significant for the interpretation.
